A letter from Dr. Lawrence Tsai on his departure from the practice. Read Message | Want to know five simple ways to improve your health now? Join our newsletter:
Throughout a man’s life, his prostate may become larger and begin to cause problems as he ages.
Dr. Shaw starts off with a simple questionnaire to understand your symptoms. Sometimes, the solution is simple, with a few dietary and lifestyle adjustments.
For others with more moderate symptoms, it still may be as easy as take a small tablet in the evening to shrink or relax the prostate. Symptomatic relief can be as fast as overnight for some.
For others with a significantly enlarged prostate that squeezes the urine tube, much like stepping on a garden hose, surgery may be required. But rest easy, the surgery is much easier than it was just a few years ago! The advance of lasers and other techniques often makes this an outpatient surgery.
There are generally a few types of men who really need surgery:
There are many names for this procedure, the correct one is TURP, or Trans-Urethral Resection of Prostate. Some however, may joke that their grandfather had a ‘roto-rooter’! Regardless, this is the same procedure that has been done for decades, however the technology and outcomes have markedly improved.
No incisions! That’s the good part. The entire procedure is done under general anesthesia (asleep) via the urethra (penis). We now utilize state-of-the-art high definition cameras to visualize the prostate. We then use either plasma-vaporization or lasers to basically remove the obstructing tissue of the prostate that squeezes the urethra as it passes through the bladder.
The best way to think of the prostate is an orange that sits under the bladder. The urethra passes like a straw, right down the middle of the prostate (orange) into the urethra. When younger, the prostate is responsible for the secretion of ejaculate. It has nothing, however, to do with sexual desire, erections, testosterone, or sperm (from testicles). As one ages, the prostate (orange) grows and squeezes the urethra (straw) that goes down the middle of it. When medicines can no longer relax the prostate to allow urine to pass freely, surgery (TURP) can easily remove much of the blocking/obstructing prostate tissue (pulp of the orange) to allow for a much better urinary flow.
TURP is usually performed in the hospital or outpatient surgical center and takes approximately 1 hour.
Depending on your prostate size a variety of options are available. Dr. Shaw prefers the Gyrus, plasma-kinetic system, which combines the best qualities of the gold-standard TURP with the advantages of a lower energy device that seals blood vessels comparably to laser technology to achieve superior results.
Common, but difficult to answer, as different folks will ‘grow’ their prostate at different rates, just like the hair on our head. Literature supports that most people will have at least 7+ years of benefit, at which point 15% of people may need a repeat procedure. Looking at it another way, for 85% of people, this will be the only procedure needed.
Erections are not affected. For some people with severe prostate enlargement, they actually tell us erections improve.
There may be some changes in ejaculation. Because the prostate cavity is enlarged after surgery, semen or ejaculate can not only go forward, as it usually does, it can ‘hiccup’ back into the bladder, where it is urinated out after ejaculation. For many people, ejaculation is not affected, whereas other patients may simply note a reduction or loss of ejaculate volume. Again erections are not affected, just ejaculate. Orgasms are not affected.
Usually, Dr. Shaw will have you finish up your current prostate medications, and then stop them (don’t refill). This is the great thing about the surgery – you can stop one or more medications for your prostate! Not only that, but most people state that their urination is vastly improved with medications alone.
It is critical that you stop any Aspirin, Coumadin, Plavix, or other blood thinners one week before. Please, call our office should you have any questions about this.
The night before your procedure, you may eat and drink as usual. However, do not take anything by mouth after 12:00 midnight the night before. Wear comfortable, loose-fitting clothing like a jogging suit on the day of your procedure. Bring a list of all the prescription and nonprescription medications that you take regularly with you on the day of the procedure.
Please plan to arrive two hours prior to your treatment.
The TURP usually takes approximately 1 hour, and Dr. Shaw will come and speak to your family afterwards.
Upon waking from the procedure, you will have a catheter draining your bladder. We have yet to meet a man who likes having a catheter, but relax, the catheter typically will remain for 48 hours and then be removed in the clinic.
It is common for the catheter to drain pink or red urine. Just as Kool-Aid can turn water red with just a small amount of coloring, just a small amount of blood turns the urine red. If there are clots, or more significant blood in the urine, Dr. Shaw may opt to keep you in the hospital overnight and discharge you in the morning.
You will be given full instructions from our nurse on how to manage, and drain the foley catheter bag when it gets full.
It is not unusual to have a sensation of wanting to urinate, or to have bladder spasms after surgery. This usually goes away within 1-2 days. You may occasionally notice a small amount of urine leak around the catheter, and this is normal.
After the procedure, patients may have a variety of minor issues. Although many patients may do fine with no issues, some patients may experience minor, temporary issues such as noticing burning with urination, frequent urination, small clots, or pink/red colored urine, or occasional discomfort that radiates from the kidney to the bladder. Again, these usually tend to be minor issues, and resolve within 1-2 days after the procedure.
Definitely rest up for a day or two after a TURP. Drink at least 6-8 glasses of water to wash out your system. Within a day or two, your urine will begin to clear up and look normal.
For pain, Advil®, Motrin® or prescription Toradol® work great – dependent upon your doctor’s advice. Never take a medication without clearing it with your doctor first. These are non-narcotic, so you don’t get sleepy, constipated or have other issues; however, they are great anti-inflammatories. Take them on a regular basis the first 2-3 days after the procedure. For pain not relieved by these medications, use the prescription Tylenol with Codeine or Vicodin that was prescribed for you. We may also occasionally give you a few days of bladder spasm medication.
Do not strain when having a bowel movement. Expect irregular bowel habits until fully recovered. Increase fiber in your diet. You may need a stool softener or laxative.
Do not take blood thinners or aspirin products for one week or as directed by your physician.
Take it easy for the first 48 hours after the procedure. Do not drive or operate dangerous equipment for 48 hours following anesthesia. You may be able to resume non-strenuous activities after 48 hours unless otherwise directed by your physician. Avoid strenuous exercise, heavy lifting greater than 20 pounds, bike riding, and yard work for two weeks, as the vibrations and movement may cause bleeding. No sexual activity for two weeks after surgery.
You will need a catheter to drain your bladder depending upon the extent of your surgery. Catheters are generally removed within 24 to 48 hours in the Urology Clinic. Wash around the catheter with soap and water and rinse well. You may shower, but avoid baths until the catheter is removed.
Avoid coffee, tea, carbonated beverages, alcoholic beverages, citrus juices, spicy foods and smoking for the first month following surgery.
Increase your intake of fluids, particularly water – 24 to 48 ounces over your usual daily fluid intake is typically recommended during the first two weeks of your recovery.
You may experience urinary urgency and/or frequency for the first month following surgery. This is normal. Talk to your doctor to discuss medications that may relieve this. You may have a small amount of bleeding with urination on occasion. This may be accompanied with small blood clots. This is normal, and should be relieved by increasing your fluid intake. You may experience some mild burning and discomfort during urination. This is normal and should subside in one to two to four weeks.
Usually, Dr. Shaw or his staff will communicate to you a desired follow-up time frame. Please call us the day after the procedure to verify a time to see us in the office, and to remove your catheter.
Time to celebrate! Once your catheter is removed, you’re on the road to recovery. Just as you won’t run right after knee surgery, have patience as your bladder and prostate gradually heal from surgery. Immediately after surgery, you may have an urge or frequent need to urinate, or have some burning with urination. On occasion, you may pass some small debris or clots in the urine, but rest assured, this WILL gradually all disappear. Most patients report a 50% improvement in symptoms within one month of surgery and 90-100% within 3-6 months postoperatively. This is largely dependent on how severe symptoms were prior to surgery. The good news is that you’ll be happy that you chose surgery, just be patient with your road to recovery!
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