Transurethral Resection of the Prostate (TURP)

Recovery After Surgery in the Hospital

The amount of time necessary to stay in the hospital depends on the type of surgery that was performed and how quickly a person recovers.

At the end of surgery, a special catheter is inserted through the opening of the penis to drain urine from the bladder into a collection bag. Called a Foley catheter, this device has a water-filled balloon on the end that is put in the bladder, which keeps the catheter in place.

This catheter is usually left in place for several days. Sometimes, the catheter causes recurring painful bladder spasms the day after surgery. These spasms may be difficult to control, but they will eventually disappear.

Many doctors start giving antibiotics before or soon after surgery to prevent infection.

After surgery, it is common to notice some blood or clots in the urine as the wound starts to heal. If the bladder is being irrigated (flushed with water), the urine often becomes red once the irrigation is stopped. Some bleeding is normal; it usually clears up by the time most people leave the hospital. During recovery, it is important to drink a lot of water (up to 8 cups a day) to help flush out the bladder and speed healing.

Recovery in the first few weeks at home

Many doctors advise taking it easy the first few weeks after getting home. Even though the pain goes away, the incision takes longer to heal—even with transurethral surgery, where the incision can't be seen. Since many people try to do too much at the beginning and then have a setback, it is a good idea to talk with a doctor before resuming a normal routine. During this initial period of recovery at home, it is important to avoid any straining or sudden movements that could tear the incision. Here are some guidelines:

• Continue drinking a lot of water to flush the bladder.
• Avoid straining when having a bowel movement.
• Eat a balanced diet to prevent constipation. If constipation occurs, doctors often prescribe laxatives.
• Do not do any heavy lifting.
• Do not drive or operate machinery.

Expected Outcome

Even though most people feel much better by the time they leave the hospital, it will probably take a couple of months for to heal completely. During the recovery period, the following are some common problems that can occur.

Problems Urinating

The urinary stream may be stronger right after surgery, but it may take awhile to urinate completely normally again. After the catheter is removed, urine will pass over the surgical wound on the prostate. This may initially cause some discomfort or a sense of urgency when urinating. This problem gradually lessens, and after a couple of months most people are able to urinate less frequently and more easily.

Incontinence

As the bladder returns to normal, many people have some temporary problems controlling urination, but long-term incontinence rarely occurs. Doctors find that the longer problems existed before surgery, the longer it takes for the bladder to regain its full function after the operation.

Bleeding

In the first few weeks after transurethral surgery, the scab inside the bladder may loosen, and blood may suddenly appear in the urine. Although this can be alarming, the bleeding usually stops with a short period of resting in bed and drinking fluids. However, if the urine is so red that it is difficult to see through or if it contains clots or if it is accompanied by a feeling of discomfort, it is important to contact a doctor.

Sexual Function After Surgery

Many men worry about whether surgery for BPH will affect their ability to enjoy sex. Some sources state that sexual function is rarely affected, while others claim that it can cause problems in up to 30% of cases. However, most doctors say that even though it takes awhile for sexual function to return fully, with time, most men are able to enjoy sex again.

Complete recovery of sexual function may take up to one year, lagging behind a person's general recovery. The exact length of time depends on how long BPH surgery was done after symptoms appeared. It also depends on the type of surgery that was done. Following is a summary of how surgery is likely to affect the following aspects of sexual function.

Erections

Most doctors agree that if a man was able to maintain an erection shortly before surgery, he will probably be able to have erections afterward. Surgery rarely causes a loss of erectile function. However, surgery cannot usually restore function that was lost before the operation.

Ejaculation

Although most men are able to continue having erections after surgery, a prostate procedure may make them sterile (unable to father children) by causing a condition called retrograde ejaculation or dry climax.

During sexual activity, sperm from the testes enters the urethra near the opening of the bladder. Normally, a muscle blocks off the entrance to the bladder, and the semen is expelled through the penis. However, the coring action of prostate surgery cuts this muscle as it widens the neck of the bladder. Following surgery, the semen takes the path of least resistance and enters the wider opening to the bladder rather than being expelled through the penis. Later it is harmlessly flushed out with urine. In some cases, this condition can be treated with a drug called pseudoephedrine, found in many cold medicines, or imipramine. These drugs improve muscle tone at the bladder neck and keep semen from entering the bladder.

Orgasm

Most men find little or no difference in the sensation of orgasm, or sexual climax, before and after surgery. Although it may take some time to get used to retrograde ejaculation, most people eventually find sex as pleasurable after surgery as before.

Many people have found that concerns about sexual function can interfere with sex as much as the operation itself. Understanding the surgical procedure and talking over any worries with the doctor before surgery often help men regain sexual function earlier. Many men also find it helpful to talk with a counselor during the adjustment period after surgery.

Further Treatment

In the years after surgery, it is important to continue having a rectal examination once a year and to have any symptoms checked by a doctor.

Since surgery for BPH leaves behind a good part of the gland, it is still possible for prostate problems, including BPH, to develop again. However, surgery usually offers relief from BPH for at least 15 years. Only 10% of the men who have surgery for BPH eventually need a second operation for enlargement. Usually these are men who had the first surgery at an early age.

Sometimes, scar tissue resulting from surgery requires treatment in the year after surgery. Rarely, the opening of the bladder becomes scarred and shrinks, causing obstruction. This problem may require a surgical procedure similar to transurethral incision. More often, scar tissue may form in the urethra and cause narrowing. The doctor can solve this problem during an office visit by stretching the urethra.