T.U.R.P. FAQs
Frequently Asked
Questions page
This
information is not intended to be a substitute for medical advice or
treatment of prostate problems. If you suspect prostate problems,
contact your health care provider.
Please see the list of
common
Questions and Answers regarding TURP below and click on the one(s)
you want the answer to. You can also scroll down the page and browse
the FAQ's. If you have a question you want on this page, please click
on the envelope and describe:
1) How
painful is the surgery and recovery from TURP?
2) How
long do I have to have this damn tube in me!?
3) When
and how often do I flush the catheter?
4) What
about sex?
5) What
are some of the other possible surgical procedures?
6) How
long do I have to wait after surgery for
improvements?
7) What
specifically are the post-operation symptoms and
problems?
8) Hey,
what's the worst that could happen?!
9) What
are the guidelines for the PSA prostate cancer tests?
10) How
does one find a good doctor to do the TURP?
11) What's
the story on Prostate cancer?
12) What
is Prostatitis, and what can I do about it?
13) Who
is the author of this TURP website?
14) What
the heck is the Prostate anyway?
FAQ Answers
1) How painful is the surgery and recovery from TURP?
The actual surgery does not have to be uncomfortable, as you should have the option to be completely unconscious if you desire. Your doctor may opt to inspect the blockage area prior to surgery for a better idea of the severity of your problem and also as an aide to how the surgery will be performed. This instrument of inspection is called a cytoscope, and should not cause you much pain, but will be quite uncomfortable during the actual examination, which thankfully, should only be a couple minutes. He/she may decide to do this after you are already unconscious for the surgery.
When
you awake in the Recovery
Room after the procedure, you will already have the catheter in your
penis, and some pain killer medication in your blood stream via the
IV. You will probably be disorientated, but you
should not be in much pain.
The
initial recovery period of
approx. one week will include some pain, especially if you, like me,
accidentally get up
while standing on your urine bag (you will only do this once - trust
me)! However, mainly it's the uncomfortableness of having the
tube in
your penis with the accompanying extra tube and bag, with you
constantly, that is the challenge to deal with. There will be
declining pain when urinating due to the urinary canal (called
urethra ) distress, as well as dealing with the
spastic convulsions of your bladder and prostate responding to the
changes, as well as the "balloon" at the end of the catheter in your
bladder. I learned to get around my yard with the bag quite
well, but I'm not recommending this to anyone.
You
will be given medications
for both the pain and spasms (may have to ask for spasm med if you need
it), and there is more detailed information
on medications in this site.
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2) How long do I have to have this damn tube in me!?
Although
it may only be a few
days that you have the catheter in you, it may well feel like a very
long time! That is because it is unavoidably uncomfortable to have
about 10 inches of tube up your penis. Your bladder does not
appreciate the "balloon" that holds the catheter in either, and after
it recovers from the operation may well attempt to push it out,
causing you spasms. Take your spasm medication for that, but only as
prescribed, or you may cause yourself other problems. I had the
catheter in for 4 days, but that may have been because a weekend was
involved. You may get yours out sooner, and you may well be the
person taking it out. Refer to Tips page for more information on dealing with
the catheter.
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3) When and how often do I flush the catheter?
You may be told that you cannot flush the catheter tubing too much, but that is not necessarily so. In fact, too much flushing can not only be unnecessary but can cause your already spastic bladder to spasm more.
You should flush if you're sure the tube in your penis is plugged, indicated by either, blood and urine coming out around the tube where it goes in your penis, or by your need to urinate yet nothing is coming out the tube (check for kinks in the tube). However, be aware that a spastic bladder can cause blood and urine to seep-out around the tube, and also prevent you from being able to relax enough to have urine flow out the tube into the bag. So make sure you are taking your medication for bladder spasms, such as B&O suppositories and you lay-down and try to relax when needing to urinate.
If
you need to flush, try to
get as much water up into the bladder as possible so that the maximum
flushing action can occur. If necessary, use the larger center tube
to inject water up into the bladder. If you try this method, make
sure you clean everything before and after.
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4) What about sex?
First, when can you have
it:
It's hard to find information about when you can have sex after the
operation, either via the internet or in printed material. I find
this a little strange considering the location of the operation and
the importance of the subject. At any rate, as a rule-of-thumb,
all
other things being equal, you should be able to start safely having
sex again about six to eight weeks after the operation ("sex" includes
masturbation). This is based upon the TURP procedure, whereas others
that are less invasive (e.g. Laser Therapy) may allow you to start
sooner. In any case, you should not start if you are still urinating
blood and tissue. If in doubt, call your doctor and ask.
Second, will this operation
affect my sexual ability or desire:
Regardless of the procedure selected for BPH, you should not have any
physical reason to have less of a sex drive or
capability of having sex, unless there was a problem with the surgery
(which rarely happens). In fact, since sexual capability is often
based at least partly (some would say mostly) on your mental state,
it may help you to know that you are less likely to impregnate your
partner after having the treatment, due to retrograde ejaculation:
This
is because the muscle
valve located at the bladder that previously directed ejaculations
out the penis is often destroyed in procedures like TURP,
and your sperm now goes the direction of less
resistance, i.e. into your bladder. The sperm is later harmlessly
expelled when you urinate. This should not be considered a fool-proof
method of birth control, as some sperm could, and probably does, find
it's way out the more traditional path, prior to, and during
ejaculation.
Whether
this mentally affects
your sexual performance is really a question of how you decide to think
about it. As stated above, it can be a "freeing" experience
regarding the possibility of impregnating your partner, as well
as a removal of objection for having oral sex done upon
you. It can
also make the sexual experience less "messy"
and reduce the chances of infections for the woman due to less fluids
going into her from you. Your choice. (Click
here for a Share Page email and response on this subject)
Still
concerned? Talk to your
physician.
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5) What are some of the other possible surgical procedures?
As
you can see below, there are
many possible treatments for BPH, including
Water-induced thermotherapy
(WIT), Laser surgery, Sonic and radio
waves, drugs, balloons
and stints, etc.. You
should collect information and study each method and how it applies
to your situation, and then discuss the results with your doctor,
before deciding on any one.
Understand
that each surgeon that specializes in a procedure will attempt to
convince you that their method is the best method for you to
have. Many procedures have less risks and
lesser recovery periods, but then the effectiveness of the procedure
to resolve your symptoms completely and long-term, may also be less.
You need to weigh the risks/benefits of all the procedures against
your particular situation, to come to the correct decision. See the
References
and Links page for more
information. Best wishes. NOTE: New procedures are
constantly being created so this list is not complete by any means
(i.e. I am not out there looking for them, if you discover a new one
let me know)!
1) Drug Therapy: Men with moderate symptoms may have success with drugs designed to shrink the prostate by blocking production of testosterone, the hormone that stimulates prostate growth. Other drugs relieve the symptoms but do nothing about resolving the physical problem of BPH. Some men find these drugs gradually lose their effectiveness. Also they may take up to six months to take effect. However, someone only wanting relief from some moderately irritating symptoms that don't seem to be getting worse, may find drugs an effective way to accomplish this.
2) Electrovaporization: A modified version of TURP, this uses a device that produces electronic waves to vaporize the enlarged prostate.
3) Needle Ablation or TUNA: Approved by the FDA in 1996, this uses radio waves to heat and destroy the enlarged prostate through needles positioned in the prostate gland itself. Generally less effective for reducing symptoms and increasing urine flow than traditional surgical procedures (e.g. TURP).
4)
Laser Therapy/PVP: A laser inserted in the urethra via a
catheter
heats and destroys the extra prostate tissue. There is
also Photoselective Vaporization
of the Prostate or PVP, that uses
a laser so strong it vaporizes the tissue in a 20 to 50 minute
outpatient operation. Link to "One
Man's Laser Turp Story"
5) Balloon Dilation: Using the same concept as angioplasty for the heart, a balloon is inserted in the urethra to where the restriction is and then expanded to push the prostate tissue out and widen the urinary path. Improvements may only last a few years with this technique.
6) Stents: A tiny metal coil is inserted into the restricted part of the urethra to widen it and keep it open. The body normally grows over the stent to hold it in place. Often this is used on patients with heart conditions or illnesses that preclude more risky, complicated surgery (e.g. TURP)
7) Water-induced thermotherapy (WIT): Administered through a closed-loop catheter system, through which water is heated and maintained at a constant temperature. The procedure is usually performed using only local anesthetic gel to anesthetize the penis, and is seemingly well tolerated. FDA approved. (e.g. ArgoMed)
8) TransUrethral Microwave Thermotherapy (TUMT): Uses microwave heat energy to shrink the enlarged prostate via a probe into the penis to the level of the prostate. Treatment is an outpatient procedure and takes about one hour. Patient can be sent home the same day and can resume normal activities within a day or two. This procedure does not however produce instant results; it may take up to four weeks for urinary problems to be completely resolved.
9) TransUrethral Incision of the Prostate (TUIP): Surgery via a small incision in the bladder where a few cuts are made in the sphincter muscle to release some of the tension.
10)
Other Experimental Treatments: One method being tested is the use of
high-frequency, high-intensity ultrasound to destroy excess prostate
tissue. It is performed much the same way as the laser or microwave
therapy. Find other new treatments on the References page. The Prostate Institute (whomever
they are?) has a comparison table of several procedures at:
Prostate
Institute BPH Procedure Options
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6) How long do I have to wait after surgery for improvements?
You
should notice an increase
flow improvement as soon as the catheter is out. Improvements
will depend on which procedure was done, the patients prostate
condition at the time of surgery, current age and health, and how
well the patient adheres to the recovery plan, whether other medical
conditions exist (e.g. Diabetes can cause an extended period of
bleeding), success of operation, etc.. Expect a lot of the
symptoms that inspired you to have a treatment done in the first
place, to continue for awhile. As well as some new ones:
including
occasional voiding of blood and/or tissue; bladder spasms (the
bladder continuing to apply pressure even after all the urine is
out); urine leakage; aches or pains when urinating, difficulty judging
when you need
to void; and possibly a feeling you need to have a BM every time you
urinate. This surgery (i.e. TURP) is a
major upset for the body and
it will take some time for things to heal. The most important issue
is: whether these symptoms are continuing to
decrease with time. Full recovery can take up to a year or
even two in some cases.
I
believe some patients also need to RETRAIN
their
bladder from the "bad " habits (not really "bad", it did what it
needed to do) it previously followed as a result
of their long term blockage due to prostate expansion. There is a
tendency for your
system to
continue to urinate small amounts of urine even after the operation,
sort of "out of habit". If
left to itself (the bladder) to figure out the new situation, it
could in some cases, take up to two years to adjust to this new
experience of
actually being full before sending the signal to void it's contents.
This may sound a little crazy, but when I went back to work I would
delay somewhat when I urinated, so that my bladder would learn that I
didn't need to go as often as before the operation. It's kind of a
mind game, in that you tell yourself you don't need to go right away
and can hold it for awhile longer. You may actually need to
forcefully tell yourself you are "not going right now"! You
of
course, do not want to carry this too far, i.e. to the point you are
in major discomfort or pain, or risk having a "urine accident".
Even
though this may seem like it's a lot to go through, remember that you
no longer have to take that daily (and probably expensive)
medication, can continually increase the time between urinating, get
more restful sleep, not have to always consider where the nearest
bathroom is, and hopefully not have to medically deal with
this part of your body again in your lifetime (See Pelvic floor
muscle exercise).
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7) What specifically are the post-operation symptoms and problems?
Listed below are some of the post-op symptoms you will experience. There are probably lots of others, so send email with yours to add.
General advice on how to deal with them is listed after, and there is more information on this subject in the other questions and answers, and also in the Medications page:
Potential
Remedies and Responses
The above are
all "normal" post-op symptoms, so if you want to eliminate them from
your life, then you
need to do something:
There is also what is known as "TURP syndrome", based upon possible post-operative complications, including temporary blindness (due to irrigation fluid entering the bloodstream) which can on very rare occasion lead to seizures, coma, and even death; toxic shock (due to bacteria entering the bloodstream) and internal hemorrhage (due to blood exiting just about anywhere). It is been said to affect up to 6% of TURP patients, whereas others (mostly TURP doctors) put the percentage at much less, around 2% or less. Generally TURP syndrome, when it does occur, is temporary (usually lasting only the first 6 hours after surgery) and is treated with medication that removes excess water from the body (diuretic).
Also there is
about a
0.01% probability of incontinence or impotence. There is about a one
in a hundred chance that you may acquire some lasting scar tissue
from the TURP
that would require a minor operation to
remove it.
Sometimes patients
after surgery get infections, like Prostatitis
(see question on this).
A small number of
TURP
patients require another TURP operation after about eight
years. And there maybe other problems that should be on
this list that I am not aware of.
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9) What are the guidelines for the PSA prostate cancer tests?
(May 2002) This common blood-scanning test for prostate cancer which previously was performed on a yearly basis, can now safely be done less frequently for the majority who have low readings (according to a major, federal funded study on PSA testing).
About half of all men over age 50 now get a regular yearly PSA test, which scans the blood for a protein that goes up as prostate cancer develops. According to Dr. E. David Crawford of the University of Colorado, who directed the study, there is a new time-table for PSA testing:
These new guidelines are amid a much larger controversy about whether PSA screening is medically helpful and should be done at all (per Dr. Steven Woolf of Virginia Commonwealth University). Falsely positive test results can cause anxiety and lead to unnecessary biopsies. Furthermore, many men live with slow-growing prostate cancers that never cause them any problems in their life time. Finding and removing them can cause incontinence and impotence. However, new studies (Sept. 2002) show that men with prostate cancer have a 50% improvement in their survival rate if they have their prostate removed instead of doing nothing about it. There are many methods of treatment for prostate cancer and this study only focused on the prostate removal option (results for other treatments will not be available for years). This controversy underlines the importance of the patient being educated regarding the good and bad of PSA testing.
Prostate
cancer is
second to lung cancer as a cancer killer of men, resulting in 30,000
deaths annually.
(Daniel Q. Haney, AP
Medical Editor, West
Hawaii Today, May
2002)
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10) How does one find a good doctor to do the TURP?
This is a challenging task, as there is not a lot of definitive help available on individual doctor performance. To my knowledge, there are no "statistics" kept "somewhere" for the consumer/patient to look up and use as a guide. One is always better served to chose a doctor who is "board certified" in their particular specialty. This means they took a specialty-specific test and passed -- reflecting a "polished" sort of knowledge, extra initiative, and keeping on the leading edge and current with the changing environment of medicine. Kind of a feather in one's cap.
One should also get referrals from fellow patients and/or trusted and respected physicians, although this is not fool-proof, as fellow patients' reasoning is not always based on medical soundness, but on emotions. And, fellow physicians use each other for referrals, and have privileges at the same hospitals, sit on the same committees, etc., and sometimes "politics" rule the referral "game". Hospitals do have review boards that review their staff physicians, as to the quality of their care, but that is pretty much a behind closed door thing, as the hospital does not want their reputation tarnished, and if it comes to denying hospital privileges to a particular physician, it is all pretty tight-lipped, i.e. one may need to be a fly on the wall to know the real scoop!
Lastly,
ask the
physician how often they've done a particular procedure, do they
specialize in doing this procedure, or if you
can speak with some of his/her other patients who have had the same
procedure done, or if he'd have it done himself, etc. Hospitals DO
keep statistical records on surgeries by type/doctor/etc. and you may
get to view this otherwise "inhouse" information by asking the Head
of the Dept. of Surgery or the administrator of the Urology Dept. To
tell the truth, the staff that works with and around the doctor
really do know -- BUT, unless you have an inside track with one or
more of them, they probably won't be completely honest. Although,
asking if they themselves would see that doctor, or have one of their
family members do so, may provide a fairly reasonably honest
response. Consider asking male friends and family who they
used, as most men have to eventually deal with this prostate problem.
The National Library of Medicine maintains a consumer-friendly listing of organizations that will assist in a search for physician and facility related information at:
National Library of Medicine website
11) What's the story on Prostate cancer?
Prostate cancer is the second leading cancer killer of men in the U.S. (lung cancer is number one). The American Cancer Society (ACS) estimates that over 189,000 new cases of prostate cancer will be discovered in the U.S. this year, and of those, 30,200 will die from the disease (that's about 16%). The death rate for prostate cancer has been dropping since the advent of early testing in the 1990's.
Prostate cancer is normally slow-growing (fast-growing versions do exist) and most men who acquire it will die WITH the cancer, rather than FROM prostate cancer. That is because since it usually grows very slow, you will probably die of old age or other causes before the prostate cancer causes you any real problems, or maybe even symptoms. However, new studies (Sept. 2002) show that men with prostate cancer have a 50% improvement in their survival rate if they have their prostate removed instead of doing nothing about it. There are many methods of treatment for prostate cancer and this study only focused on the prostate removal option (results for other treatments will not be available for years).
Today with early detection and treatment the five-year survival rate of patients is almost 100 percent if the cancer is localized (is only in the prostate gland). This would seemingly warrant men over 50 to get regular PSA prostate cancer testing -- however even this is not without its detractors (see New Guidelines for PSA Testing).
The exact cause of Prostate cancer is not currently known, however researchers have identified "risk factors" than can increase the likelihood of one getting the disease. These include: Age. After age 50 your chances of getting it increase, e.g. at age 70 you are 12 times more likely to have Prostate cancer than a 50 year old; Race. For unknown reasons, prostate cancer occurs almost 70% more in black men than in white; Nationality. Prostate cancer is most common in North America and northwestern Europe and much less common in Asia, Africa, Central and South Americas; Diet. High animal fat (meat, dairy) diets seem to increase risk, while fruits, vegetables and fiber seem to decrease risk; Family History. There seems to be a genetic factor to Prostate cancer, in that if your father or brother has the cancer, you are twice as likely to get it yourself. The risk increases with the number of relatives diagnosed with the disease.
Things you can do to help yourself: (1) You can reduce your risk by eating a diet low in fat and high in vegetables, fruits and grains. (2) Regular exercise and maintaining a healthy weight may help reduce both prostate cancer and cancer risk as a whole. (3) Antioxidant lycopene, found in tomatoes (raw, cooked or processed in sauces or ketchup), grapefruit and watermelon seems to lower prostate cancer risk by preventing damage to DNA. (4) Taking vitamin supplements may help (e.g. Vitamin E), but so far (2005) the research has brought mixed results.
12) What is Prostatitis, and what can I do about it?
Prostatitis
is
not uncommon. It's an infection of the prostate, basically.
My brother
acquired it after riding his bike in one of his many triathelons.
It can
be stubborn, and so a longer
course of antibiotics is sometimes
necessary.
There is a very good web site by the
"Prostatitis Foundation",
at www.prostatitis.org. The website states that often
doctors don't know
the actual cause...bacterial, autoimmune, yeast infection, physical
injury
problem, etc., and that the causes are not completely understood and
there
is controversy even among the
experts.
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13) Who is the author
of this TURP website?
This
information is not intended to be a substitute for medical advice or
treatment of prostate problems. If you suspect prostate problems,
contact your health care provider.
What is TURP? References/Links
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