DR. VIVEK VENKAT

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Recurrent acute urinary retention (twice or more).
Chronic urinary retention with kidney damage.
Bladder stones.
Recurrent bleeding in the urine
Recurrent urinary infections
When symptoms are not responding to medicines or men who do not wish to take lifelong medications may also opt for surgery.

WHAT ARE THE SURGICAL ALTERNATIVES FOR BPH?

There are a number of forms of surgery available to treat BPH. All the surgeries described below have an excellent success rate (90% and above) with significant and quick improvement in the quality of a man’s life.

Trans-urethral resection of the prostate (TURP)

Standard procedure for the prostate done for over a century.
Camera and endoscope inserted through the urine passage obstructing part of the prostate (adenoma) removed completely.
Works very well for most prostates.
No cuts on the outside of the body.
Bipolar use allows 90-120minutes surgery safely and larger prostates can be operated.
Enucleation (shelling off) of the adenoma similar to laser can also be performed.
Men need a catheter for 2-3 days after the procedure.

Laser prostate surgery (HoLEP or ThuLep)

Especially useful in men with very large prostates (>80g)
Also used in cardiac patients where blood thinning medicines cannot be stopped.
Results are similar to TURP with a potential for more rapid recovery and less blood loss.

Robotic surgery for BPH (Robotic simple prostatectomy)

Excellent minimally-invasive alternative for men with very large prostates (>80-100g).
Equivalent efficiency of open surgery in completely removing the entire adenoma
Advantages of robotics including reduced blood loss, precise magnified surgery, small incisions and a rapid recovery.

WHAT ARE THE COMPLICATIONS OF PROSTATE SURGERY?

Bleeding – Mild bleeding is common. If there is significant bleeding needing transfusion or passage of clots in the urine a second surgery to remove the clots and stop the bleeding may be needed (<1%).
Urinary infection – Most infections are mild and respond very well to antibiotics.
Temporary urinary difficulty – Men in whom the bladder muscle is weak may may need to have a catheter for a longer time.
Difficulty in controlling urine (increased frequency and urgency) – Immediately after catheter removal men have some burning in the urine, increased frequency and urgency to pass urine. This is quite normal and improves over the next 1-2 weeks as the cut area within heals.
Retrograde ejaculation (dry orgasm) – This is very common (90%). During prostate surgery the bladder neck valve is cut and semen enters into the bladder at the time of orgasm. This is harmless and does not affect sexual pleasure.
Incontinence – Temporary leakage for up to 3 months can occur after Laser or robotic enucleation of very large prostates (2-5% cases).

WHAT TO EXPECT ?

How to prepare for prostate surgery?

What to expect during and after the surgery?

What are the precautions needed after surgery?

What are the results of prostate surgery?

How to prepare for of prostate surgery?

Basic investigations to assess your fitness for surgery.
If a urinary infection is detected you will be placed on appropriate antibiotics.
Blood thinners will need to stopped for about 5-7 days before the surgery and this should be discussed with your cardiologist.

What to expect during and after the surgery?

Depending on the type of anesthesia you choose you may be awake (if spinal anesthesia below the waist level is used) or completely asleep (general anesthesia, which is essential for robotic surgery).
The surgery typically lasts for 1-2 hours.
Once you are awake you will notice the urinary catheter which is a tube inserted into the bladder to drain the urine because of the immediate swelling after the surgery. It is generally left in place for 2-3 days. Most men experience an odd sensation and occasional discomfort because of the catheter and feel like passing urine. This is very common and gradually reduces as the man gets used to the catheter.
Most patients will stay in the hospital for 2-3 days after the procedure.
Some blood in the urine is normal after surgery, however if the bleeding is increasing or thick like ketchup, or if you notice blood clots then please inform the doctor.
Once the catheter is removed most men pass urine satisfactorily and this improves consistently over the next few weeks.
Following catheter removal most men will notice some burning or pain in the urine and an increased frequency and urgency to pass. This progressively improves over 2-4 weeks as the raw area within heals completely.
A mild red tinge of blood to the urine is expected for 2-4 weeks.

What are the precautions needed after surgery?

Plenty of fluids during the day to flush the bladder
Eating high-fiber food or take a stool softener to avoid constipation. Straining during a bowel movement can aggravate bleeding.
Start your blood thinner medications only after consulting the surgeon.
Avoid strenuous activity including weight-lifting and sex for about 4 to 6 weeks.
Walking is encouraged.
You will need to contact your doctor in case of fever, difficulty passing urine or bleeding as described.

What are the results of prostate surgery?

Surgery produces rapid and long-lasting in >90% of men.
In about one-third of men who had urgency and bladder overactivity before the procedure these symptoms will persist after surgery.
In some men in whom the bladder muscle is weak, poor emptying of the bladder may persist needing further investigations like urodynamics.
After 10 years, about 10% of men will need a repeat surgery due to regrowth of the prostate gland.

How to prepare for prostate surgery?

Basic investigations to assess your fitness for surgery.
If a urinary infection is detected you will be placed on appropriate antibiotics.
Blood thinners will need to stopped for about 5-7 days before the surgery and this should be discussed with your cardiologist.

What to expect during and after the surgery?

Depending on the type of anesthesia you choose you may be awake (if spinal anesthesia below the waist level is used) or completely asleep (general anesthesia, which is essential for robotic surgery).
The surgery typically lasts for 1-2 hours.
Once you are awake you will notice the urinary catheter which is a tube inserted into the bladder to drain the urine because of the immediate swelling after the surgery. It is generally left in place for 2-3 days. Most men experience an odd sensation and occasional discomfort because of the catheter and feel like passing urine. This is very common and gradually reduces as the man gets used to the catheter.
Most patients will stay in the hospital for 2-3 days after the procedure.
Some blood in the urine is normal after surgery, however if the bleeding is increasing or thick like ketchup, or if you notice blood clots then please inform the doctor.
Once the catheter is removed most men pass urine satisfactorily and this improves consistently over the next few weeks.
Following catheter removal most men will notice some burning or pain in the urine and an increased frequency and urgency to pass. This progressively improves over 2-4 weeks as the raw area within heals completely.
A mild red tinge of blood to the urine is expected for 2-4 weeks.

What are the precautions needed after surgery?

Plenty of fluids during the day to flush the bladder
Eating high-fiber food or take a stool softener to avoid constipation. Straining during a bowel movement can aggravate bleeding.
Start your blood thinner medications only after consulting the surgeon.
Avoid strenuous activity including weight-lifting and sex for about 4 to 6 weeks.
Walking is encouraged.
You will need to contact your doctor in case of fever, difficulty passing urine or bleeding as described.

What are the results of prostate surgery?

Surgery produces rapid and long-lasting in >90% of men.
In about one-third of men who had urgency and bladder overactivity before the procedure these symptoms will persist after surgery.
In some men in whom the bladder muscle is weak, poor emptying of the bladder may persist needing further investigations like urodynamics.
After 10 years, about 10% of men will need a repeat surgery due to regrowth of the prostate gland.

FAQs

Is prostate surgery painful?

Prostate surgery is associated with minimal pain. Discomfort due to the catheter is the most common problem.

How long will I need a catheter?

The catheter is removed in 2-3 days in most patients. If there was a large prostate or more extensive surgery then it may be needed for up to 2 weeks.

When can I return to work?

Once the catheter is removed and your urinary frequency and control are better you can return to work. This takes 2-4 weeks after the surgery.

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