After TURP

The information in this booklet is to give you advice on what to expect after your operation and when you leave the hospital. You may already have been given information about TURP from your doctor during your pre-admission clinic appointment.

It is advised that you should not drive for the first 2 weeks. You should check with your insurance company about your coverage. It is advised that you should not have sex for at least 3 weeks because this may cause the internal wound to bleed. TURP involves removing part of the bladder neck which causes semen to travel up to the bladder instead of down the urethra (known as retrograde ejaculation, causing your urine to be cloudy). This is also known as dry ejaculation, thus affecting fertility. Nevertheless, this does not affect your sensation during sexual intercourse. You may have discussed this with your Urologist prior to your surgery. Some of the symptoms you experience prior to your operation may still continue for 2 to 3 weeks. Frequency and urgency can get worse straight after surgery. It may take up to 6 months for frequency and urgency to settle. There is also a chance of re-growth of the prostate gland and some patients may require a repeat TURP within 5 years of their original operation. If you have any concerns that have not been addressed in this leaflet, please do not hesitate to contact the Urology Nurse or Urologist.

Driving

Sex/fertility

Mr Michael Dinneen Consultant Urologist Mr Bijan Khoubehi Consultant Urologist Mr Mohammed Masaarane Staff Grade Urologist Caroline Websdale Urology Nurse Practitioner Jessica Hancox Urology Nurse Specialist for Urological Cancers Angelo Batoon Urology Nurse Holly Ashforth Clinical Lead Nurse for Surgery

After TURP
(transurethral resection of the prostate) What happens next?

Chelsea and Westminster Hospital 369 Fulham Road London SW10 9NH T: 020 8746 8000 W: www.chelwest.nhs.uk
February 2009

Urology Department

Chelsea and Westminster Hospital 369 Fulham Road London SW10 9NH Direct line: 020 8237 5348

Pictured on front (left - right): Jessica Hancox (Urology Nurse Specialist for Urological Cancers), Angelo Batoon (Urology Nurse), Mr Bijan Khoubehi (Consultant Urologist) and Mr Michael Dinneen (Consultant Urologist)

On the hospital ward

After your surgery, you will be admitted to the ward. You will have a drip to keep you hydrated. You will have a drainage tube (catheter) in your penis, this will be attached to irrigation fluid to continuously wash out your bladder to stop the formation of clots which could block your catheter. You will feel a little bit drowsy from the spinal or general anaesthesia but this will soon wear off. When your urine is almost clear, your catheter will be removed. This is usually 1 to 4 days after surgery. You will hear the word TWOC which means a Trial Without Catheter. Usually your catheter will be removed in the morning. You will be asked to mobilise and to drink plenty of water. The aim is for you to fill up your bladder and to pass urine normally. You may experience some frequency and urgency once the catheter is out which may make it difficult to control urination at first. This usually settles down within a few weeks. It is important to practice pelvic floor exercises which help strengthen and tighten up the pelvic floor muscles which help you to hold on to your urine. A leaflet explaining these exercises may have been given to you at the pre-admission clinic or you can request one from the Urology Nurse. In the unlikely event that you fail the TWOC and are not able to pass urine independently, a smaller more flexible catheter is re-inserted. You can still be discharged but you will need to come back to the TWOC Clinic after 2 weeks. Complications or problems after surgery are rare but you may experience some of the following signs and symptoms: The pain is likely be coming from the catheter. If pain persists, the doctor can prescribe a gel to numb the area to be applied locally to the urethral surface. This may be acute, spasmodic, lower abdominal pain. It is caused by irritation from the balloon which secures the catheter in position. Securing the catheter to the leg to prevent pulling will aid comfort. However, the doctors can also prescribe an anti-spasmodic drug.

The prostate gland has a rich blood supply and bleeding can occur. The nurses will be continuously monitoring your blood pressure and pulse rate. Your urine will look red at first but will gradually become lighter in colour. It is important for you to drink plenty to help keep your urine clear and prevent the catheter from blocking. If your catheter does block, you may feel that you want to pass urine. A bladder washout can be performed which involves introducing a sterile fluid into the bladder to relieve the blockage. However, if after this procedure your catheter is still not draining, it may be changed by the doctor. Your temperature will be monitored regularly and a rise after surgery might be a sign of an infection. Urine will be sent for testing and you may be prescribed an antibiotic. This may be due to you being afraid to strain with the catheter. A high fibre diet is encouraged and a laxative may also be prescribed. If you experience any of the above signs and symptoms, inform your nurse immediately so that the doctors can be notified as soon as possible. Routinely, you will not have an outpatient follow-up appointment. The Urology Nurse will do a telephone follow-up and you will be sent a telephone appointment follow-up letter. The appointment is made 6 to 8 weeks after your surgery. The Urology Nurse will call you and will ask a series of questions. You are encouraged to verbalise any concerns you have. After the telephone appointment, if indicated, you may need come back to the hospital to see the Urologist for further evaluation and intervention.

Bleeding

This is common especially during the second week and sometimes up to a month after surgery. This is due to scabs falling off from the operation site of the prostate. It is advised that you drink at least 2 litres of fluid a day to flush out and dilute the urine. If you continue to pass clots or cannot pass urine, go to the nearest Accident and Emergency Department. Frequency and urgency can take up to 6 months to settle. There may be some leakage of urine either at coughing or sneezing which is due to surgeryin this case, pelvic floor exercises help. If this continues to be a problem, then this should be addressed in the telephone follow-up.

Blood clots in your urine

Incontinence

Infection

Constipation

Constipation

Food high in fibre is advised including fruit and vegetables to avoid constipation. Constipation leading to straining may cause internal wounds to bleed.

Daily living
You can eat and drink what you please. It is advised that you drink at least 1.52 litres of fluids a day. Alcohol is permitted in moderation. To avoid getting up at night, limit your fluid intake after 8pm. Extra fibre in the diet will help to ensure regular soft bowel actions. To limit the risk of bleeding from the operation site, it is important not to over exert during the recovery phase thus, heavy lifting should be avoided. Short walks are safe. Mild sports such as swimming and golf may be resumed after 2 to 4 weeks or so, however anything more active should be totally avoided for up to 6 weeks. You may return to work depending on the type of work. This can be from 1 week to 1 month. However, for heavy manual jobs recovery time may be longer.

Diet

Activity/exercise

Penile pain

At home
When you return home, you should take things easy for a few weeks. It is common to feel tired and low which is natural and will soon pass. If you feel that something is not right, call your GP who will have a detailed report about your operation. During your recovery, you may experience the following symptoms:

Bladder spasm

Work