by Rosalyn Carson-DeWitt, MD
Anatomy and Physiology
The walnut-sized prostate gland is part of a man's reproductive system. Located below the bladder and in front of the rectum, the prostate wraps around the urethra, the tube carrying urine out of the bladder. The prostate produces and stores seminal fluid, which nourishes sperm and allows it to travel.
Reasons for Procedure
Both benign and cancerous conditions can affect the prostate. As men age, the prostate gland frequently becomes enlarged. This non-cancerous condition is called benign prostatic hyperplasia, commonly referred to as BPH. In BPH, the enlarged prostate presses against the urethra and bladder, interfering with the normal flow of urine.
Prostate cancer is one of the most common cancers among older men, usually striking men over the age of 70. Like BPH, prostate cancer can also cause urinary obstruction.
Symptoms of an enlarged prostate include: need to urinate frequently, difficulty starting to urinate, difficulty completely emptying the bladder resulting in leaking or dribbling after urinating, urinating only very small amounts, weak stream of urine, pain or burning with urination.
In addition, blood in the urine or semen of an older man may indicate prostate cancer. And persistent pain in the thighs, hips, or lower back may mean that the cancer has spread.
Non-surgical options for urinary obstruction due to BPH include watchful waiting and medications. Watchful waiting involves carefully monitoring prostate size and symptoms, and reverting to active treatment only if symptoms of obstruction worsen There are two main types of medications that have been shown to improve symptoms of BPH: alpha-blockers and 5-alpha reductase inhibitors. In addition, there is evidence that the herb saw palmetto may relieve BPH symptoms in some men.
Surgical options for prostate conditions include the following procedures: radical prostatectomy is used only for cancer patients. In this procedure the entire prostate is removed through an incision in the abdomen or the perineum, which is the area between the anus and scrotum. Transurethral Resection of the Prostate, or TURP, is a procedure that removes part of the prostate through an instrument that is inserted in the urethra. Simple prostatectomy is a surgical option for patients with BPH whose prostate gland is too large to safely perform a TURP. In this procedure the prostate is removed through an incision in the lower abdomen.
A TURP is often performed to relieve the urinary obstruction of BPH. It may also be done when a man has a cancerous prostate but radical prostatectomy is deemed too risky. In this case, a TURP is performed to relieve the symptoms of urinary obstruction, but not to cure the cancer.
In the days leading up to your procedure: arrange for a ride to and from the hospital and for help at home as you recover. You may be given laxatives and/or an enema to clean out your intestines. You may be given antibiotics to take before coming to the hospital. If you regularly take medications, herbs, or dietary supplements your doctor may recommend temporarily discontinuing them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor. The night before, eat a light dinner and do not eat or drink anything after midnight.
You may receive general, spinal, or local anesthesia prior to TURP. If you receive general anesthesia, you will be unconscious throughout the procedure. If you receive spinal or local anesthesia, you will remain awake, but sedated, during the surgery.
Your surgeon will begin by slipping a small, lighted instrument called a cystoscope through the opening of the penis. After filling your bladder with a sterile solution for better visibility, your surgeon will carefully examine the urethra, prostate, and bladder.
A wire loop called a resectoscope will then be passed through the cystoscope to the prostate. An electric current passes through this wire loop, allowing it to shave off layers of prostate tissue.
The bits of removed prostate tissue will be washed into the bladder and out through a special port in the cystoscope. The procedure will be complete when the surgeon feels that the optimal amount of prostate tissue has been removed.
After the cystoscope has been taken out, a catheter will be put into the bladder to keep it draining for several days following surgery.
Risks and Benefits
TURP syndrome is a complication that occurs in about 2% of patients, usually within the first 24 hours. Its symptoms include: increased blood pressure, slow heart rate, rapid breathing, confusion, agitation.
Other complications associated with a TURP are rare, but may include: infection, thrombophlebitis, excessive swelling or bleeding, problems related to the anesthesia used, erectile dysfunction, and/or dry orgasms, called retrograde ejaculation.
Benefits of a TURP include: durable and effective relief of BPH symptoms with only rare recurrences, improved force of urine stream, more complete bladder emptying, and usually decreased frequency of urination.
In a TURP, as with any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.
After the Procedure
A catheter will be left in the bladder to drain urine for several days after the procedure. Sterile solution may be intermittently flushed through the catheter into your bladder, in order to wash out blood and clots. Always keep the catheter drainage bag below bladder level.
After your procedure: clean area where catheter enters urethra several times a day; drink lots of fluids to help flush the bladder; avoid heavy lifting or exertion for 3-4 weeks; avoid sexual activity for 4-6 weeks; avoid alcohol, caffeine, and spicy foods that may overstimulate the bladder.
Call your doctor immediately if you notice: signs of infection, such as fever and chills, redness, swelling, increased pain, excessive bleeding, or discharge from the urethral opening, pain, burning, urgency, frequency or difficulty urinating, nausea or vomiting, cough, shortness of breath, or chest pain, impotence more than three months after surgery.
- About Prostatectomy (For Benign Prostatic Hypertrophy). American College of Surgeons. Available at: http://www.medem.com/search/article_display.cfm?path=TANQUERAYM_ContentItem&mstr=/M_ContentItem/ZZZBLD85IWC.html&soc=ACS&srch_typ=NAV_SERCH. Accessed February 23, 2004.
- Benign Prostatic Hyperplasia (BPH). Emory Healthcare. Available at:http://www.emoryhealthcare.org/departments/urology/sub_menu/bph.html. Accessed August 24, 2004.
- Cookson MS. et al. Urology. Sabiston Textbook of Surgery, 16th edition. Philadelphia: W.B. Saunders Company; 2001: 1649-1693.
- How is Prostate Cancer Treated? American Cancer Society. Available at: http://www.cancer.org/docroot/CRI/content/RI_2_2_4X_How_Is_Prostate_Cancer_Treated_36.asp?sitearea. Accessed February 23. 2004.
- Prostate Gland Enlargement, Mayo Clinic Website. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=E569D2C1-B4F8-4E5E-B7D8534A26D35B37. Accessed February 23, 2004.
- Prostate BPH: Surgical Treatment. Urology Channel. Available at: http://www.urologychannel.com/prostate/bph/treatment_surg.shtml. Accessed February 23, 2004.
- Transurethral Resection of the Prostate. EMedicine. Available at: http://www.emedicine.com/med/topic3071.htm. Accessed February 23, 2004.
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