information for patients

Transcription

1 information for patients Surgery of the Prostate (Trans Urethral Prostatectomy or TURP) Your consultant has diagnosed that you have a problem with your prostate gland and has recommended that you have an operation called TURP (Trans Urethral Prostatectomy). This means that part of the prostate gland is removed. This booklet contains some of the questions you may want to ask about your operation. It will help you to understand the operation and the care that you will receive. If you want to know any more information about the prostate and what the operation involves, please speak to one of the doctors or nurses. They will be more than happy to help. Kidney Ureter Bladder Prostate Uretra Testes The urinary tract and the prostate gland Your kidneys filter waste chemicals from the blood to form urine which passes into the kidneys collecting systems and then on to the ureter and bladder. The bladder is a hollow muscular balloonlike organ that collects urine which it stores until you are ready to urinate. The tube from the bladder to the outside world is called a urethra. It passes through the prostate gland and along the penis. The urethra is surrounded by a muscle called a urethral sphincter. When your bladder is storing urine the sphincter muscle compresses the urethra and keeps you continent by preventing urinary leakage. When you urinate your bladder muscle contracts (squeezes) and the sphincter muscle relaxes (opens) and urine is expelled along your urethra. The prostate is a gland situated at the base of the bladder and surrounds the urethra. Although it can cause problems with urination as you get older it has no function in normal urination. The purpose of the gland is to produce a fluid which is important for sperm function. After you have had a family, it serves no useful purpose. The best way of describing it is to imagine it is like an apple with the core removed. What problem do I have with my prostate? The prostate tends to grow as men get older. In some cases, it becomes large enough to put pressure on the urethra, narrowing it. The narrowing leads to symptoms such as delay in starting to pass urine and passing urine very slowly with stops and starts. Sometimes, if the narrowing causes a complete blockage you may not be able to pass urine at all.

2 The bladder muscle has to squeeze harder to force urine through the narrowed urethra and as a result can become overactive. This over activity may cause the symptoms of having to pass urine frequently and urgently, getting up in the night to pass urine and sometimes even loss of bladder control causing incontinence. What are the benefits of having an operation to remove part of my prostate? A TURP removes the narrowing or blockage caused by the prostate. The operation should improve your symptoms considerably. In particular, you will notice an improvement in the force of your urine stream within a few days. Your other symptoms, due to bladder over activity, may take longer to improve and it may be several months before you feel the full benefit. It is important that you realise the operation should improve your symptoms, but it may not cure them completely. Your bladder will not return to what is was 20 years ago. For example, you may still find that you have to get up once or twice in the night to urinate. This is quite normal as you get older. Are there any risks involved in having prostate surgery? Most people get through their operation with no problems and are very pleased with the results. However, it is important to realise that sometimes there can be difficulties. Some people get little or no benefit from having the operation and are left with the same symptoms as before. Very few people (less than one per cent) can become critically ill as a result or the operation - usually as a result of heavy bleeding or severe infection. It is also possible for too much water to be absorbed from the fluid used to flush the bladder during the operation. This can temporarily upset the balance of salts in the blood which can be harmful, particularly for people who already have heart or kidney problems. The condition is very rare and known as TURP syndrome. Rarely, it is also possible to develop a blood clot (known as a deep vein thrombosis or DVT) in the veins of the leg. This clot can break off and travel to the lungs to cause a blockage. In the majority of cases, this is treatable, but it can be a dangerous condition. People having surgery are routinely given medicines or compression stockings to wear during the operation to help prevent a DVT. There are also a number of specific side effects that you need to be aware of: There is a definite chance (50% or more) that you will experience retrograde ejaculation after the operation. This means that during orgasm, instead of squirting out in the normal way, semen passes backwards, up the urethra, into the bladder and is later passed out with the urine - making the urine appear cloudy. This happens because a muscle at the neck of the bladder is partly cut during the operation. This muscle usually contracts at the moment of ejaculation and prevents the semen passing into the bladder. In many cases it will not be able to perform this function once the TURP operation has been carried out. Retrograde ejaculation will not do any harm, but the sensation of an orgasm may be different. There is also a risk of infertility, but this is not usually a problem for men in the age group who normally have prostate surgery. The operation can affect your ability to have an erection and a small proportion of men (approx 10%) become impotent afterwards. Finally, there is a very small risk (less than one percent) that the operation can cause permanent incontinence. A minor degree of incontinence immediately after the operation is not unusual, but it almost always settles down. If you are worried about any of the risks listed here, please talk to a doctor or nurse.

3 What are the alternatives to a TURP? No treatment - if you choose to have no treatment your symptoms are likely to get slowly worse over time but you are not at a greater risk of developing a major health problem than if you had no treatment. Herbal remedies - Saw palmetto extract is one of several herbal remedies that some men find helpful. There is some scientific evidence that it may be a beneficial treatment for men with enlarged prostate glands. Medicines - These need to be taken daily, to improve the flow of urine and/or shrink the prostate and are more effective than herbal remedies. Getting ready for the operation We run a pre-assessment clinic which you will probably have been asked to come to during the weeks before your operation. The idea of this clinic is to do much of the administration and investigations required for the operation before you come in. This helps to shorten the time you have to spend in hospital before the operation and allows us to identify any potential problems (such as high blood pressure) in time for them to be sorted out beforehand. Tests may include:- Taking a sample of urine to check that you have no infection Blood samples ECG (heart tracing) Weight/height Temperature, pulse and blood pressure You will be seen by a nurse, and a consultant will discuss your surgery and ask you to sign a consent form. At any stage please feel free to ask questions about anything you do not fully understand or are concerned or worried about. Your anaesthetist will see you in the preadmission clinics or on the ward when you come in. She/he will explain the details of the anaesthetic to you. See What sort of anaesthetic will I have? Later on in the booklet. The nurse will inform you when to come in to hospital and where to report and also when to stop eating and drinking. Note: If you do not need to attend the preassessment clinic your documentation and investigations will be carried out on the day of your admission to hospital. What happens on the day of the operation? The nurse will prepare you for theatre and help you to put on a theatre gown. If the anaesthetist has requested it you will be given pre-medication (usually in the form of tablets). After this you will be asked to remain on your bed as you may begin to feel sleepy. Typically, no food and drink is allowed for about six hours before a general anaesthetic. However, some anaesthetists allow a few sips of water until two hours beforehand. You will be taken to theatre reception by a nurse and a theatre porter. The theatre nurse will check your details and escort you into the anaesthetic room. What sort of anaesthetic will I have? You may have a spinal or a general anaesthetic. A general anaesthetic means that you will be fully asleep whilst the operation is carried out. In a spinal anaesthetic, you are given an injection in your back, which completely numbs the lower half of your body and stops you from feeling any pain. However, you will still be awake and aware of your surroundings. The choice of anaesthetic will be made by the anaesthetist, because for some patients, one technique may have advantages over the other. If there is no particular medical reason to recommend one method, the anaesthetist will usually offer you the choice. What is the operation? The operation itself takes about an hour and removes part, not all, of the prostate gland. It is carried out by passing a rod-like instrument called a resectoscope up the urethra and into your bladder.

4 The resectoscope includes a camera and specially adapted surgical instruments that allow the surgeon to see inside clearly and perform operations. A wire loop attachment that carries an electric current is used to chip away at the prostate. By removing many pieces or chips, the size of the urethra can be enlarged - rather like re-boring a pipe or coring an apple. The same instrument, with a different type of electric current, is used to stem any bleeding. During the operation, the bladder is flushed with a sterile solution to remove the chips of prostate tissue. A catheter (a thin flexible tube) is then inserted through the urethra into the bladder. An advantage of surgery through the urethra is that there is no external wound, enabling you to move around more quickly and easily after your surgery. All the tissue removed from the prostate is sent to the laboratory for examination. What should I expect after the operation? When the operation is over you will spend a short time in the recovery room until the ward nurse collects you and takes you back to the ward. You will have your blood pressure, pulse and breathing checked regularly by the nurse. You will have a drip running into a vein in your arm which will maintain your body fluids until you are eating and drinking again. There a catheter going up the urethra into your bladder to drain away urine and blood. There may also be an irrigation solution running through the catheter to flush out blood from the bladder. The irrigation will be stopped in a day or so. A drainage bag is attached to the catheter and you may find that the fluid draining looks very bloodstained. This is normal. As the anaesthetic wears off, there may be some pain and the anaesthetist may prescribe painkillers. If you start to feel uncomfortable, as if you urgently need to pass urine, the catheter maybe blocked and you need to tell the nurse straight away so that the blockage can be relieved. Visiting on the afternoon of the day you have been to theatre is not advised. A relative or friend is welcome to visit in the evening. The day after the operation, you can usually get out of bed and walk around. You should be able to eat and drink normally. You may seem a little tired, so it is advisable to have plenty of rest during the next few days. The catheter will be removed when your urine is pale pink in colour, usually one or two days after the operation. In order to make sure your urine clears quickly you should drink one or two glasses of fluid every hour. Occasionally, it is not possible to pass urine after the operation. If this happens, a catheter will be put back into your bladder and you will go home with the catheter in - usually for about two to four weeks. At the end of this time you will come back to hospital and have the catheter removed. You should then be able to empty your bladder without difficulty. How long will I have to stay in hospital and when can I go home? A TURP usually involves a hospital stay for around two to three days but a few patients stay in hospital between five and seven days. You will be able to go home after your catheter has been removed and if: Your urine is clear enough You can pass urine with good control and you are emptying your bladder completely (this may be checked using a bladder scanner) You have a normal temperature What should I do when I get home? Once home, further painkillers may be taken if needed, as advised by the hospital. Drinking at least two litres of fluid a day will help flush out the bladder and assist recovery. It is common to have occasional blood clots (red-brown or purple flecks) in the urine. Also leaks of urine can happen when coughing or straining for a number of weeks. To help with this an absorbent liner can be worn inside the underpants.

5 information for patients What should I do if I have problems at home? It is quite normal to see a little blood in your urine for up to four weeks after your surgery. As with any wounds, scabs form and eventually drop off, causing minor bleeding after your surgery. If this happens make sure you drink plenty of fluids to flush and dilute the blood. If bleeding persists for more than 48 hours then you should contact your own GP. If you experience pain on passing urine, or have a temperature, you have a urine infection and again you need to contact your GP. He/she may give you a course of antibiotics. Your GP should be contacted immediately if heavy bleeding returns, there is a high temperature, if it s not possible to urinate or if the level of pain increases. You may continue to pass urine rather frequently for a time. This should gradually improve over the next five to six weeks. When will I be able to go back to work? This depends on the type of work you do, but as a rough guide light jobs may be resumed after four weeks. Heavy jobs should be avoided for at least six weeks. Your GP will advise you. What exercise can I do? Strenuous exercise such as gardening, decorating, heavy lifting, golf and dancing, should be avoided for two weeks. You can then increase your exercise as you feel able. The speed of recovery can vary greatly between patients, but as a rough guide, you should be more or less back to normal after four to six weeks. Gentle walking and swimming are beneficial and may be undertaken immediately. Will I be able to drive? Driving is best avoided for a few days after you get home. You may drive short distances when you feel comfortable, normally alert and able to do so. Driving for long distances should be avoided until you have completely recovered. When can I have sex? Sexual activity should be avoided for four weeks. Sex earlier than this can trigger bleeding from the raw area left in the prostate. Do not be surprised if you do not feel like having sex for longer than this. It is quite normal. General things to remember If you think you may have an infection or feel ill, contact your own GP If you have been given antibiotics, make sure you complete the course If you are unsure about the tablets given to you contact your GP for advice Do not strain to pass stools, if you become constipated contact your GP If the blood in your urine increases and you are worried, contact your GP If you have any problems or are unsure what to do please do not hesitate to contact any of the ward staff for advice. We hope you have found this information useful. If you have any questions, or are worried about anything, please speak to your GP or contact Barnes Ward at Chesterfield Royal Hospital on Surgery of the Prostate (TURP): February 2013 Next Planned Review date: February 2017 Directorate: Surgical Specialties (Urology)