Removing the enlarged part of the prostate is usually the best long-term treatment for an enlarged prostate gland. The portion of the gland that is not squeezing the urethra stays in place. The outside capsule around the gland is also untouched.
Transurethral electro-resection of the prostate (TURP) is the traditional way to remove prostate tissue using minimally invasive surgical techniques. Nearly 90% of all surgeries done for benign prostatic hyperplasia are TURPs. No outside incision is needed. There's less pain, fewer complications and faster healing.
With TURP, an instrument called a resectoscope is inserted through the penis. This device is about 12 inches long and half an inch around. It has a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. During the surgery, the surgeon uses the wire loop to remove the tissue one piece at a time. The pieces are carried by the fluid into the bladder and then flushed out at the end of the operation. The surgery lasts about 90 minutes.
If you have surgery, you will need to stay in the hospital one to two days.
You may be given antibiotics to prevent infection. Many doctors start giving antibiotics before or soon after surgery; others prefer to wait until an infection is present to give them.
After surgery, you may notice some blood or clots in your urine as the wound starts to heal. If your bladder is being irrigated (flushed with water), you may notice that your urine becomes red once the irrigation is stopped. Some bleeding is normal. It should clear up before you leave the hospital.
Even though you have no visible incision and may have little pain, you are recovering from surgery. Don't try to overdo it getting back into your normal activities. Discuss what to expect during recovering with your doctor. The following guidelines will help you have a smoother recovery:
- Avoid straining, especially when moving your bowel. Eat a balanced, high fiber diet to prevent constipation. If constipation does occur, ask your doctor if you can take a laxative.
- Don't do any heavy lifting.
- Avoid sudden movements.
- Drink plenty of water (up to eight cups a day) to flush the bladder and help prevent infection.
- Don't drive or operate machinery.
Due to the nature of the surgery, you may notice changes in your urination or sexual function. Usually these are typical of the surgery and go away over time. Here are a few things you may notice:
- Problems urinating. Although the surgery may make your urine stream stronger almost right away, it may take time before you can urinate completely normally. As you heal, you may have some discomfort or feel a sense of urgency when you urinate. This will slowly disappear. After a couple of months, you should be able to urinate less often and more easily.
- Inability to control urination (incontinence). As you recover, you may have some problems controlling urination. It is rare that this lasts long-term. Usually, the longer you were having problems before surgery, the longer it will take for your bladder and urethra to return to full normal function afterward.
- Bleeding. In the first weeks after TURP surgery, the scab inside the bladder may loosen. Blood may suddenly appear in your urine. Usually, the bleeding stops with some bed rest and drinking fluids. However, if the bleeding is so heavy that it is difficult to see through the urine or if it contains clots or if you feel discomfort, contact your doctor.
- Sexual function. While it may take time for some men to regain full sexual function, most are able to enjoy sex again. Sometimes, concerns about sexual function interfere with sex more than the surgery itself. Talking to your doctor before surgery and understanding what is being done is helpful. Usually, if you could have an erection before surgery, you will after surgery. Prostate surgery usually makes a many unable to father children. This is because the surgery interferes with the function of a muscle. This muscle plays a role in diverting sperm through the penis by blocking the entrance to the bladder. After surgery, sperm goes into the bladder and is then voided out.
Since surgery for benign prostatic hyperplasia leaves behind most of the prostate gland, it is still possible for prostate problems including prostate cancer or benign prostatic hyperplasia to develop or return.
After your surgery, it is important to continue having a rectal exam once a year and to have any symptoms checked by your doctor.
Usually, surgery for benign prostatic hyperplasia offers relief for about 15 years. Only about one man out of every 10 of have the surgery will need a second operation for an enlarged prostate. Typically, these men were younger when they had the first surgery.
Sometimes, scar tissue from surgery requires treatment in the year after surgery. Rarely, the opening of the bladder becomes scarred and shrinks, causing obstruction. More often, scar tissue may form in the urethra and cause narrowing.
