Prostate surgery (TURP) in Niš

The prostate is a walnut-sized gland that sits below the bladder and surrounds the first part of the urethra (the tube that carries urine out of the body). In many men it gradually grows larger with age. This is benign enlargement of the prostate, known in medicine as benign prostatic hyperplasia (BPH) and often also called prostate adenoma. The enlarged tissue can narrow the urethra and make it harder to empty the bladder.

Transurethral resection of the prostate (TURP) is an endoscopic operation. The urologist passes a thin instrument (a resectoscope) through the urethra, views the inside on a screen and uses an electric wire loop to remove, in small pieces, the inner part of the prostate that is pressing on the urethra. There are no cuts to the skin.

In bipolar TURP, which is listed in the urology price list of Maja Hospital, the electric current passes between two electrodes at the tip of the instrument rather than through the patient's body. During the procedure the bladder is flushed with saline solution.

TURP does not remove the whole prostate. The outer part of the gland remains, so follow-up appointments with a urologist are still needed after the operation, and the urologist also decides on any further PSA checks.

The decision to operate is made after a consultation with a urologist and diagnostic tests, not on the basis of the size of the prostate alone. TURP is most often considered for men with benign enlargement of the prostate (prostate adenoma) when urinary symptoms have a significant effect on daily life and medication does not work well enough or does not suit the patient.

Surgery is also considered when problems develop as a result of difficulty emptying the bladder: repeated urinary retention (being unable to pass urine) that requires a catheter, recurrent urinary tract infections, a bladder stone, recurrent bleeding from the prostate or declining kidney function.

Before deciding, the urologist usually asks for an ultrasound scan of the prostate and bladder with measurement of residual urine (the urine left in the bladder after passing urine), uroflowmetry (a measurement of urine flow), a PSA blood test and a urine test. If prostate cancer is suspected, the approach is different and is discussed separately.

Bipolar transurethral resection of the prostate (TURP) is listed in the urology price list of Maja Hospital. Laser prostate surgery and water vapour (steam) treatment are not listed in the price list. The removed tissue is sent for histopathology (laboratory examination of the tissue). In the price list this test is listed as ‘Histopathology, prostate resection specimen’, and whether it is included in the price of the procedure is confirmed when booking.

In urology there are also other methods for treating benign enlargement of the prostate: monopolar TURP, laser methods (holmium laser enucleation, known as HoLEP, and laser vaporisation), water vapour (steam) treatment, transurethral incision for a smaller prostate, and open or laparoscopic surgery for a very large prostate. When the aim is to treat prostate cancer, a different operation is performed (radical prostatectomy) or other types of treatment are used. In prostate cancer, TURP is sometimes performed only to make passing urine easier.

Before any operation for benign enlargement, monitoring and medication are also considered. The choice of method depends on the size of the prostate, the test results, the patient's general health and the medicines they take. The urologist assesses at the consultation which method suits the individual patient.

The patient arrives at the hospital at the agreed time, having fasted as instructed when the procedure was booked. After admission, the anaesthetist checks the patient's condition once more and agrees the type of anaesthetic. TURP is usually performed under a spinal anaesthetic, which numbs the body from the waist down, and the patient can stay awake or be lightly sedated. With a spinal anaesthetic the patient usually feels no pain during the procedure, although he may feel touch or pressure. Sometimes the procedure is performed under a general anaesthetic.

The procedure usually takes about an hour, longer for a larger prostate. At the end, the urologist inserts a catheter through the urethra. For the first few hours, and sometimes days, the bladder is flushed with fluid through the catheter to prevent blood clots from forming.

After the procedure the patient stays in a hospital room, where his general condition, urine and pain are monitored. For the first few days the urine is usually pink. Discomfort from the catheter and occasional bladder spasms are common and are relieved with medication. The catheter is removed once the urine is clear enough, usually after 1 to 3 days. Before discharge, staff check that the patient can pass urine on his own, and the urologist gives instructions for recovery at home.

Like any operation, TURP carries certain risks, which the urologist discusses with the patient before the consent form for the procedure is signed.

A common after-effect is retrograde ejaculation: at orgasm, semen goes into the bladder instead of out of the body. It happens in most men after TURP and is usually permanent. The sensation of orgasm is usually preserved, but this after-effect is important for men who are planning to have children.

In the first few weeks, a burning sensation when passing urine, blood in the urine and a frequent, urgent need to pass urine are common. In some men, the frequency and urgency settle only after a few months. The operation may not relieve all symptoms, particularly if the bladder has been weakened by long-term difficulty emptying.

Less common are bleeding that requires a blood transfusion or a further procedure, infection, and being unable to pass urine after the catheter is removed, in which case the catheter is put back in for a while. Also less common are urinary incontinence (leakage of urine), which is usually temporary and rarely permanent, narrowing of the urethra or the bladder neck, and weaker erections. Rare complications include a disturbance of sodium levels in the blood caused by absorption of the irrigation fluid (TUR syndrome), and heart or blood vessel complications, for example a blood clot in a leg vein. The risks of anaesthesia are discussed separately by the anaesthetist.

Previously undetected prostate cancer is sometimes found in the removed tissue, so the histopathology result is important for further planning. Over the years the remaining prostate tissue can grow again, so some men need a repeat procedure after a number of years.