Trans-Urethral Resection of the Prostate (TURP)

Dr Peter Swindle is a urologist who specialises solely in prostate cancer and diseases of the prostate. His expertise and interest lies in the treatment of benign prostatic hyperplasia.

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After the surgery you will be transferred from recovery to the ward. When you first arrive back in the ward you will have a drip in your arm giving you fluids which is removed when you are drinking enough oral fluids. You will have a catheter in your bladder connected to irrigation fluids. The drip and the catheter will be removed when the urine is clear with a minimal amount of blood in it.

Pain:

You can expect to have mild pain at the operation site. Pain in the prostate is felt in the rectum, perineum or lower abdomen, and there are a number of ways to manage your pain. You will be ordered painkillers and if you have pain, it is important that you ask your nurse for some pain killers as you will recover faster if your pain level is controlled. The pain is usually not severe and should continue to decrease in intensity for 7-10 days after the operation.

Occasionally, patients can have pain at the tip of their penis and the urgent desire to pass urine despite having a catheter in the bladder draining urine. This is called bladder spasms. It is due to the catheter irritating the bladder and causing the bladder to contract giving the sensation of the urgent need to pass urine. If this occurs, let the nursing staff know as there are several medications that can be used to treat these symptoms.

Intravenous Fluid (Drip):

You will have a drip in your arm when you come back from surgery. This will be removed when you are able to eat and drink normally and when you are no longer feeling sick. If you feel nauseated please tell your nurse as she will be able to give you medication to make you feel better.

Bowels:

You may experience some difficulty with moving your bowels in the early days after the surgery. It is important that you do not strain and if you are having trouble moving your bowels, let the nursing staff know so they can give you some laxatives and stool softeners.

The catheter:

Immediately after the operation the catheter is connected to irrigation fluids, to wash blood and blood clots out of the bladder. As the urine clears the irrigation will be slowed and eventually stopped. The catheter will be removed when the urine is clear and this will usually occur on the second morning after the surgery. To remove the catheter, the balloon that held it in the bladder is deflated. There is often a stinging sensation for a few seconds as the catheter passes out of the bladder into the urethra.

After it is removed, most men pass urine normally however occasionally, some men have difficulty and require another catheter to be reinserted for a short time. Once the catheter is removed, you will be observed for approximately 4 hours and if you are passing urine normally, you will be allowed to be discharged from hospital.

Urination:

Once the catheter comes out you make have a burning sensation when you pass urine. This is quite normal and will usually settle within a few days. If the burning sensation lasts longer than 3 days or you have fevers, temperatures or feel unwell then you must contact Dr Swindle or your GP immediately.

Most patients will have an excellent flow immediately after the surgery but many will have a period when they pass urine frequently and with some urgency. This is variable but can last up to 8-12 weeks and will eventually resolve. After a TURP, a scab forms on the cut surface of the prostate. This scab usually falls off at around 7-10 days. When this occurs a small piece of tissue can be passed and some bleeding can occur. If this occurs don’t be alarmed, but increase your fluid intake. It will usually settle within 24-48 hours. Contact Dr Swindle if you are passing large amounts of blood clots or if you are having trouble urinating.

Potential complications following a TURP

Many men worry about whether surgery for benign prostatic hyperplasia of the prostate will affect their ability to enjoy sex. Most men are able to have a normal sex life after a TURP. There are potential side effects that can occur following the procedure and it is important that you understand what may potentially happen following a TURP.

Bleeding:

Blood loss during the operation can very rarely be large and may require a transfusion. The risk of transfusion is approximately 1 in 200. Please talk to Dr Swindle if you can not have a blood transfusion. Most men also have a small amount of bleeding when the scab falls off the raw surface of the prostate 7-10 days after the procedure. This rarely results in significant bleeding. The risk of bleeding usually lasts until the prostate is fully healed at around 6-8 weeks.

Urinary Retention:

Blood clots or swelling of the bladder neck can occasionally stop the flow of urine following catheter removal and a catheter may need to be replaced until the swelling resolves or the bleeding stops.

Infection:

Infection can occur in the urine or prostate following a TURP and requires treatment with antibiotics. The symptoms of a urinary tract infection are difficulty urinating, burning on urination, frequent urination or fevers. If this occurs, contact Dr Swindle immediately on 0409103333, or if Dr Swindle is not available, go to your local doctor or nearest emergency department.

Scarring of the bladder neck or urethra:

A stricture (scar) can develop in the urethra or the bladder neck (junction of the prostate and bladder). This can slow or block the flow of urine and may occur several months or years after the operation. If a stricture occurs it usually requires stretching or cutting to open up the narrowing and allow the urine to flow freely. This may occur in up to 10% of men undergoing a TURP.

Sexual Function:

Some men may experience alteration in their sexual function following a TURP. The following problems may occur:

  • Retrograde Ejaculation: After a TURP, the internal sphincter or bladder neck is cored out to open up the prostate. During sexual activity, the semen passes back through the wide open bladder neck into the bladder instead of passing out the penis at the time of orgasm and ejaculation. Later, the semen is harmlessly flushed out with urine and may make the urine a little cloudy. This will result in a dry ejaculation and renders most men infertile. It should however not be used as a contraceptive method. The quality sexual climax, or orgasm, at the time of ejaculation should not be altered.

  • Impotence: Some men report mild to moderate difficulty in getting an erection after a TURP. It is rare and occurs in approximately 10% of men and usually occurs in older men who are already starting to have trouble with their erections.

Incontinence:

Incontinence, or leaking urine without control, may occur following a TURP. It usually improves in a few weeks but rarely can be permanent. Permanent incontinence occurs in about 1 in 200 cases and in this event, treatment is available.

Injury to Rectum:

Very rarely, injury to the rectum can occur during the operation and to repair the injury open surgery may be required. This complication is extremely uncommon.

Pain in the testicles:

Swelling and pain in the testicles can occur due to inflammation.

Posted in: TURP
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