Transurethral Resection of the Prostate- Indications, Procedure, and Risks

Introduction:

The prostate gland is an essential part of the male reproductive system that carries out several reproductive and sexual functions. The gland is about the size of a walnut and is located close to the neck of the urinary bladder. A tube known as the urethra passes through the middle of the gland and facilitates urine drainage. The prostate gland also releases a fluid that nourishes and protects the sperm. During ejaculation, the prostate releases this fluid into the urethra, which is expelled from the body as semen containing sperm. If the prostate gland enlarges or experiences any other disorders, the patient is most likely to experience urologic complications because of the close proximity of the gland to the urinary bladder.

What Is the Importance of Transurethral Resection of the Prostate (TURP)?

Transurethral resection of the prostate gland is done to remove a portion of the prostate gland that has become enlarged and causing urologic problems in a patient. The surgeon inserts an instrument known as the resectoscope into the urethra through the penis tip. It helps to visualize the prostate gland and remove the excess prostate tissue blocking the urine flow. However, an important point to note here is that TURP is only recommended for patients with moderate to severe problems that do not subside even after taking medications. Though TURP is considered one of the most effective methods to treat benign prostate hyperplasia or prostate enlargement, several other conservative and minimally invasive methods are available that help manage the condition. These procedures are beneficial, and the patient has to undergo less surgical trauma than other procedures.

Why Is the Transurethral Resection of the Prostate Gland Done?

Transurethral resection of the prostate gland is done when the patient experiences urologic difficulties due to the enlargement of the prostate gland. TURP helps relieve the patient of the following symptoms:

• Urinary frequency (passing urine more than eight to ten times per day).

• Difficulty in starting the urine stream.

• Prolonged urination.

• Nocturia or increased urinary frequency at night.

• Interrupted urine stream.

• Inability to empty the bladder completely.

• Urinary tract infections.

TURP also helps the patient overcome the complications that occur due to enlargement of the prostate gland:

• Recurrent urinary tract infections.

• Damage to the kidneys and bladder.

• Inability to pass urine.

• Bladder stones.

• Blood in the urine.

What Are the Risks of Transurethral Resection of the Prostate (TURP)?

The risks of transurethral resection of the prostate are listed below:

• Difficulty in Urinating - The patient might have difficulty passing urine for a few days after the procedure. So, he might need to insert a catheter into the penis to facilitate urine drainage.

• Urinary Tract Infection - It is one of the most common complications of prostate-related surgeries. The longer the catheter stays in the palace, the greater the chances of urinary tract infections. Some males might have recurring urinary tract infections.

• Erectile Dysfunction - There are fewer chances of erectile dysfunction after prostate treatments.

• Dry Orgasm -The most common complication of prostate surgery is dry orgasm because the semen gets released onto the bladder instead of outside the penis. As a result, the patient might have difficulty becoming a father, but his sexual pleasure would not be affected. This phenomenon is also known as retrograde ejaculation.

• Heavy Bleeding - Sometimes, males might experience heavy bleeding after the surgery and require a blood transfusion.

• Low Sodium in Blood - In rare cases, the body might absorb too much of the liquid used for washing the surgical site. This condition is known as retrograde ejaculation and can be life-threatening if left untreated for a long time.

• Re-treatment - Some males might require follow-up after the surgical procedure, whereas some might need re-treatment if the surgery causes urethral contracture.

How Does the Patient Prepare for the Procedure?

The doctor might ask the patient to do the following things before the procedure:

1. The doctor will explain the procedure and ask the patient to sign the consent form.

2. The doctor will review the patient’s medical history and do a physical examination to check whether he is clinically fit for the procedure or not. He might order some blood tests or urine tests before the procedure.

3. The patient must not drink or eat anything eight hours before the surgery.

4. The patient must inform the doctor if he is allergic to latex, contrast dyes, or iodine.

5. Inform the doctor about the prescription and over-the-counter drugs you take to avoid drug interactions. Also, inform about the herbal supplements the patient is taking.

6. If the patient takes blood thinners or has a history of bleeding disorders, the doctor might ask him to stop taking those medications a week before the surgery.

7. The patient must quit smoking before the procedure.

8. He will be given a sedative or general anesthesia before the procedure to become unconscious for some time.

What Happens During the Procedure?

The TURP procedure gets completed in 60 to 90 minutes, and the patient might be given antibiotics before and after the procedure to prevent infections. The procedure is carried out under the following steps:

1. First, the patient will be asked to remove the jewelry or other objects that might interfere with the surgery, and he must change into a hospital gown before the procedure.

2. The patient will be asked to urinate, and an IV line will be attached to the patient’s arm.

3. The patient will be laid on his back, and his legs will be placed in stirrups.

4. The patient will be given general anesthesia and put to sleep.

5. The patient’s heart rate, blood pressure, and respiratory rate will be constantly monitored during the procedure.

6. Next, the doctor will insert an endoscope into the urethra to inspect the bladder and other organs for stones and tumors.

7. After the inspection is complete, the doctor will insert a resectoscope into the urethra. It is used to remove the excess prostate tissues that are blocking the urethra. Electric current will be passed through the resectoscope to prevent bleeding. Finally, the pieces are flushed into the bladder and drained through the urethra.

8. Finally, the resectoscope is removed, and a catheter is inserted for a few days.

What Happens After the Procedure?

In the Hospital: After the procedure, the patient is taken to the recovery room and is closely monitored. Once his blood pressure, respiratory rate, and breathing become normal, he will be taken to the hospital room. The patient might be asked to take the pain medications orally or through an intravenous line. Once the patient wakes up, he will be asked to have a liquid diet for some time. The catheter will remain in place for one to three days after the surgery to facilitate urine drainage. After the surgery, the patient might notice some blood in the urine, so a pouch will be attached to the catheter to drain the blood and blood clots. Bleeding will slowly decrease in a few days after the surgery when the prostate tissues heal completely.

At Home: The doctor might recommend the following after the procedure:

• Drink plenty of water to flush the bacteria out of the body.

• Have a fiber-rich diet to avoid constipation and straining during the bowel movement.

• Do not take blood thinners without consulting the doctor.

• Avoid strenuous activities or lifting heavy objects for four to six weeks after the surgery.

• Do not engage in sexual activities for four weeks after the surgery.

• Do not drive until your catheter is removed.

When Should the Patient Consult the Doctor After the Procedure?

The patient must consult the doctor if the following symptoms do not subside in a few days:

1. Fever or chills.

2. Difficulty in passing urine.

3. Red blood clots in the urine.

4. Trouble controlling the bladder.

5. Changes in urine output, color, and odor.

Conclusion:

Transurethral resection of the prostate is a surgical procedure that is usually done to remove the excess prostate tissues. Several other procedures are available to treat prostate enlargement, but this procedure is usually preferred because of its effectiveness. Though the patient might experience complications for some time, the procedure is usually done a lot nowadays. Males above 50 are more likely to undergo TURP because they are at an increased risk of experiencing prostate enlargement. So, the patient need not worry and must consult his doctor soon to know about TURP.