Transurethral resection requires only a brief hospital stay, usually 4-5 days. As the TURP procedure does not involve a surgical incision, postoperative pain is considerably less than in a more invasive type of surgery.
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After the operation, a flexible tube called a catheter is put into the bladder to drain the urine; it is usually removed within two days. Although the urologist controls most of the bleeding at the end of the operation, some blood will drain with the urine. This can be quite bloody for a day or two. Occasionally, the blood will clot and block the catheter. If this happens a doctor or nurse will clear the clot with a syringe. Many urologists use special catheters to run fluid through the bladder to reduce the risk of clotting occurring.
Will It Be Painful?
You will not have any of the usual type of postoperative pain, but the catheter can be uncomfortable, and may make the bladder feel full. Sometimes painful spasms occur. If these are severe, drugs can be prescribed to control them. You will be asked to drink a lot of water each day to help flush out your bladder.
Returning to Normal Life
Once the catheter is removed, you should be able to pass urine almost at once. It is normal to have some frequency for a day or two, and often it is difficult to control the urine at first. A physiotherapist (or a nurse) will teach you some exercises to help control the urine. Most men go home a couple of days after the catheter is removed. Sometimes it is difficult to pass urine first of all, but persevering for a few hours usually does the trick. If not the catheter sometimes needs replacing. If this happens, do not despair – usually everything is fine when it is taken out again.
Although there is no painful incision to heal up, it is important to realise that, inside, the prostate is raw and needs time to heal. This takes a few weeks, and it is important to take it easy for this time. Continue to drink plenty of fluid (but not alcohol!). Avoid heavy lifting and don’t drive for 2-3 weeks. Sexual intercourse should also be avoided for this period. You must expect to see some bits of tissue in the urine from time to time – this is like the scab coming off a skin wound and, as happens when a scab comes off, a little bleeding sometimes occurs.
Traces of blood in the urine are very common after a prostate operation. Sometimes heavier bleeding occurs, usually 1-2 weeks after the operation. Do not panic if this happens; a little blood goes a long way in the urine and often it looks worse than it is. Drink plenty, and if it does not stop in a few hours, contact your doctor.
Sometimes blood clots make it difficult to pass urine. If that happens you might need to go back into hospital, and sometimes a catheter will be put back for a day or two. Such bleeding usually settles down. Sometimes it is due to an infection, in which case antibiotics are given. Because BPH creeps up on most men unawares over some years, they are surprised by the force of their urine stream after a TURP. This usually is immediately obvious, but when frequency is the main symptom it may take longer to improve, and may not return completely to normal. Needing to pass urine in the night may persist after the operation because this symptom is often as much a feature of getting old as of actual prostate disease. The other symptom that may not improve is leakage at the end of passing urine. Indeed some men only notice this for the first time after the operation. Urine leaks out from the cavity inside the prostate. It can usually be controlled by taking a little care when passing urine.
Something that almost always happens after the operation is what doctors call ‘retrograde ejaculation’. At the end of the sex act, a normal climax is felt, but nothing comes out. ‘Having a dry run’ describes exactly what happens. The muscle at the neck of the bladder, above the prostate, has to be removed with the prostate tissue and this means that semen leaks into the bladder rather than coming out normally. Usually, sex is otherwise unaffected, although a few men do experience difficulty in having an erection after the operation.
After a prostate operation, your control of urine should be normal. If your symptoms before the operation were of the irritative type, leakage may occur at first and you may need some tablets to calm down your bladder, often only as a temporary measure. More rarely, the lower sphincter muscle is weakened by the operation. This will usually improve with muscle strengthening exercises. It is very unusual for this to be permanent, but operations can be done to put it right if all else fails. Leakage can occasionally be due to insufficient prostate being cut away and the bladder not emptying completely. If so, a second TURP might be needed.
Men who have had a TURP are among the most satisfied customers seen in a urology clinic. The majority are delighted with the operation. A few are disappointed with the result – often those whose symptoms were fairly mild before the operation, and who find that side-effects such as those above are worse than their original symptoms.
A poor result from a TURP usually means that the operation was not the best treatment for that patient, rather than anything having gone wrong with the operation itself. That is why it is important for the right tests to be done beforehand and why the patient often must decide himself if his symptoms are worth the discomfort of an operation and the risk of side-effects. Above all, it is important to go to a urologist expecting to be given helpful advice but not necessarily to have an operation.