SURGICAL MANAGEMENT of bph

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TURP is an operation to treat prostate enlargement due to BPH. This is a minimally invasive procedure. Mr Aw uses a special telescope that is passed through the urethra, to slowly bore a channel in the middle of the prostate and remove them in chips to relieve the blockage. The tissues are analysed in the laboratory, and Mr Aw will discuss the results and assess your flow after the procedure.  

Risks

• Bleeding: it is very common to have some bleeding for 4-6 weeks as the lining of the urethra and prostate heals
• Inability to pass urine: after the TURP, we will ensure that you are emptying your bladder well before you are discharged
• Swelling after surgery may cause a temporary inability to pass urine, and you may require a temporary re-insertion of the catheter
• Infection: this occurs in less than 5% of cases
• Retrograde ejaculation: this is an expected outcome in 70% of cases. This means during ejaculation semen will pass into the bladder instead of passing out of the penis. The semen will be expelled the next time you empty your bladder
• Urinary irritation and incontinence: irritation of the lining to urine may cause urinary urgency, and some men may even have some incontinence. For most this resolves after a short period. Long-term incontinence rarely occurs, in less than 1% of cases
• Regrowth of prostate: the prostate may regrow, and this may require further treatment in the future
• Unexpected finding of prostate cancer: the prostate tissues are sent to the laboratory, and occasionally we may detect prostate cancer. This may require further investigations at your next follow-up visit
• Fluid absorption and electrolyte imbalance: this is rare and usually limited to very large prostates. Modern technology with bipolar saline limits the risk.

Preparing for your surgery

If you are advised that you are undergoing surgery, please inform the clinic if you are taking blood thinning medications.

Recovery after your surgery

You will have a catheter with gentle irrigation connected after the procedure. You will most likely stay in the hospital for one to two nights.  Dr. Ivan Aw will determine this based on the size of your prostate and findings during the procedure. The catheter will be removed and the nurse will check that you are emptying your bladder well before you go home. You should hydrate yourself well. Avoid any heavy lifting or straining when going to the toilet as this can increase the bleeding risk. If needed, you should take laxatives so you do not need to strain. 

You will receive a follow-up appointment from the clinic around 6 weeks, to check your bladder emptying and discuss the prostate samples that were sent for analysis. If you do not receive an appointment, please call the clinic on (08) 6317 3464.

When should I be concerned?

There are some things to look out for as you recover after your surgery. These include symptoms like:

• Unable to pass urine
• Passing large clots in urine
• Fever with temperature >38 degrees
• Have not received follow up appointment

If any of the above symptoms occur, please contact the clinic on (08) 6317 3464 during the hours of 9am – 5pm, Monday to Friday.  For medical emergencies after hours, go to your local emergency department. 

This is a less invasive option for the treatment of BPH. Through a special telescopic instrument inserted into the urethra, Mr Aw will make an incision in the prostate to release the tension and un-obstruct the passage of urine flow from the bladder.

This procedure is ideal for men with small prostates. Younger men may also benefit from this as there is less risk of sexual dysfunction and retrograde ejaculation.

Risks

• Bleeding: it is very common to have some bleeding for 4-6 weeks as the lining of the urethra and prostate heals
• Inability to pass urine: we will ensure that you are emptying your bladder well before you are discharged
• Swelling after surgery may cause a temporary inability to pass urine, and you may require a temporary re-insertion of the catheter
• Infection: this occurs in less than 2% of cases
• Retrograde ejaculation: this is an expected outcome in 30% of cases. This means during ejaculation semen will pass into the bladder instead of passing out of the penis. The semen will be expelled the next time you empty your bladder
• Urinary irritation and incontinence: irritation of the lining to urine may cause urinary urgency, and some men may even have some incontinence. For most this resolves after a short period. Long-term incontinence rarely occurs, in less than 1% of cases
• Regrowth of prostate: the prostate may regrow, and this may require further treatment in the future

Preparing for your surgery

If you are advised that you are undergoing surgery, please inform the  clinic if you are taking blood thinning medications. 

Recovery after your surgery

You will have a catheter with gentle irrigation connected after the procedure. You will most likely stay in the hospital for one night.  The catheter will be removed and the nurse will check that you are emptying your bladder well before you go home. You should hydrate yourself well. Avoid any heavy lifting or straining when going to the toilet as this can increase the bleeding risk. If needed, you should take laxatives so you do not need to strain. 

You will receive a follow-up appointment from the clinic around 6 weeks, to check your bladder emptying and discuss the prostate samples that were sent for analysis. If you do not receive an appointment, please call the clinic on (08) 6317 3464. 

When should you be concerned?

There are some things to look out for as you recover after your surgery. These include symptoms like: 

• Unable to pass urine
• Passing large clots in urine
• Fever with temperature >38 degrees
• Have not received follow up appointment

If any of the above symptoms occur, please contact the clinic on (08) 6317 3464 during the hours of 9am – 5pm, Monday to Friday. For medical emergencies after hours, go to your local emergency department.    

Urolift is a minimally invasive procedure. Implants are permanently placed to lift and hold the enlarged lobes apart to increase the opening of the urethra. This procedure does not involve diathermy or removal of any prostatic tissues. This may also be a suitable option for men wanting to preserve their ejaculatory function.  

Preparing for your surgery

Mr Aw will assess your suitability for this procedure, and may need to perform a cystoscopy prior to assess your prostate size and anatomy. If you are advised that you are undergoing surgery, please inform Mr Aw’s clinic if you are taking blood thinning medications. Some may be safely continued throughout the procedure 

Recovery after your surgery

Urolift can be done as a day case. You will receive an appointment in 4 weeks to assess your urinary flow. If you do not receive an appointment, please call the clinic on (08) 6317 3464.

When should you be concerned?

There are some things to look out for as you recover after your surgery. These include symptoms like:

• Unable to pass urine
• Passing large blood clots in urine
• Fever with temperature >38 degrees

If any of the above symptoms occur, please contact the clinic on (08) 6317 3464 during the hours of 9am – 5pm, Monday to Friday. For medical emergencies after hours, go to your local emergency department.