Indwelling Urethral Catheter – IDC

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Non-invasive placement of a silicone tube which is secured inside the bladder and attached to a drainage bag on the outside, in order to drain an obstructed bladder (urinary retention)

Why is it done?

  • This can be placed as an emergency for patients in acute urinary retention
    • Prostate obstruction
    • Urethral strictures
    • Blood clot obstruction caused by bleeding
    • Hematuria (bleeding)
    • Severe urinary tract infections
  • Commonly placed intra-operatively for long, non-urological surgical procedures to enable urine drainage and monitoring urine output.
  • Commonly placed at the end of a Urological procedure to enable urine drainage and to enable hemostasis (stopping bleeding)

 

How is it done?

  • This is done as a sterile procedure; therefore, the genital area will be cleaned with a non-abrasive disinfectant.
  • A sterile catheter will be used
  • A local anesthetic gel is placed in the urethra a few minutes prior to the placement of the catheter. This may initially sting for a few seconds until it numbs the mucosa.
  • An appropriate size catheter (14-18Fr) will be inserted
  • Urine should be aspirated with a syringe to confirm the correct position in the bladder.
  • An anchoring balloon will be inflated with 10cc of sterile water.
  • A drainage urine bag will be attached
  • The catheter will be secured to your leg. (check that this is always secured)

 

Complications

  • Urethra with resulting discomfort.
  • In the presence of urethral stricture, it may be impossible to pass the catheter, and a flexible cystoscopy with dilatation of the stricture may be required prior to placement.
  • If you had a large over-stretched bladder (urine retention) you may experience bleeding as the bladder empties, caused by the mucosal tears that have occurred.
  • Catheters that have been placed long term, may cause irritation and possibly attract infection. Permanent catheters are usually changed every 6-8 weeks.

 

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Wes Catheters Indwelling Catheter

Copyright 2019 Dr Jo Schoeman

Greenlight Laser Trans Urethral Vaporization of Prostate

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This is an endoscopic technique of enucleation of the prostate using Greenlight laser therapy. Similar to a TURP – “Re-bore” only with minimal bleeding and shorted hospital stays. Some would argue this is ” The new Gold Standard”

Why is it done?

Endoscopic vaporization of a benign enlarged prostate, using laser.

Indications:

  • Patients on anticoagulation / anti-platelet therapy
    • Warfarin needs to be placed on Clexane 7 days prior.
    • Clopidogrel should be down scaled down to Aspirin.
    • This allows patients on anti-coagulation therapy to continue their medication with minimal risk of hemorrhage. It also allows a shorter stay in hospital.
  • Prostates up to 120cc.
  • Where conservative management has failed.
  • Patient choice.
  • This procedure is performed when the prostate gland is enlarged to such an extent that medication cannot relieve the urinary symptoms.
  • Symptoms include: LUTS
    • 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 could have been used for prostates larger than 35-50cc where indicated, with either Duodart, Avodart or Proscar.
  • 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.

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 lignocaine gel.
    • Saline is used to irrigate the bladder, therefore NO DILUTIONAL HYPONATRAEMIA
    • The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
    • A vaporization of the prostate is then started and should take 60-120 minutes depending on the size of the prostate.
    • Prophylactic antibiotics will be given to prevent any infections.
    • Post– operative antibiotics will be continued for 10 days.
    • No specimen will be obtained due to vaporization, unless PSA was suspicious and an MRI with view to prostate biopsy has excluded a prostate cancer.

What can go wrong?

  • Any anesthesia has its risks, and the anesthetist will explain this to you.
  • No blood loss is expected.
  • In rare circumstances you may develop fluid overload requiring a High Care Facility admission, especially with the upper edge of prostate sizes.
  • You will wake up with a catheter in your urethra and bladder. This will remain in the bladder overnight.
  • Lower abdominal discomfort for a few days.
  • NB! Each person is unique and for this reason symptoms vary!

What next?

  • You will spend 1 night in hospital.
  • You will a trial without catheter the next day.
  • You will be discharged as soon as you can completely empty your bladder.
  • You may initially suffer from urge incontinence and dysuria (discomfort) and will improve within the next 6 weeks.
  • You will pass a grey, wet scab at the 2–3-week mark.
  • Some bleeding may be associated with this, especially if you are on anticoagulation therapy.
  • 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 follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
  • 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. Not a given, therefore continue your contraceptives
  • 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 stricturing in <2% of patients, requiring intermittent self-dilatation.
  • Regrowth of prostate lobes can occur 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).

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Wes TUVP Greenlight

Low Dose Brachytherapy

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Perineal placement of Radioactive Iodine-125 seeds in the prostate as treatment for Intermediate-Risk Prostate Cancer

Why is it done?

This is a radiation therapy option for the management of a localized prostate cancer.

Criteria include:

  • PSA less than 10
  • Gleason 3,4 adenocarcinoma prostate,
  • Higher grades may have extra-prostatic extension requiring combined External Beam Radiation
  • Staging negative, (bone scan negative, CT negative)
  • Not younger than 65
  • It is the localized radiation of the prostate, by means of trans-perineal placement of Radio-active I-125 seeds.
  • This is a nerve sparing procedure and patients have a good opportunity to maintain this.
  • The procedure takes 2-3hours excluding the anesthetic time.
  • This is an alternative to a Radical Retropubic Prostatectomy for low-intermediate risk prostate cancer. Prostates are generally smaller than 50cc.
  • Could be ideal for those patients with excessive BMI and fitting the cancer specific criteria.

 

How is it done?

  • Under a General Anaesthetic
  • Presence of Radiation Oncologist and Physicist
  • Lithotomy position
  • Trans-rectal placement of an ultrasound probe
  • Real-time accumulation of digital images to allow real-time placement of Radioactive Iodine seeds according to an intra-operative plan

PSA failure:

  • PSA not dropping to a nadir value, preferably 0,2ng/ml.
  • 3 consecutive PSA rises following RRP.

Complications

  • Perineal hematoma
  • Wound infections
  • Urgency frequency and weak stream
  • Limited Erectile Dysfunction, which may only surface after 18 months after treatment.
  • Lower ejaculate volume.
  • Testicular pain similar to vasectomy for 2-3 days

 

Post operative care:

  • A post-procedure CT scan to account all the seeds and exclude migration of seeds.
  • Normal diet
  • A salt water or Betadine Douche is required after every stool for the first week
  • A 3-month course of Flomaxtra to ease Lower Urinary Tract Symptoms
  • Wounds generally heal in 7-10 days

Catheter care

  • Your catheter will remain until you are awake.
  • Post-operative review:
  • Radio-Oncology will review a few weeks later.
  • You will review with me at 6 weeks post-procedure to check if you are doing fine.
  • Review PSA roughly 3 months after the procedure to assess PSA track
  • You should reach your Nadir (lowest PSA) at 6– 9 months after the procedure. The lower the better.
  • 6 monthly PSAs thereafter.
  • Expect a PSA Bump at approximately 9-12 months after the procedure, The PSA should drop thereafter
  • If stable with good PSA outcomes, refer back to GP for 6 monthly PSA review

 

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Wes Low Dose Brachytherapy

Trans Urethral Resection Prostate (TURP) – Monopolar

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This is the procedure used to resect the inside (enlarged, obstructive part) of the prostate. Known generally as the “Re-Bore”.  Glycine is used as an irrigate.                                                           

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 obstruction,
    • bladder stones,
    • recurrent bladder infections due to retaining urine.
  • Medication such as Flomaxtra, Urorec or Minipress etc. should always be given as a first resort.
  • Step-up therapy could have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar, where indicated and appropriate.
  • 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.

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 irrigant 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.
  • Prophylactic antibiotics will be given to prevent any infections.

 

Complications

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 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 5% 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.

 

Download Information Sheet

Wes TURP Monopolar

Copyright 2019 Dr Jo Schoeman

Focal Therapy for Prostate Cancer – NanoKnife

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Not covered by Medicare / Health Fund yet, possibly early 2026

What is IRE

  • Irreversible Electroporation Therapy—breaking up of cell membranes using electric current by means of creating holes in the cell walls (Nano-pores)
  • Non-thermal ablation

 

Why is it done?

  • Treatment for localized prostate cancer
  • Single focus disease
  • Prostate preserving
  • Ejaculate sparing
  • Continence preserving

 

How is it done?

  • Focal therapy of prostate cancer, usually a single lesion
  • Preferably Gleason 3,4 or more aggressive
  • Preserving prostate supporting tissue and erectile function and continence

You would have had a 3T MRI study possibly a PET PSMA as well prior to confirming your prostate cancer. Usually, whole gland biopsies are taken of the prostate via the perineum to prove unifocal cancer.

  • This procedure is done under general anesthesia as a day procedure and takes approximately 60-90min (incl anesthetic time)
  • It is performed with the patient lying in lithotomy (legs in stirrups) position
  • Prophylactic antibiotics are essential and a script with details is provided on the day of signing consent.
  • A trans-rectal ultrasound is placed
  • 4-5 NanoKnife electrodes are paced approximately 2cm apart surrounding the focal cancer.
  • An electrical current of 3A is run at 800-1331mcs pulse causing a non-thermal ablative technique
  • Total treatment as soon as electrodes are placed is < 5 minutes

 

Complications

Side–effects

  • Hematuria (blood in urine) 2-3days
  • Hematospermia (blood in ejaculate) will become less the more often you ejaculate.
  • Bacteremia (infection) with low-grade fever and feeling unwell
  • Perineal hematoma
  • Perineal pain and penis tip pain
  • Prostate swelling causing bladder outlet obstruction requiring a catheter for up to 5 days

ANY FEVER REQUIRES URGENT ATTENTION

What next?

  • You will be discharged with an indwelling catheter for 3-5 days depending on the size of your prostate and the lesion treated
  • You may have necrotic tissue developing requiring a resection (treatment involving the urethra).
  • Difficulty in urination up to 6 weeks after the procedure
  • It could feel like you are sitting on a golf ball for a week

 

Should there be any signs of fever or cold shivers, you are to return to the hospital or Emergency Department without hesitation

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Wes Nanoknife

Copyright 2019 Dr Jo Schoeman

Prostatic Stent

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Minimal invasive management for the relief of LUTS (lower urinary tract symptoms) or Urinary Retention

Why is it done?

  • This procedure is performed when the prostate gland is causing LUTS and you want an alternative to invasive procedures
  • Symptoms include:
    • a weak stream,
    • nocturia,
    • frequent urination,
    • inability to urinate,
    • Urinary Retention
  • This is alternative to an invasive procedure where long periods of anesthetic are contraindicated.
  • Usually for chronically sick patients who cannot undergo surgery yet are active enough not to want a permanent catheter.
  • Usually, a trial of alpha-blockers would be attempted and Step-up Therapy with 5 Alpha Reductase Inhibitors have been unsuccessful
  • Any prostate size

 

How is it done?

  • Patients will receive sedation with local anesthetic gel placed in the urethra.
  • A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and an irrigate fluid.
  • The measurements of the prostatic urethra are taken (length)
  • Appropriate length coil is chosen.
  • The device is placed through the cystoscopy sheath, to sit snug in the prostate urethra stretching from the bladder neck to the apex of the prostate
  • Prophylactic antibiotics will be given to prevent any infections.

Complications

  • Retrograde Ejaculation
  • Stress incontinence especially in the elderly and diabetic patients
  • Urgency and urge incontinence especially until detrusor hyperactivity dissipate
  • Urge symptoms may persist due to detrusor fibrosis caused by long term bladder outlet obstruction
  • May experience a slower stream initially due to swelling
  • Possible infection due to cystoscopy (<2%)
  • Migration of the device into the bladder, requiring a procedure to retrieve this.
  • Long term yields the risk for encrustation and recurrent infections
  • NB! Each person is unique and for this reason, symptoms vary!

 

Download Information Sheet

Wes UROLUME Urethral Stent

Wes Prostate Stent

Copyright 2019 Dr Jo Schoeman

Radical Perineal Prostatectomy

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Why is it done?

This is the alternate surgical management option for a localized prostate cancer. Widely used in the USA in the early 2000’s prior to robotic assisted surgery.

  • Still a great technique to avoid a frozen abdomen due to multiple previous surgeries
  • Transplanted kidney.
  • Obesity
  • Smaller than 50 cc prostates are better

Criteria include:

  • PSA less than 10.
  • Gleason 3,4 adenocarcinoma prostate.
  • Higher grades with no extra-prostatic extension
  • Staging negative, (bone scan negative, CT negative).
  • 75 years and younger.
  • It is the complete removal of the prostate, seminal vesicles and bladder neck.
  • A nerve sparing procedure is attempted for those guys who have good erections and wish to maintain this.
  • The procedure takes 2-3hours excluding the anesthetic time.

 

How is it done?

    • General anesthetic.
    • You will be placed in hyper-lithotomy.
    • Anus at eye-level.
    • The surgical filed is prepared.
    • A flexible cystoscopy is done to exclude any urethral strictures, bladder cancers and any other pathology.
    • An IDC is then placed.
    • A horseshoe incision is made around the anus.
    • The space in the front part of the rectum is entered and passed under the sphincteric muscle.
    • Dennon Villiers Fascia is cleared and opened in the midline, this brushing the erectile nerves laterally.
    • The urethra is encircled and cut just distal to the prostate sparing the sphincter.
    • The prostate is loosened anteriorly from the dorsal venous complex, thus sparing the complex and avoiding major blood loss (DVC).
    • The anterior bladder neck is opened.
    • The UO identified.
    • The posterior bladder neck cut.
    • The lateral pedicles are clipped.
    • The seminal vesicles and ampullae of the Vas Deferens, the SV are removed and the Vas clipped.
    • The prostate is loosened and removed.
    • The bladder mucosa is everted.
    • The bladder neck reconstructed.
    • The anastomosis with the urethra completed over an Indwelling Catheter.
    • A drain is left.

Complications

  • Blood loss 200-400cc.
  • Wound infections.
  • Wound breakdown.
  • Managed with Betadine sit baths.
  • Stress incontinence which will improve over the next 12 months (12%).
  • Complete incontinence at 12 months (2%).
  • Erectile dysfunction (40-50%) where a nerve sparing procedure has been performed. It may take 12-18 months to recover.
  • Anejaculation/ Infertility.
  • Testicular pain similar to vasectomy for 2-3 day.

Post operative care:

  • Sutures are dissolvable and will not be required to be removed.
  • Normal diet.
  • A salt water or Betadine Douche is required after every stool for the first week.
  • Apical wound dehiscence can occur in 7% which requires extra care in the form of prolonged Salt water or Betadine Douches.
  • Wounds generally heal in 7-10 days.

Post-operative review:

  • Your catheter will remain for 10-14 days.
  • Only after a cystogram (radiological investigations where radio-opaque contrast is placed in the bladder) confirms no leakages from the bladder-urethra-anastomosis, will the catheter be removed.
  • Should there be any urine leakages on the cystogram, the catheter may remain another 7 days.
  • Review PSA roughly 6 weeks after the surgery to assess post-operative Nadir.
  • Review in rooms a week later.
  • 3-6 monthly review depending on risk factors.
  • If stable with good PSA outcomes, refer back to GP for 6 monthly PSA review.
  • You will be referred to a Men’s Health Physician to assist with erectile function recovery – erections can take as long as 18 months to recover
  • Continue your pelvic physiotherapy

PSA failure:

  • PSA never dropping to undetectable with positive margins in histology.
  • 3 consecutive PSA rises following RRP.

 

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Wes Prostatectomy Radical (Perineal)

Radical Retropubic Prostatectomy – Open

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Why is it done?

This is the surgical management option for a prostate cancer which fits all the criteria set out by the Urology Society of Australia for Surgery.

Largely been replaced by the robotic technique.

Indication:

  • PSA less than 20
  • Gleason 3,4 to low volume Gleason 4,5 contained adenocarcinoma prostate.
  • Higher grades may be considered with patients fully informed of the positive margins and need for adjuvant radiation therapy. See D’Amico criteria in terminology. These patients will be counselled about multiple therapy approach which may involve salvage radiation therapy.
  • Staging negative, (bone scan negative, CT negative).
  • 75 years and younger.
  • It is the complete removal of the prostate, seminal vesicles and bladder neck.
  • It may include a bilateral pelvic lymphadenectomy. (Gleason 4,3 and higher)
  • A nerve sparing procedure is attempted for those guys who have good erections with no tumour infiltrating the erectile nerves.
  • The procedure takes 2-3hours excluding the anesthetic time.

PSA failure:

  • PSA never dropping to undetectable with positive margins in histology
  • 3 consecutive PSA rises following RRP

How is it done?

  • General anesthetic.
  • The surgical filed is prepared
  • A flexible cystoscopy is done to exclude any urethral strictures, bladder cancers and any other pathology.
  • An IDC is then placed.
  • A midline lower abdominal incision is made.
  • The retropubic space of Retzuis is entered.
  • Endopelvic fascia is cleared and opened exposing the lateral sides of the prostate.
  • The urethra is cut just distal to the prostate sparing the sphincter.
  • The ‘Veil of Aphrodites’ is loosened from the prostate sparing the neuro-vascular bundle.
  • The prostate is lifted off the rectal bed.
  • The lateral pedicles are tied.
  • Dennon Villiers fascia is opened to expose the Seminal Vesicles and ampullae of the Vas Deferens, the SV are removed and the Vas clipped.
  • The prostate is loosened from the bladder neck.
  • Prostate is removed.
  • The bladder mucosa is everted.
  • The bladder neck reconstructed with a Rocco repair.
  • The anastomosis with the urethra completed over an Indwelling Catheter.

Obturator nodes may be removed depending on the D’Amico Risk category. (Controversial)

Complications

  • Blood loss 400-1200cc.
  • Wound infections.
  • The first 6 weeks are the worst with frequency and urgency as a result.
  • Stress incontinence may occur and will improve over the next 12 months (12%).
  • Complete incontinence at 12 months (2%).
  • Erectile dysfunction (40-50%) where a nerve sparing procedure has been performed yet may improve over the next 18 months.
  • Bladder neck stenosis 5 % requiring intermittent self-dilatation.
  • Anejaculation/ Infertility.
  • Testicular pain similar to vasectomy for up to a week.

Post operative care:

  • Sutures are subcutaneous and will be dissolved.
  • You will have a drain in the wound for 24-48 hours until it drains less than 30ml / 24 hours.
  • You spend your first 24 hours in a High Dependency Unit.
  • Normal diet will be commenced.

Catheter care

  • Your catheter will remain for 10-14 days.
  • Only after a cystogram (radiological investigations where radio-opaque contrast is placed in the bladder) confirms no leakages from the bladder-urethra-anastomosis, will the catheter be removed.
  • Remember you will leak initially, with gradual improvement up to 6 weeks post-operatively.
  • Nursing staff will teach you catheter care.
  • Your catheter should always be fixed to your leg with a catheter dressing.

Post-operative review:

  • Cystogram at 10 days post-operatively to assess complete healing of urethra bladder neck anastomosis to exclude any leakages.
  • Should there be any leakages, the catheter may remain another 7 days.
  • Review PSA roughly 6 weeks after the surgery to assess post-operative Nadir.
  • Review in rooms a week later.
  • 6 monthly reviews depending on risk factors.
  • If stable with good PSA outcomes, refer back to GP for 6 monthly PSA review.
  • You will be referred to a Men’s Health Physician to assist with erectile function recovery – erections can take as long as 18 months to recover
  • Continue your pelvic physiotherapy

 

Download Information Sheet

Wes Radical Retropubic Prostatectomy -Open

Simple Prostatectomy – Robotic Assisted Enucleation

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Robotic assisted enucleation of the prostate adenoma.

  • For those large benign prostates where a TURP would be too time consuming, and too dangerous.
  • Generally, prostates over 150cc.

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.
  • Your prostate is larger than 120 cc
  • Symptoms include: LUTS
    • 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, Xatral 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 and can be used as a first line in these huge prostates.
  • Conservative management with medication has failed
  • Doing transurethral resection may take excessively long causing side-effects to your urethra as well as risk of irrigation fluid being reabsorbed in your vascular system leading to increased cardiac load
  • You may be at risk for electrolyte disturbances with a transurethral resection of the prostate when Glycine is used
  • You have BPH—benign prostate enlargement
  • Prostate cancer has been 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 staged-TURP can also be performed to dis-obstruct a huge prostate. Either Bipolar resection or Laser can be utilized.
  • Patient informed decision is vital.
  • It provides a quicker solution with more marked side-effects and risks.

How is it done?

  • Patients will receive a general anesthesia, unless contra-indicated.
  • Prophylactic anti-biotics is given.
  • A Flexible cystoscopy is done to exclude any urethral strictures, bladder cancers and any other pathology
  • An IDC is then placed
  • A Camera port is placed above the Umbilicus
  • 3 Additional ports for robotic arms in a horizontal line on the abdomen with 2 assistant ports on the right side of the abdomen
  • The abdominal space is entered and the bladder dropped from the abdominal wall.
  • Bladder opened at the dome as the prostate will be removed through the bladder
  • Bladder neck opened
  • Prostate adenoma enucleated
  • Haemostasis
  • Trigonalization of bladder, bladder pulled down into prostate cavity
  • Catheter replaced
  • Drain placed if required

What next?

  • You will spend up to 5-7 nights in hospital.
  • You will have a catheter for that time.
  • A drain for 2-3 days.
  • You will a trial without the catheter on the 5th day.
  • You will be discharged as soon as you can completely empty your bladder.
  • You may initially suffer from urge incontinence and dysuria (irritable voiding) 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. Remember there is no pathology due to vaporisation.
  • Don’t hesitate to ask Jo if you have any queries.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Side-effects

  • Blood loss requiring blood transfusion.
  • Infection.
  • Prolonged hospital stays.
  • 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.
  • Less chance of growth of prostate lobes usually 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.

 

Download Information Sheet

Wes RA-Enucleation Prostatectomy BPH

 

Rezum Water Vapor Therapy

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Minimal invasive management for the relief of LUTS (lower urinary tract symptoms)

Why is it done?

  • This procedure is performed when the prostate gland is causing LUTS and you want an alternative to medication without the complications of a permanent procedure.
  • Symptoms include (LUTS):
    • a weak stream,
    • nightly urination,
    • frequent urination,
    • inability to urinate,
    • kidney failure due to the obstruction,
    • bladder stones,
    • recurrent bladder infections.
  • Medication such as Flomaxtra, Urorec Minipress etc. should always be given as a first resort. All have side effects that you may not like.
  • This is alternative to medication where the ejaculatory function is to be preserved.
  • 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. Prostate sizes up to 80 cc, even mid lobe are acceptable

 

How is it done?

  • Patients will receive 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 irrigant (fluid).
  • The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
  • The device is placed through the cystoscopy sheath.
  • Prostate lobes are injected with water vapor, 2-6 injections 10 seconds each
  • Prophylactic antibiotics will be given to prevent any infections.
  • Any anesthesia has its risks, and the anesthetist will explain this to you.
  • You will require an indwelling urinary catheter for 5-10 days depending on the size of your prostate
  • Lower abdominal discomfort for a few days
  • Could have an inflammatory response requiring antibiotics.
  • Discomfort in urination can last 6 weeks.
  • Full results will be experienced at 3 months

 NB! Hang in there, it is worth it! Each person is unique and for this reason, symptoms vary!

Complications

  • Ejaculation will mostly not be affected as is the case with medication, TURP and TUVP, therefore no retrograde ejaculation, thus preserving sexual function,
  • In a small % of cases the bladder neck is treated, there may be retrograde ejaculation, this will be discussed with you.
  • Infertility should not be an issue as there is no retrograde ejaculation. Don’t do it if you still want children.
  • You will be discharged with a catheter.
  • A trial of void (removal catheter) will be scheduled 5-10 later as soon as the major swelling has gone down
  • Larger prostates may fail and require the catheter for a further 5 days.
  • Suprapubic pain will improve over the next 7 days.
  • No Stress incontinence especially in the elderly and the diabetic patients
  • You may experience a slower stream initially due to swelling
  • Some urgency and dysuria for 6 weeks
  • Possible infection due to avascular / necrotic tissue
  • You will pass the hemolyzed dead tissue in the form of brown discolored fluid at the 14-day mark.
  • Allow for 6 weeks for stabilization of symptoms thereafter.
  • There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
  • A follow-up appointment will be scheduled for 6 weeks.
  • The full extent of this procedure will only appreciated at 3 months.

 

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Wes REZUM Therapy

Copyright 2019 Dr Jo Schoeman