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What should I expect after my surgery?

Post-operative Expectations and Care after a Transurethral Procedure for Your Prostate

While the number of treatments for your prostate may be many, the post-operative symptoms from most of these procedures will be similar.


From our experience and personal opinion, after any transurethral prostate procedure you should expect:

  1. Increased frequency of urination
  2. Urgency and maybe some urinary leakage with the urgency
  3. Burning with urination
  4. Blood tinged urine


You should not have:

  1. Fevers
  2. Flank pain
  3. Nausea or vomiting

 

The Risks of Prostate Procedures include, but are NOT limited to:

1) Erectile dysfunction

2) Decreased penile sensation

3) Decreased sexual libido

4) Bladder neck contracture (scar tissue formation near the bladder opening)

5) Bleeding requiring a second procedure or transfusion (<5%)

6) No alleviation of symptoms

7) Decreased ejaculate volume (retrograde ejaculation – not harmful)

8) Regrowth of the prostate

 

COMPARING THE PROCEDURES:

 

Microwave Therapy

  • Usually indicated for smaller prostates without median lobe
  • Least likely to have a sustained effect (usually less than 5 years)
  • Least invasive – no bleeding
  • Less likely to cause erectile dysfunction, decreased sexual libido, urethral stricture or bladder neck contracture

Standard Monopolar Transurethral Resection of the Prostate

(aka “rotor-rooter”,”TURP”, “standard loop TURP”)

  • Gold standard for transurethral prostate procedures (in practice since 1920’s)
  • Sustained effect on voiding for up to 10-15 years
  • Allows prostate resection “chips” to be analyzed for possible cancer
  • Usual transurethral irritative symptoms last for 1-2 weeks
  • Increased risk of bleeding, risk of seizure due to dilution of sodium levels in the blood, risk of bladder neck contracture, time-limited procedure due to possible dilution of the blood with the irrigation required for the procedure.
  • Risk of erectile dysfunction, decreased sexual libido, retrograde ejaculation is higher.
  • Usually requires an overnight stay in the hospital to monitor blood levels and blood in the urine
  • Bladder catheter stays in place for 1 week

Button TURP

  • Recently developed in the past few years
  • Creates the same prostatic channel as Standard TURP
  • Sustained effect on voiding possibly 10-15 years as the prostatic channel appears widely open as in Standard TURP
  • Faster ablation of large prostates which decreases anesthesia risks
  • Uses saline irrigation which causes no risk of seizures, no time limit to resect large prostates, almost no bleeding during the procedure
  • Usual transurethral irritative symptoms last for 4-6 weeks
  • Risk of erectile dysfunction, decreased sexual libido, retrograde ejaculation is the same as the Standard TURP.
  • Does not require an overnight stay.
  • Bladder catheter stays in place for 1 week

KTP Laser Photoselective Vaporization

(aka Greenlight PVP, Laser TURP)
  • One of several types of laser ablation of the prostate (another popular method is Holmium:Yag Laser)
  • Creates a prostate channel like Standard TURP, but usually takes much longer for larger prostates
  • Sustained effect on voiding possibly 10-15 years as the prostatic channel appears widely open as in Standard TURP
  • Uses saline irrigation which causes no risk of seizures, no time limit to resect large prostates, almost no bleeding during the procedure
  • Usual transurethral irritative symptoms last for 4-6 weeks
  • Risk of erectile dysfunction, decreased sexual libido, retrograde ejaculation is the same as the Standard TURP.
  • Does not require an overnight stay.
  • Bladder catheter stays in place for 1 week

Simple Prostatectomy

(Surgical removal of the “meat” of the prostate, leaving the capsule or “rind” intact)

  • Reserved for extremely large prostate glands
  • Removes 99% of the gland in a single procedure – much more than any other surgery BUT:
  • High blood loss due to maximally invasive technique and higher risk of blood transfusion
  • Usually performed as an open surgery through a low midline or transverse incision (can be performed laparoscopic or robotic)
  • At least 3-5 day hospital stay
  • At least 7-14 days with a bladder catheter, and possible suprapubic catheter as well.


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