Trans-urethral resection of prostate (TURP) or prostatectomy

Transcription

1 Department of Urology Trans-urethral resection of prostate (TURP) or prostatectomy Information for patients Page 1 of 6

2 This leaflet has been written to help answer any questions you may have about your operation. Although all of your tests and visits have been here at the QE, your operation will be carried out at the urology department at the Freeman Hospital, Newcastle. You will be seen by the same consultant urologist who is responsible for the care you receive at the QE. If there is anything that you are unclear or unhappy about you can speak to any of the urology nurses here at the Queen Elizabeth Hospital, or a member of the urology team at the Freeman Hospital, when you attend for a pre- assessment visit or while on the ward prior to your operation. The contact numbers for the urology nurses at the QE are at the back of this information leaflet. Why is a prostatectomy necessary? The lower part of the urinary tract consists of the bladder, the urine passage (urethra), the muscles that control the urine (sphincters) and other glands such as the prostate. The two main functions of the lower part of the urinary tract are to store urine and then to get rid of it at a convenient time. The prostate is normally about the size of a walnut and lies at the outlet of the bladder at the top of the urethra. Its job is to make the fluid for your ejaculation. As you get older it can enlarge and cause problems. When you first came to the urology department you were seeking advice about the changes in the way that you pass your urine. These symptoms may have included problems with the storage of urine, such as having to urinate frequently, having to get up at night or having to rush to get to the toilet. You may also have experienced problems getting rid of urine such as having to wait to start passing urine, a poor stream or having to strain. These symptoms can be caused by a number of problems that occur in the kidneys, bladder and prostate. In men the commonest cause is a partial blockage to the outlet of the bladder usually caused by benign (non cancerous) enlargement of the prostate gland. To help us decide where the problem lies you will have been examined and had some tests done including urine samples, a urine flow test, a cuff test and sometimes a bladder pressure study (done at the Freeman) Your urologist has assessed your symptoms and how much they bother you and looked at the test results to decide whether you are likely to benefit from a prostatectomy. How is the operation done? The first part of the operation is to give you an anaesthetic, so that you will not be aware of anything while the operation is being performed. Sometimes the anaesthetist will make your tummy and legs go numb so that you do not feel anything but you will remain awake, this is known as a spinal anaesthetic. The operation is designed to remove the inner part of the prostate which is causing the blockage. In almost all cases we can do this using a special operating telescope that we can pass down the urinary passage (urethra). Sometimes we have to stretch the urethra a bit before hand. Page 2 of 6

3 If the prostate is quite big we cut it away while looking down the telescope. If the prostate is large some surgeons remove the prostate through a cut in the lower part of the tummy, whilst others may decide to remove most of it through a telescope and then remove the rest at a later date if symptoms are still troublesome. After all these operations a tube (catheter) is passed through the urine passage and left in place to drain the urine, which may be blood stained. What preparation is necessary? The most important preparation is for you to understand what is being done and why and for you to be happy to have the operation. You need to be ready for a five day stay in hospital, but you will be up and about the following day. Many patients are ready for home after three or four days. You can expect it to take between two to four weeks to recover at home before you are able to get back to normal activities. If you are a smoker it is very helpful if you can stop a day or two before you come into hospital. You will need to have routine blood and urine tests, and possibly a heart tracing and chest x- ray to make sure you are fit for the operation. These are usually done in the pre-admission clinic a week before the operation. You will come into hospital on either the day of the operation or the day before (depending on your health) and be seen by the nursing and medical staff. You will also be seen by the anaesthetist who will explain what will happen when you are put under anaesthetic. On the morning of the operation you will change into a hospital gown and given elasticated stockings to prevent clots forming in your legs veins. A nurse from the ward will escort you to the operating theatre, where a member of the theatre nursing staff will ask you questions regarding your name and date of birth and check your hospital identity bracelet. The anaesthetist will then put you to sleep, usually by an injection into your hand. What will happen after the operation? You will wake up in the recovery area in your bed and when the nurses are happy with your condition, they will contact one of the nurses from your ward who will come and take you back to the ward. You will have a tube (catheter) in your bladder draining the urine which may be blood stained. To make sure that the urine keeps flowing there will also be a bag of fluid connected to the catheter which will continually flush the bladder out. The catheter drains into a bag by the side of your bed and will be emptied periodically by the ward staff. You will also have a drip into a vein in your arm. You may feel groggy the first night after the operation and you may experience some discomfort, which can be quickly relieved by asking your nurse for painkillers. The next day you will be up and about. The drip will be removed and you will be asked to drink plenty and to try to open your bowels. The catheter is removed when your urine is fairly clear or pink, usually in the evening or next morning. Page 3 of 6

4 After the catheter is out you may find that you have to rush to the toilet and you may have to go quite frequently. These symptoms usually last a few days but can take longer to settle. When you and the ward staff are happy that you can manage you can go home. A three month clinic appointment at the Queen Elizabeth Hospital will be sent to your home address. Are there any problems which may occur? The operation leaves a raw area in the urine passage, which heals over. Occasionally you can get quite heavy bleeding from the raw area either during or shortly after the operation. This is usually corrected by flushing the bladder through the catheter and occasionally a blood transfusion may need to be given. The chance of this happening is about three in every 100 patients. Very occasionally we have to give a further anaesthetic to flush the bladder and stop the bleeding in theatre. Some men do have some bleeding in the week after the operation at home; this can be set off by straining to open your bowels for example or by doing too much physical work. Usually this settles by drinking plenty but you may have to be readmitted to hospital if this does persist. Minor urinary infections are quite common after any operation on the prostate and you may need a course of antibiotics when you go home. Having an anaesthetic and an operation may make other illnesses such as angina or bronchitis worse. If you suffer such health problems the anaesthetist, surgeon and ward staff will take special care during your hospital stay. The chance (risk) of having something go wrong with your general health whilst you are in hospital is about 2%, but this depends upon your age and other health problems you may suffer from. Enlargement of the prostate is caused by benign (non cancerous) changes in the gland. We do however get our pathologist (a doctor who examines tissue under the microscope) to look carefully at the pieces of the prostate removed during the operation. This careful examination sometimes reveals abnormal cells, which can be a form of prostate cancer. We then keep a vigilant eye on the prostate if such a tumour is found. We find such tumours in about 10% of men who have a prostate operation. You will be told about the results of the tissue examination by letter or at your follow up appointment. The main side effect of the operation is re-routing the ejaculation of semen that occurs when you make love. Instead of coming out of the tip of the penis it goes into the bladder. This means that your ejaculation will be dry and you may find your urine is cloudy with the semen the next time you go to the toilet. This happens to about 70% who have a TURP, and about 20% who have a BNI (bladder neck incision) Some men find that their sex life isn t as good after the operation, either because the feelings are less strong or their erection is less stiff. Other men find their sex life is improved since they don t have to worry about their urinary symptoms. A few men find the urine flow slows down again a few months after the operation. This is usually due to a narrowing in the urine tube that can simply be fixed by gently stretching the tube under anaesthetic. Page 4 of 6

5 Is the operation always successful? When men are asked about their prostate operation about 80% say they are extremely happy with the results, 20% who have surgery don t feel that there is any improvement. The operation is very unlikely to make your symptoms worse. However, symptoms such as having to rush to the toilet (urgency) are caused by the bladder muscle, so often this symptom doesn t get any better after the operation and this can make men unhappy with the result. It can be controlled to some extent by tablets. Most men find that their symptoms are much better immediately after the operation; other men feel that they gradually improve over two three months. Since we don t remove all the prostate gland it will continue to grow to some extent. We find that about 10% of men will need a second operation in their lifetime, usually years after the first one. Are there any alternatives? Urologists have been performing prostatectomy for over 100 years but it still remains the most effective operation to improve urinary symptoms. New technology such as lasers, microwaves and heat therapy, do not as yet give such good results and remain experimental. There are tablets that relax the outlet of the bladder called alpha blockers. These tablets do give some improvement for urinary symptoms but need to be taken every day. They are most suitable for men with moderate symptoms which aren t too much bother or for men who would like to avoid an operation. If you have severe symptoms, an operation gives much more effective relief. If your symptoms are mild and do not bother you, it might be best to wait and see how they develop since for most men they either stay the same or even get a bit better. What can I do when I get home? It is important to take things easy for the first two weeks, to drink plenty of fruit, vegetables and fibre. If you strain to lift something heavy or open your bowels you may have some bleeding in your urine. If this occurs, you should rest and drink plenty. After two weeks you can get back to your normal activities, including driving if you have a car. If you have to keep rushing to the toilet you can get some tablets form your doctor that will relax your bladder. If you feel you may have a urine infection you should put a urine sample in to your GP who may decide to give you some antibiotics. How can other questions be answered? If you are concerned about any aspects of your operation you can contact the urology nurse specialist /nurse practitioners at the Queen Elizabeth Hospital- contact numbers are at the end of this information leaflet. Alternatively you can speak to the staff you see at the preadmission clinic or the consultant or deputy when they see you the day before the operation. Your GP will always be happy to give you general advice. Urology nurse contact phone numbers The urology nurses at the Queen Elizabeth Hospital are available to clarify any queries or concerns you may have, either before or after your surgery. They are available Monday to Friday 9am 5pm on the numbers below. Page 5 of 6

6 If we are unavailable there is an answer machine on the first number, if you leave your name address and date of birth, together with your own phone number we will ring you back as soon as possible. We must stress if you experience heavy bleeding, increasing abdominal pain or are unable to pass urine you must contact your GP who will arrange admission to hospital if necessary. Telephone numbers Urology nurse practitioners Mon - Fri 9am 5pm (there is an answer machine available) Urology Secretary Mon- Fri pm Main switchboard bleep 2583 urology nurse practitioners The Patient Advice and Liaison Service (PALS) can provide help, advice and support to patients, relatives or carers who have any questions or concerns regarding their health care. PALS are unable to give medical advice. You can contact PALS on free phone Monday - Friday, 9.00am 5.00pm. An answer phone is available outside of these hours and calls will be returned the next working day. Data Protection Any personal information is kept confidential. There may be occasions where your information needs to shared with other care professionals to ensure you receive the best care possible. In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service Information Leaflet: NoIL327 Version: 1 Title: Trans-urethral resection of prostate or prostatectomy (TURP) First Published: December 2010 Review Date: December 2012 Author: Lorraine Montgomery Urology Nurse Specialist This leaflet can be made available in other languages and formats upon request Page 6 of 6