Trans Urethral Resection Prostate (TURP) – Bipolar

Why is it done?

• This procedure is performed when the prostate gland is enlarged to such an extent that medication cannot relieve the urinary symptoms.
• Symptoms include:
  • a weak stream,
  • nightly urination,
  • frequent urination,
  • inability to urinate,
  • kidney failure due to the weak urination (obstruction),
  • bladder stones,
  • recurrent bladder infections.
• Medication such as Flomaxtra, Urorec or Minipress etc. should always be given as a first resort.
• Step-up therapy should have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar, where indicated at this can cause a loss of libido.
• Prostate cancer first needs to be ruled out by doing a PSA, and when indicated, with a 3T MRI scan of the prostate with an abnormal PSA with a possible prostate biopsy of any suspicious lesions.
• A channel-TURP can also be performed to dis-obstruct a severe prostate cancer, to allow a normal urination process.

How is it done?

• Patients will receive a general anesthesia, unless contra-indicated.

• A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and an irrigate (fluid).
• The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
• A resection of the prostate is then started and should take 60-90 minutes.
• Saline is used as irrigation fluid
• Prophylactic antibiotics will be given to prevent any infections.

What can go wrong?

• Any anesthesia has its risks and the anesthetist will explain this to you.
• You may in extreme cases experience blood loss, which may require a blood transfusion. (<1%)
• Please inform the practice and the hospital if you are a Jehova’s witness and cannot use blood products.
• A TURP Syndrome is rare.
• You will wake up with a catheter in your urethra and bladder. This will remain in the bladder for 3 days.
• You will have a continuous bladder irrigate with Saline running in and out of your bladder to prevent clot formation.
• Lower abdominal discomfort for a few days.
• NB! Each person is unique and for this reason symptoms vary!

What next?

• You will spend 3-5 days in hospital.
• You will a trial without catheter as soon as your urine is clear (day 3).
• You will be discharged as soon as you can completely empty your bladder.
• You may initially suffer from urge incontinence and will improve within the next 6 weeks.
• Allow for 6 weeks for stabilization of symptoms.
• There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
• A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
• A follow-up appointment will be scheduled for 6 weeks. Should your pathology be worrisome, you will be contacted for an earlier appointment.
• Don’t hesitate to ask Jo if you have any queries.
• DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Side-effects

• Retrograde ejaculation in more than 90% of patients. Therefore, if you have not completed your family, this procedure is not for you unless absolutely necessary.
• Infertility as a result of the retrograde ejaculation.
• Stress incontinence especially in the elderly and the diabetic patients
• Patients with Multiple Sclerosis, Strokes and Parkinsons have a higher risk of incontinence and risks should be discussed and accepted prior to surgery.
• Urethral structuring in 2-3% of patients, requiring intermittent self-dilatation.
• Regrowth of prostate lobes within 3-5 years requiring a second procedure.
• NB! Each person is unique and for this reason symptoms vary!

Remember

You still have a peripheral zone of your prostate and regular PSA reviews are required up to the age of 75.

(This could be seen as controversial).

Download Information Sheet

Wes TURP Bipolar Saline