As a man ages, his prostate may become larger and begin to cause problems. Drs. Rahul Mehan and Harpreet Wadhwa start off with a simple questionnaire to understand your symptoms. Sometimes, the solution is simple, with a few dietary and lifestyle adjustments.
For others with more moderate symptoms, it still may be as easy as taking a small tablet in the evening to shrink or relax the prostate. Symptomatic relief can be as fast as overnight.
For others with a significantly enlarged prostate that squeezes the urine tube, much like stepping on a garden hose, surgery may be required. But rest easy; the surgery is much easier than it was just a few years ago! The advancement of lasers and other techniques often makes this an outpatient surgery.
Do I need a TURP?
There are generally a few type of men who truly need surgery:
- You have tried multiple medications, and continue to have significant problems urinating.
- You have been taking several medications, and no longer like taking them, or don’t want to continue having to pay for monthly medications when a TURP would likely take care of most symptoms without the need for medication.
- Your symptoms are so severe, that you no longer feel like you are emptying your bladder. We have the latest ultrasound tools at our office to scan your bladder after urination. Lots of urine left in your bladder after urinating is a bad sign that your bladder is getting tired of pushing to urinate.
What is a TURP?
There are many names for this procedure. The correct one is TURP, or Trans-Urethral Resection of Prostate. Some may joke that their grandfather had a ‘roto-rooter.’ This is the same procedure that has been done for decades; however, the technology and outcomes have markedly improved.
No incisions! That’s the good part. The entire procedure is done under general anesthesia (asleep) via the urethra. We now use state-of-the-art high-definition cameras to look at the prostate. We then use either plasma-vaporization or lasers to remove the obstructing tissue of the prostate that squeezes the urethra as it passes through the bladder.
The best way to think of the prostate is like an orange that sits under the bladder. The urethra passes like a straw right down the middle of the prostate into the urethra. When you’re younger, the prostate is responsible for secretion of ejaculate. It has nothing to do with sexual desire, erections, testosterone, or sperm.
As you get older, the prostate grows, squeezing the urethra running down the middle. When medicines can no longer relax the prostate to allow urine to pass freely, surgery, through TURP, can easily remove much of the blocking/obstructing prostate tissue, or pulp of the orange, to allow for a much better urinary flow.
TURP is usually performed in the hospital or outpatient surgical center, and takes approximately one hour.
What about the different types of TURP procedure?
Depending on your prostate size, a variety of options are available. Drs. Mehan and Wadhwa prefer the Gyrus plasma-kinetic system, which combines the best qualities of the gold-standard TURP with the advantages of a lower energy device that seals blood vessels comparable to laser technology to achieve superior results.
How long should the procedure last?
As different folks’ prostate grow at different rates, just like the hair on our head, this is a difficult question to answer. Literature supports that most people will have at least seven or more years of benefit, at which point 15% of people may need a repeat procedure. Looking at it another way, for 85% of people, this will be the only procedure needed.
What are common side effects?
Erections are not affected. For some people with severe prostate enlargement, they actually tell us erections improve.
There may be some changes in ejaculation. Because the prostate cavity is enlarged after surgery, semen or ejaculate can not only go forward, as it usually does, it can “hiccup” back into the bladder, where it is urinated out after ejaculation. For many people, ejaculation is not affected, whereas other patients may simply note a reduction or loss of ejaculate volume. Again, erections are not affected. Orgasms are also not affected.
What about my medications?
Usually, Dr. Mehan will have you finish up your current prostate medications, and then stop them. This is the great thing about the surgery: You can stop one or more medications for your prostate! Not only that, but most people state that urination is vastly improved with medications alone.
It is critical that you stop any Aspirin, Coumadin, Plavix, or other blood thinners one week beforehand. Call our office if you have any questions about this.
The night before your procedure, you may eat and drink as usual. However, do not take anything by mouth after midnight the night before. Wear comfortable, loose-fitting clothing like a jogging suit on the day of your procedure. Bring a list of all prescription and nonprescription medications you take regularly.
Plan to arrive two hours prior to your treatment. The TURP usually takes approximately one hour, and Dr. Mehan or Dr. Wadhwa will come and speak to your family afterward.
Upon awakening from the procedure, you will have a catheter draining your bladder. We have yet to meet a man who likes having a catheter. Relax — the catheter typically will remain for 48 hours and then be removed in the clinic.
It is common for the catheter to drain pink or red urine. Just as Kool-Aid can turn water red with just a small amount of coloring, a small amount of blood turns the urine red. If there are clots, or more significant blood in the urine, Dr. Mehan and Dr. Wadhwa may opt to keep you in the hospital overnight and discharge you in the morning.
You will be given full instructions from our nurse on how to manage and drain the Foley catheter bag when it gets full.
It is not unusual to have a sensation of wanting to urinate, or to have bladder spasms after surgery. This usually goes away within one to two days. You may occasionally notice a small amount of urine leak around the catheter. This is normal.
After the procedure, patients may have a variety of minor issues. Although many patients do fine, some patients may experience minor, temporary problems such as burning with urination, frequent urination, small clots, pink/red urine, or occasional discomfort that radiates from the kidney to the bladder. Again, these tend to be minor issues, and resolve within one to two days after the procedure.
Definitely rest up for a day or two after a TURP. Drink at least six to eight glasses of water to wash out your system. Within a day or two, your urine will begin to clear up and look normal.
For pain, Advil, Motrin, or prescription Toradol work great. Depend upon your doctor’s advice. Never take a medication without clearing it with your doctor first. These are great anti-inflammatories, and are also non-narcotic, so you won’t get sleepy or constipated, or have other issues. Take them on a regular basis the first two to three days after the procedure. For pain not relieved by these medications, use the prescription Tylenol with codeine or Vicodin that was prescribed for you. We may also occasionally give you a few days of bladder spasm medication.
Do not strain when having a bowel movement. Expect irregular bowel habits until you have fully recovered. Increase fiber in your diet. You may need a stool softener or laxative. Do not take blood thinners or aspirin products for one week or as directed by your physician.
Take it easy for the first 48 hours after the procedure. Do not drive or operate dangerous equipment for 48 hours following anesthesia. You may be able to resume nonstrenuous activities after 48 hours unless otherwise directed by your physician. Avoid strenuous exercise, heavy lifting greater than 20 pounds, bike riding, and yard work for two weeks, as the vibrations and movement may cause bleeding. Refrain from sexual activity for two weeks after surgery.
You will need a catheter to drain your bladder, depending upon the extent of your surgery. Catheters generally are removed within 24 to 48 hours in the Urology Clinic. Wash around the catheter with soap and water and rinse well. You may shower, but avoid baths until the catheter is removed.
Diet and Fluid
Avoid coffee, tea, carbonated beverages, alcoholic beverages, citrus juices, spicy foods, and smoking for the first month following surgery.
Increase your intake of fluids, particularly water; 24 to 48 ounces over your usual daily fluid intake is typically recommended during the first two weeks of your recovery.
Expected Signs and Symptoms
You may experience urinary urgency and/or frequency for the first month following surgery. This is normal. Talk to your doctor to discuss medications that may relieve this. You may have a small amount of bleeding with urination on occasion. This may be accompanied by small blood clots. This is normal, and should be relieved by increasing your fluid intake. You may experience some mild burning and discomfort during urination. This is normal and should subside in one to two to four weeks.
Usually, Drs. Mehan or Wadhwa or their staff will communicate to you a desired follow-up time frame. Please call us the day after the procedure to verify a time to see us in the office and to remove your catheter.
Time to celebrate! Once your catheter is removed, you’re on the road to recovery. Just as you won’t run right after knee surgery, have patience as your bladder and prostate gradually heal from surgery. Immediately after surgery, you may have an urge or frequent need to urinate, or have some burning with urination. On occasion, you may pass some small debris or clots in the urine, but rest assured, this will gradually all disappear. Most patients report 50% improvement in symptoms within one month of surgery, and 90-100% within three to six months postoperatively. This is largely dependent on how severe your symptoms were prior to surgery. The good news is that you’ll be happy that you chose surgery; just be patient with your road to recovery!