What is it?
The prostate gland is a thick ring of muscle and gristle that lies
between the outlet of the bladder and the penis. It is rather like the
bung in the outlet of a home made wine bottle, holding the outflow tube
in place. It lies deeply behind the bone in the front of the pelvis
(which is the lower part of your abdomen). It makes the fluid that
carries sperm. Sometimes the centre of the prostate ring becomes narrow
because of overgrowth or scarring. This causes difficulty in passing
urine, as well as back-pressure effects on the bladder and kidneys.
The operation
The back wall of the prostate ring is cut using an instrument passed
up the penis. Most patients have a general anaesthetic, so that they are
asleep during the operation. It is quite common, however, for patients
to be numbed from the waist down with an injection in the back. If this
is the case, you will be awake during the operation, but feel no pain.
The operation takes about 20 minutes. You will be in hospital for about
two days.
Any alternatives
If you just have a little slowness when passing urine and are having
to get up onec or twice at night to pass urine, simply waiting and
seeing if you have more trouble is a reasonable idea. If you find your
life is being upset by the prostate problem, then treatment is sensible.
Drug treatment may be helpful in the short term, but there may be
side-effects. A complete blockage definitely needs treatment, at first
with a drainage tube (catheter) through the penis or through the lower
tummy wall, followed usually with a cut of the back wall of the prostate
ring made through the penis. A formal coring out of the prostate is
needed if the gland is over a certain size. Keeping the path through the
prostate using short indwelling tubes are experimental. An open
operation through the tummy is rarely needed, unless the prostate is
very big, or you have some bladder condition such as large bladder
stones or a blowout on the bladder wall. Sometimes a permanent catheter
with a collecting bag for urine strapped to the leg is the best plan if
an operation would be very risky.
Before the operation
Stop smoking and get your weight down. (See Healthy Living). If you
know that you have problems with your blood pressure, your heart, or
your lungs, ask your family doctor to check that these are under
control. Bring all your tablets and medicines with you to the hospital.
On the ward, you may be checked for past illnesses and may have special
tests to make sure that you are well prepared and that you can have the
operation as safely as possible. Many hospitals now run special
preadmission clinics, where you visit for an hour or two, a few weeks or
so before the operation for these checks.
After - in hospital
You should be able to return to a light job in one week and a heavy
one in two weeks. You may restart sexual relations within a week or two,
when the wound is comfortable enough. You may find that at intercourse
no liquid comes, and that afterwards you notice milky fluid in the
urine. This can happen in up to 80% of cases and is because the widened
prostate ring allows the sperm to pass up into the bladder instead of
down the penis. You may be sterile. Some men (5-10%) find that after the
operation they cannot have sex as well as they could before it.
After - at home
If you have this operation under general anaesthetic, there is a very
small risk of complications related to your heart and lungs. The tests
that you will have before the operation will make sure that you can have
the operation in the safest possible way and will bring the risk for
such complications very close to zero.
If you have an anaesthetic injection at the back, there is a
very small chance of a blood clot forming on top of your spine which can
lead to a feeling of numbness or pins and needles in your legs. Most of
the time the clot dissolves on its own and this solves the problem.
Extremely rarely, the injections can cause permanent damage to your
spine.
In the first 48 hours, bleeding in the urine may be a
problem. The medical and nursing staff will deal with this. There is a
5% chance that a blood transfusion may be required because of the blood
loss.
Chest infections may arise, particularly in smokers. Do not
smoke. Getting out of bed as quickly as possible, being as mobile as
possible and co-operating with the physiotherapists to clear the air
passages is important in preventing an infection. When the catheter is
first removed you may notice that you want to pass urine every few
minutes. This is normal and passes off in a day or two. Sometimes after
removal of the catheter there is difficulty passing urine at all. It may
mean replacing the catheter for three days or more. Sometimes after
removal of the catheter there is some dribbling or moistness from the
penis after passing urine. This improves with time and the improvement
can continue gradually for up to three months. However, there is about
1% chance that you may experience mild to moderate urine incontinence in
the long term. Ask the surgeon for advice if it is troublesome.
Infection of the urine can give a burning feeling and a need to
pass urine every hour or so. This can be tested and treated by the
surgical team. Sometimes blood stains the urine again 7 to 10 days after
the operation. You should seek medical advice, but the condition
settles down.
There is 10-15% chance that the prostate ring becomes
narrow again over months or years. If this happens you should seek
medical advice. It is most likely you will need another operation to fix
the problem.
Possible complications
If you have this operation under general anaesthetic, there is a very
small risk of complications related to your heart and lungs. The tests
that you will have before the operation will make sure that you can have
the operation in the safest possible way and will bring the risk for
such complications very close to zero.
If you have an anaesthetic injection at the back, there is a
very small chance of a blood clot forming on top of your spine which can
lead to a feeling of numbness or pins and needles in your legs. Most of
the time the clot dissolves on its own and this solves the problem.
Extremely rarely, the injections can cause permanent damage to your
spine.
In the first 48 hours, bleeding in the urine may be a problem.
The medical and nursing staff will deal with this. There is a 5% chance
that a blood transfusion may be required because of the blood loss.
Chest infections may arise, particularly in smokers. Do not
smoke. Getting out of bed as quickly as possible, being as mobile as
possible and co-operating with the physiotherapists to clear the air
passages is important in preventing an infection. When the catheter is
first removed you may notice that you want to pass urine every few
minutes. This is normal and passes off in a day or two. Sometimes after
removal of the catheter there is difficulty passing urine at all. It may
mean replacing the catheter for three days or more. Sometimes after
removal of the catheter there is some dribbling or moistness from the
penis after passing urine. This improves with time and the improvement
can continue gradually for up to three months. However, there is about
1% chance that you may experience mild to moderate urine incontinence in
the long term. Ask the surgeon for advice if it is troublesome.
Infection of the urine can give a burning feeling and a need to
pass urine every hour or so. This can be tested and treated by the
surgical team. Sometimes blood stains the urine again 7 to 10 days after
the operation. You should seek medical advice, but the condition
settles down.
There is 10-15% chance that the prostate ring becomes
narrow again over months or years. If this happens you should seek
medical advice. It is most likely you will need another operation to fix
the problem.
General advice
The operation gives good results. Patients are usually surprised how
quickly they get better. However, there are many technical points in the
operation and they vary for patient to patient. The surgical and
nursing staff will be pleased to explain what is happening in your
particular case. These notes should help you through your operation.
They are a general guide. They do not cover everything. Also, all
hospitals and surgeons vary a little. If you have any queries or
problems, please ask the doctors or nurses.
