Transurethral Resection of the Prostate Health Article

Aftercare

When the patient awakens in the recovery room after the procedure, he already has a catheter in his penis, and is receiving pain medication via the IV line inserted prior to surgery.

The initial recovery period lasts approximately one week, and includes some pain and discomfort from the urinary catheter. Spastic convulsions of the bladder and prostate are expected as they respond to the surgical changes. The following medications are commonly prescribed after TURP:

• B&O suppository (Belladonna and Opium). This medication has the dual purpose of providing pain relief and reducing the ureteral and bladder spasms that follow TURP surgery. It is a strong medication that must be used only as prescribed.
• Bulk-forming laxative. Because of the surgical trauma and large quantities of liquids that patients are required to drink, they may need some form of laxative to promote normal bowel movements.
• Detrol. This pain reliever is not as strong as B&O. There may be wide variations in its effectiveness and the patient's response. It also controls involuntary bladder contractions.
• Macrobid. This antibiotic helps prevent urinary tract infections.
• Pyridium. This medication offers symptomatic relief from pain, burning, urgency, frequency, and other urinary tract discomfort.

When discharged from the hospital, patients are advised to:

• Refrain from alcoholic beverages.
• Avoid sexual activities for a few weeks.
• Avoid driving a car for a week or more.
• Keep domestic activities to a minimum.
• Avoid weight lifting or strenuous exercise.
• Check their temperature and report any fever to the physician.
• Practice good hygiene, especially of the hands and penis.
• Drink plenty of liquids.

Risks

Serious complications are less common for prostate surgery patients because of advances in operative methods. Nerve-sparing surgical procedures help prevent permanent injury to the nerves that control erection, as well as injury to the opening of the bladder. However, there are risks associated with prostate surgery. The first is the possible development of incontinence, the inability to control urination, which may result in urine leakage or dribbling, especially just after surgery. Normal control usually returns within several weeks or months after surgery, but some patients have become permanently incontinent. There is also a risk of impotence, the inability to achieve penile erection. For a month or so after surgery, most men are not able to become erect. Eventually, approximately 40–60% of men will be able to have an erection sufficient for sexual intercourse. They no longer ejaculate semen because removal of the prostate gland prevents that process. This effect is related to many factors, such as overall health and age. Other risks associated with TURP include:

• blood loss requiring transfusion
• postoperative urinary tract infection
• unsatisfactory long-term outcome

TURP syndrome effects 2–6% of TURP patients. Symptoms may include temporary blindness due to irrigation fluid entering the bloodstream. On very rare occasions, this can lead to seizures, coma, and even death. The syndrome may also include toxic shock due to bacteria entering the bloodstream, as well as internal hemorrhage.

Normal results

TURP patients usually notice urine flow improvement as soon as the catheter is removed. Other improvements depend on the condition of the patient's prostate before TURP, his age, and overall health status. Patients are told to expect the persistance of some pre-surgery symptoms. In fact, some new symptoms may appear following TURP, such as occasional blood and tissue in the urine, bladder spasms, pain when urinating, and difficulty judging when to urinate. TURP represents a major adaptation for the body, and healing requires some time. Full recovery may take up to one year. Patients are almost always satisfied with their TURP outcome, and the adaptation to new symptoms is offset by the disappearance of previous problems. For example, most patients no longer have to take daily prostate medication, and quickly learn to gradually increase the time between urinating while enjoying uninterrupted and more restful sleep at night.

Normal post-operative symptoms include:

• urination at night and reduced flow
• mild burning and stinging sensation while urinating
• reduced semen at ejaculation
• bladder control problems
• mild bladder spams
• fatigue
• urination linked to bowel movements

To eliminate these symptoms, patients are advised to:

• Exercise.
• Retrain their bladder
• Take all medications that were prescribed after TURP
• Inform themselves via support groups or pertinent reading
• Get plenty of rest to facilitate the post-surgery healing process

Morbidity and mortality rates

TURP reduces symptoms in 88% of BPH patients. TURP mortality rates are 0.2%, but they can be as high as 10% in patients over 80 years of age. Following surgery, inadequate relief of BPH symptoms occurs in 20–25% of patients, and 15–20% require another operation within 10 years. Urinary incontinence affects 2–4%, and 5–10% of TURP patients become impotent.