Transurethral Prostatectomy

WHAT YOU SHOULD KNOW:

• A transurethral (trans-u-REETH-rull) prostatectomy (prah-stuh-TEK-tuh-mee) may also be called a transurethral resection of the prostate, or "TURP". This is surgery to remove or freeze part of your prostate (PRAH-stat) gland. "Transurethral" means through the urethra. Your urethra is the tube inside you that drains urine from your bladder to the outside of your body. Caregivers will not have to make incisions (cuts) to remove or freeze your prostate. It will be taken out through your urethra. You may need this surgery if your prostate has gotten too big, or for other problems.
  
  
• The prostate is a male sex gland that is normally about the size of a walnut. It is located in your pelvis, near your bladder (the organ where urine is held). The prostate gland makes semen. Semen is the fluid that comes out of your penis during an orgasm (OR-gaz-um).

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• There are always risks with surgery. You may bleed more than usual, get an infection (in-FECK-shun), have trouble breathing, or get blood clots. Caregivers will watch you closely and treat these problems.
  
  
• You may have problems having sex up to two years after surgery. You may have trouble controlling your urine up to a year after surgery. You may have other problems with your bladder, or problems having bowel movements. If you have cancer, removing or freezing your prostate may not cure it.
  
  
• If you do not have surgery, your prostate may get too big and, it may be hard to urinate. If you have cancer of the prostate and do not have surgery, the cancer may spread. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Before Surgery:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Chest X-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing before your surgery. Caregivers may also use the x-ray to look for signs of infection (in-FECK-shun) like pneumonia (new-MOAN-yuh).
  
  
• Gown: A hospital gown is needed so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.
  
  
• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Pre-Op Care: You may be given medicine right before the surgery, which makes you feel sleepy and more relaxed. You are taken on a cart to the room where your surgery will be done. Caregivers help you get comfortable on the bed. A belt may be put over your legs for safety. If you get cold, ask for more blankets.

• Anesthesia (an-iss-THEE-zuh): This is medicine to make you comfortable during surgery. Caregivers work with you to decide which anesthesia is best and whether you will be awake or completely asleep. Do not sign legal documents for 24 hours after having anesthesia. The medicine may make you sleepy and your thinking unclear. An adult may need to drive you home and stay with you for 24 hours after your surgery. Ask your caregiver for the CareNotes™ handout about the following types of anesthesia if you want more information.
  
  
  • General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
    
    
  • Spinal or epidural anesthesia: This is medicine put into your back to numb you below the waist. With spinal anesthesia, the medicine is given through a shot. Feeling returns in about two hours. Epidural anesthesia is put into your back through a tiny tube. The tube may be left in place to give you more medicine later if needed. After epidural anesthesia, feeling returns to your legs when the medicine wears off.
  
  
  
  • Local or Monitored Anesthesia Care: This is medicine put into your urethra to numb (make you lose feeling in) your penis. You may still feel pressure or pushing during surgery but you should not have pain. With local anesthesia, you will be fully awake during the procedure. With monitored anesthesia care, you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and sleepy during the procedure.
    
    
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• Antibiotics(an-ti-bi-AH-tiks): This is medicine that may be given to help you fight infection caused by a germ called bacteria (bak-TEER-e-uh). It may be given before your surgery to help prevent infection after surgery.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

During Surgery:

• You will be asked to change into a hospital gown. You may be given medicine in your IV to help you relax or make you drowsy. You will be taken on a cart to the operating room. Caregivers may put medicine into your urethra that will make your penis numb (without feeling). You may get medicine called regional anesthesia (an-iss-THEE-zuh) that will numb you below the waist. You may get general anesthesia so that you will be completely asleep. You and your caregiver will decide which type of anesthesia is best for you. You will lie on your back with a sheet covering you during surgery. The area where your upper legs meet your abdomen will be cleaned with soap and water. This soap may make your skin yellow, but it will be cleaned off later.
  
  
• Special fluids may be run through your bladder during surgery. This helps stop blood clots from forming. A caregiver may put a resectoscope (re-SECT-uh-scope) into your urethra. This is a long, thin device with a small loop on the end. It is put in until it reaches your prostate. Caregivers will freeze or remove part of your prostate a little at a time. Prostate tissue may be sent to the lab for tests.

After Surgery: You will be taken to a recovery room where caregivers can watch you very closely. You will be there until you wake up and caregivers can make sure that you are OK. Then you will be taken to your hospital room. You may be able to go home the same day of surgery or the day after. If there are problems you may have to stay in the hospital longer. Do not get out of bed until your caregiver says it is OK.

• Activity: You may need to rest in bed. You may be allowed out of bed once you are feeling better, usually the day of surgery. If you are not allowed out of bed, ask your caregiver if you may exercise your legs in bed. You may do this by lifting one leg off the bed and drawing big circles with your toes. Then do it with the other leg. Call your caregiver before getting up for the first time. If you feel weak or dizzy, sit or lie down right away and call your caregiver.
  
  
• Bowel movements (BMs): This is also called having a stool. Do not strain to have a BM. Straining may cause bleeding. Walking helps to get your bowels moving. It also helps you feel better faster. Foods like fruit, bran, and prune juice can help you have a BM. Drinking water can help too. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular.
  
  
• Catheter (KATH-uh-ter): This is a tube that drains your urine into a bag. The catheter will come out of your urethra (u-REE-thruh). The urethra is the tube inside you that drains urine from your bladder to the outside of your body. The catheter may make you feel like you have to pass urine. Relax and the catheter will do it for you. When the catheter is taken out, you should be able to urinate on your own. Your urine may look red or pink because of blood. This should go away in 2 to 4 days. You may also have a small amount of sand-looking material in the catheter tube or bag.
  
  
  • You may have cramps in your lower abdomen called bladder "spasms" (SPAH-zmz). Pushing like you are trying to urinate may make these worse. Tell your caregiver if you are having bladder spasms. Your caregiver can give you medicine to decrease or take away the spasms. Drinking plenty of fluids can also help decrease spasms. After 1 or 2 days the spasms should decrease or stop completely.
    
    
  • Do not pull on the catheter because this will make you hurt or bleed. Hang the catheter bag on the frame of the bed where it is less likely to be pulled. Do not hang it on the bed rail. Do not kink or lie on the catheter tube because the urine will not be able to drain.
    
    
  • Do not lift the bag of urine above your waist. If you do this, the urine will flow back into your bladder. This may cause an infection.
  
  
• Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Ice: Ice causes blood vessels to constrict (get small) which helps decrease inflammation (swelling, pain, and redness). Caregivers may put crushed ice in a plastic bag and cover it with a towel. A pre-made ice pack may also be used. Place this on your groin or scrotum for 15 to 20 minutes every hour as long as you need it. Do not sleep with the ice pack because you may get frostbite.
  
  
• Intake and Output (I & O): Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Caregivers often call this "I&O".
  
  
  • When you are allowed, drink 6 to 8 (soda-pop can size) glasses of water each day. Follow your caregiverʼs advice if you are on a fluid limit. If you are on I&O, write down and tell your caregiver how much liquid you drink.
    
    
  • If you have a catheter, your caregiver will measure and empty the urine that comes out in the bag. If you do not have a catheter, ask your caregiver if it is OK to flush your urine down the toilet.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Muscle relaxers: This is medicine to help your muscles relax. When your muscles relax, you may move more easily and have less pain.
    
    
  • Pain Medicine: Caregivers may give you medicine to decrease your pain. Tell caregivers if the pain does not go away or comes back.
    
    
  • Stool Softeners: You may be given stool softeners to keep you from getting constipated (KON-stih-pa-ted). Constipation means that you are unable to have a BM for more than 3 days. Stool softeners make your BM softer so you do not need to strain when having a BM.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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