Prostate Surgery – Page 6 – Dr. Jo Schoeman

Non invasive opening of an abscess found in the prostate, Very similar to a TURP with the exception that the bladder neck is preserved

This procedure is performed when you have been diagnosed with a prostatic abscess, usually after an MRI investigation.
You would have had a history of swinging low to high grade fevers, a history of catheterization or instrumentation.
Not improving on antibiotics.
You may possibly be very sick with High Dependancy Unit (HDU) admission on intravenous antibiotics.
This procedure is done where the abscess or fluid collection in the parenchyma of the prostate is in the transitional zone of the prostate and easily accessible via endoscopic technique.
It is done under a general anaesthetic with prophylactic antibiotics in place, or appropriate Antibiotics as per your serum cultures.

Patients will receive a general Anaesthesia unless otherwise indicated.
A cystoscopy is performed by placing a camera in the urethra with the help of lignocaine gel.
The inside of the prostatic urethra and bladder is viewed for pathology and especially signs of the abcess. If any suspicious lesions are seen, a biopsy will be taken.
The area of the prostatic urethra above the abcess is resected until the abcess is opened and drained.
The bladder neck and urethral sphincter is preserved.
Laser can also be utilized and is probably preferred due to lack of bleeding.
Prophylactic antibiotics will be given to prevent any infections.

Any anaesthesia has its risks and the anaethiatist will explain this to you.
You will wake up with a catheter in your urethra and bladder. This will remain in the bladder for 1-3 days depending on the technique used and incidence of post-operatve bleeding. And until signs of sepsis have cleared.
You may have a continuous bladder irrigate running in and out of your bladder to prevent clot formation until the urine clears.
Lower abdominal discomfort for a few days.
NB! Each person is unique and for this reason symptoms vary!

You will be hospitalized until all signs of sepsis have cleared.
You will a trial without catheter as soon as your urine is clear.
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.
You may have a change in ejaculate volume and could even suffer retrograde ejaculation.
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. Should your pathology be worrisome, you will be contacted for an earlier appointment.
DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

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Wes TUR Deroofing of Prostate Abscess

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

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:
- 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.
This is an 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.
Usually, a trial of alpha-blockers would be attempted
Prostate sizes up to 80-100 cc with NO mid lobe.

Patients will receive general anesthesia.
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.
The device is placed through the cystoscopy sheath.
Prostate lobes are drawn apart similar to opening a curtain.
Occasionally a Bladder Neck Incision may be done if the bladder neck is too narrow.
Prophylactic antibiotics will be given to prevent any infections.

Side–effects

Ejaculation will not be affected as with medication, TURP and TUVP, therefore no retrograde ejaculation, thus preserving sexual function.
Fertility is not guaranteed. If it is an issue, DON’T DO IT!
Some urinary urge symptoms especially in the first 6 weeks.
May experience a slower stream initially due to swelling
Some urgency symptoms.
Possible infection due to cystoscopy (<2%)
Rare cases of stone formation on clips.
Further enlargement of prostate lobes within 3-5 years requiring a definite procedure.
NB! Each person is unique and for this reason, symptoms vary!

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Wes UROLIFT

Trans Urethral De-Roofing of Prostate Abscess