What is the prostate gland?
The prostate is part of the male genitourinary tract, located just below the bladder neck. It plays a specific role in the reproductive process, producing proteins in the ejaculate that aid the survival of spermatocytes.
Prostatic enlargement is a natural part of aging, with most men older than sixty years experiencing lower urinary tract symptoms due to prostatic obstruction at some point. This may lead to frequent or poor urinary flow, urinary tract infections, bladder stones and/or renal failure.
The initial management of benign enlargement of the prostate (BPH) is medical treatment with alpha-blockers and/or 5 alpha reductase inhibitors. In cases of persistent or worsening symptoms despite medical treatment, surgical management is required.
What are the surgical options?
Surgical management include transurethral resection of the prostate (TURP), transurethral enucleation of the prostate (TULEP), or open removal of the obstructing adenoma (rarely performed for very large prostates). If bladder stones are also present surgery will include concomitant removal.
1. Usually performed under spinal anaesthesia
2. Prophylactic antibiotics will be administered
- Remember to inform your urologist of any known allergies
3. Resection / enucleation of prostate
- Bleeding is common
i. Transfusions rare but possible
ii. Clot retention with bladder washouts may occur
- Irrigation bladder catheter post-operatively
i. Continuous irrigation in hospital until clear
ii. Average hospital stay 2-3 days
- Risk of urinary tract infections and/or testicular cord infections (epididymitis)
- Urinary retention requiring reinsertion of catheter may occur
What are the medium & long-term effects?
- Intermittent bloodstained urine may persist for a few weeks after the surgery
2. Overactive bladder symptoms
- Overactivity is a normal part of the healing process – it should improve a few weeks after the surgery
- Minor discomfort only use analgesia as needed
4. Sexual function
- Retrograde ejaculation (ejaculation into the bladder) is unavoidable – an open bladder neck is the path of least resistance for ejaculate. Only a problem when attempting conception – avoid procedure where possible if family is not completed.
- Prostatic tissue will be sent for Histology
- Results will be discussed as they become available, and further work-up may be needed
- Will be arranged as needed, with intermittent ultrasounds and / or flowrate measurements.