• Reference Number: HEY-461/2021
• Departments: Urology
• Last Updated: 11 June 2021

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Why do I need this procedure?

The prostate gland is situated at the base of the bladder. The tube through which you pass your urine, known as the urethra passes through your prostate gland.  Many men over the age of 50 will experience some degree of prostate enlargement. You have probably been troubled by some symptoms such as feeling you are not emptying your bladder properly, getting up more often in the night to pass urine, a weak stream or trouble in passing your urine.  You may also have been taking medication to relax your prostate which no longer seems to be as effective.

Following discussion with your consultant he has advised that an operation on your prostate gland is necessary to improve these symptoms. If you do not have the surgery then your symptoms may continue to worsen meaning your urethra becomes completely obstructed by your prostate and urine is unable to pass.

What is a trans-urethral resection of the prostrate (TURP)?

You will receive a full general anaesthetic or less commonly a spinal anaesthetic (where you are awake but unable to feel anything from the waist down). A telescopic instrument is passed into the bladder via your penis and the central part of the prostate is removed.  The prostate fragments are evacuated and sent for analysis.  A urinary catheter will be inserted as a temporary measure after the procedure to help your bladder empty itself of urine.  The procedure usually takes 45 – 60 minutes.

Can there be any complications or risks?

All operations requiring an anaesthetic carry with them a small chance of complications. Every care is taken to keep the risks as low as possible.

 Common side effects (greater than 1 in 10 men may experience)

• Temporary mild burning, bleeding and frequency of urination following the procedure
• No semen is produced during an orgasm
• Poor erections (impotence in 1 in 14 people)
• Infection of the bladder, testicles or kidney requiring antibiotics
• Bleeding requiring return to theatre and/or blood transfusion
• Possible need to repeat treatment later due to re-obstruction
• Injury to the urethra causing delayed scar formation

Occasional (between 1 in 10 and 1 in 50 men may experience)

• Finding unsuspected cancer in the removed tissue which may need further treatment
• Failure to pass urine after surgery requiring a new catheter
• Loss of urinary control (incontinence) which may be temporary or permanent (1 to 4 men in 100)

How do I prepare for the TURP?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.  Leaflets are available to relatives and visitors containing useful information on the ward.

Smoking

If you are a smoker, it would benefit you greatly to stop smoking or cut down before you have your operation. If you need further information about stopping smoking please contact:

• Your doctor
• Smokefree National Helpline: 0300 123 1044
• nhs.uk/live-well/quit-smoking/nhs-stop-smoking-services-help-you-quit/
• smokefree.nhs.uk/

Pre-assessment

You will attend a pre-assessment appointment 1 – 3 weeks before your surgery which will give you an opportunity to discuss your surgery with a nurse and ask any questions you may have. The nurse will also take some general information from you and perform some routine checks such as blood pressure and pulse rate, some blood tests and swabs.  You may also undergo some other routine tests such as a heart tracing and chest X-ray.  This is to ensure that you are well enough to have your surgery.  The nurse will also inform you if you need to stop taking any medications in the days prior to your surgery such as clopidodrel or warfarin and also which medications you should continue to take before your surgery.  You will also receive instructions asking you not to eat or drink anything before your operation.  Usually you can expect to eat up until six hours before your operation and drink clear fluids up until two hours before your operation.

Preparing for your discharge home

The anticipated length of stay in hospital for your operation is 2 – 3 days. This is not to say that you will be in hospital for this amount of time, it may mean that you need to stay longer than this, or, you may recover more quickly than this and require less time in hospital.  When you are admitted to the ward, the nurse will give you an expected date of discharge.  You will be seen by the surgical team on a daily basis who will decide when you are well enough to go home. When a discharge date is agreed you can expect, in most cases, to be discharged home from hospital by late morning.  However, sometimes if we are still waiting for some medication for you to be supplied, you may be asked to wait for this in the dayroom or discharge lounge.

Medication

You will need to bring with you all the medication that you are currently taking. You will also need to arrange a 28 day supply of your usual medication ready for when you get home. The nurse will also check you have the right medication to go home with and give you information about your medicines.  You may have been given some pain relief medication to take home (if not, take mild pain relief medication such as you might take for a headache).

What will happen?

You will usually be admitted on the day of surgery. This may be to the Surgical Admissions Lounge where you will be prepared for your surgery and transferred to the ward following your operation or you may be admitted directly to the ward. You will receive written information about this.  You will need to bring nightwear and slippers with you.

Please read the patient information file available for you at your bedside which contains useful information about your hospital stay.

Before your operation you will be given a surgical gown to wear and fitted with support stockings to help reduce the risk of blood clots.

After your operation

• Following your TURP you will wake up in the recovery area before returning to the ward. Most patients will be cared for in the main ward but if the surgeon or anaesthetist feels you need closer observation then you may be nursed in the High Observation Bay on the ward.
• You may be very sleepy and be given oxygen through a clear face mask to help you breath comfortably after your operation.
• The surgeon will have placed a catheter in your bladder to drain your urine. It is normal for the prostate to bleed following surgery and the catheter will enable the bladder to be continually irrigated, flushing any small clots out. It is very common to experience the need to urinate whilst the catheter is in and this is normal.  However if this sensation becomes painful or too uncomfortable you must inform the nurse who is looking after you. Most catheters will be removed within 1 – 2 days of surgery.
• You may be attached to an intravenous infusion also know as a ‘drip’ to keep you hydrated. You will be able to eat and drink as soon as you feel able.
• Your nurse will check with you on a regular basis to assess your need for pain relief. Please inform the nurse at any time if you are experiencing pain so that you can be kept as comfortable as possible.
• Your blood pressure, pulse, oxygen levels and temperature will be checked regularly.
• You will need to stay in bed for at least six hours to ensure that the bleeding from your prostate has settled down. As soon as it is safe for you to do so, you will be encouraged to get out of bed and gently mobilise. This will help your recovery and help to prevent complications such as chest infections and blood clots.
• The surgeon who performed your surgery will visit you afterwards on the ward. Each day that you are in hospital a consultant and team of doctors will review your care.

Recovering at home

When can you get back to normal?

• It is normal to feel tired for a week or two. Strenuous exercise (such as cutting the grass) or heavy lifting should be avoided for a month following surgery. You should gradually build up the amount of exercise you do over this time.
• You should continue to drink about two litres of fluid per day to help flush away any debris and prevent urine infections.
• Your urine will be slightly blood stained for a few days, this will clear but you may then start to bleed again after a week to 10 days. This may be due to a water infection or just the ‘scab’ breaking down after the internal wound has healed. Increase your fluid intake for a few days. If it does not improve or gets worse please contact your doctor for an appointment or contact the Urology Department on the number below for advice.
• Make sure you eat plenty of fruit and vegetables in your diet to avoid constipation. Straining on the toilet may cause you to bleed, so you should take laxatives if you do become constipated.
• It can take up to three months for your urinary symptoms to settle down. Initial post-operative symptoms such as an urgent desire to urinate or slight leakage of urine at times should eventually subside.
• Occasionally some patients may need to go home with a catheter for a few weeks. You will be given a booklet about this and taught how to care for your catheter yourself. A district nurse will be arranged to visit you at home. We will also arrange a further appointment to have your catheter removed at our clinic.
• Sexual Intercourse should be avoided for three weeks after surgery as it may induce bleeding. This may then be resumed when you are comfortable.
• You are at increased risk of developing venous thromboembolism (blood clots) in the weeks following your hospital admission. It will help reduce the risk if you keep active. If your calf becomes swollen, red and painful or if you should experience chest pains or difficulty in breathing you must seek immediate medical advice either by telephoning the ward on which you were a patient, call the NHS 111 service, or contact your doctor. Alternatively you can attend the hospital Emergency Department.

Please make sure that you read the leaflet given to you ‘Venous Thromboembolism (VTE) – Reducing the risk’ carefully in the patient information pack at the side of your hospital bed.

Driving after surgery

It is your responsibility to ensure that you are fit to drive following your surgery. However you should refrain from driving for at least two weeks following this surgery. Your hospital doctors will be happy to provide you with advice on request.

The nurse discharging you from hospital will check that you understand the advice given to you in this leaflet. The nurse will also check you have the right medication to go home with and give you information about your medicines.  You will also be given an Immediate Discharge Letter which is a summary of your hospital visit.  This will include details about further appointments that have been made following your surgery.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Department of Urology (01482) 623015

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.