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Prostate surgery

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What causes prostate trouble?

Prostate surgery anatomyThe prostate gland sits at the base of the bladder and primarily has the job of adding fluid to sperm. With increasing age, the prostate tends to enlarge and is known as BPH (Benign Prostatic Hyperplasia). As it grows larger the prostate can squeeze the urethra (wee tube), slowly closing off the tube and causing problems with urination. This is an extremely common problem.

Occasionally, the prostate gland can cause problems as a result of turning cancerous. For this reason, any concerns about the prostate should cause you to seek medical advice as soon as possible.

 

What problems can the prostate cause?

As the urethra becomes slowly squeezed shut, a number of symptoms can begin. These may progressively worsen over months or years:

  • Frequency - you may notice that you need to pass water more often than you used to

  • Urgency - when you need to pass water, you feel a very strong urge to urinate

  • Dysuria - passing water may cause some discomfort

  • Nocturia - you need to get up during the night to pass water

  • Poor stream - you can't pee as strongly, and may take a long time to empty the bladder

  • Hesitancy - it may take a long while to start to pee

  • Dribbling - when finishing, the stream slows to a dribble for a while before stopping

  • Bleeding - blood may occasionally appear in the urine

These symptoms may be present in any combination and can vary in severity. As the urethra becomes closed off, pressure is put onto the kidneys. If the prostate problem is not addressed, this kidney pressure can eventually lead to kidney failure.

Whilst the above symptoms are most commonly due to Benign Prostatic Hyperplasia (BPH), prostate cancer can also cause similar symptoms. If the cancer has spread, then weight loss, back pain or anaemia may also be caused.

 

What tests can be done?

Your specialist will ask a number of questions about your symptoms, and check inside the back passage with a finger - the prostate gland can be examined by this route to check for abnormal lumps. Blood tests may be organised and the urine checked. Occasionally, special x-rays or scans may be needed to give the specialist more information on the rest of the urine system. You may also be asked to have your urine flow rate measured - this tests how fast the urine comes out, giving an idea as to the severity of obstruction.

A biopsy of the prostate may also be performed - a scope is passed up the back passage, allowing the specialist to take small samples of the prostate - this is relatively pain-free.

 

How can prostate problems be treated?

For some men, medication may be able to improve urine flow and relieve symptoms. In others, surgery is required to reduce the size of the prostate. A TURP (Trans Urethral Resection of Prostate) is performed by passing a thin telescope up the penis whilst you are under anaesthetic. The telescope has a cautery attachment which allows the specialist to shave portions of the prostate away and relieve the narrowing of the urethra. A catheter is often left in the bladder for a few days to help you pass water and wash out the small shavings of prostate. You can usually go home after a few days; passing water will often be uncomfortable for a while, and it is quite normal to pass a small amount of blood or clots for about a week.

If prostate cancer is causing the problems, then a number of treatment options may be employed; a small incidental tumour may simply be observed carefully, and no further problems may arise. A larger tumour, though, may need open surgery, radiotherapy or medication. Treatment will be tailored to your condition and circumstances.

 

What are the risks of prostate surgery?

  • Bleeding - this usually settles in time but may occasionally need a transfusion or even further surgery

  • Infection - this may require treatment with antibiotics

  • Impotence - the general risks of this are about 1 in 20, but are greater with increasing age where impotence may already be starting to occur

  • Incontinence - this often resolves soon after surgery, but about 1 in 50 may have long-term problems

  • Urine retention - when the catheter is removed, you may still have problems passing water and may need to have the catheter replaced. This can usually come out after a week or two.

  • Fertility - after a TURP, the ejaculate often passes into the bladder rather than coming out of the penis. A climax is still felt though. Some sperm may still run 'normally', so contraception should still be used if required.

  • Urethral stricture - rarely, scar tissue can form in the urethra which may cause obstruction to the urine and need further surgery

  • Recurrence - in cases of benign problems, the prostate can gradually enlarge again to cause recurrence of the symptoms. In cases of cancer, the surgery may not remove all the tumour or the tumour may recur.

  • Blood clots - this is a rare complication, but can be serious if it happens. Blood clots in the calf (Deep Vein Thrombosis) can cause leg swelling and pain. If the clots move to the lungs, then they can cause chest pain and even death.

 

 

Other SurgeryWise articles

You may also be interested to read our articles on cystoscopy or bladder cancer

 

 

Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.

The information provided is for guidance only and you should discuss matters fully with your specialist before deciding if this is the right procedure for you. Please also read our disclaimer

 

 

 
 
 
 
 

 

 

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