Urinary Control (3)
Transurethral Resection of the Prostate, known as TURP can relieve the following symptoms:
- Slowness in starting
- Poor stream
- Dribbling at the end of passing urine
- Getting up at night to pass urine
- Blood in the urine
- Urinary leakage when coughing or sneezing
- Difficulty in getting to the toilet in time when the desire to go occurs
- Complete stoppage of urine.
The procedure is usually carried out under general anaesthesia and is ideal for flow issues stemming from prostate cancer or benign prostate enlargement.
TURP is carried out with an endoscopic instrument passed up through the opening of the penis and the centre of the prostate gland is removed. It is important to note that the prostate is not completely removed and occasionally symptoms recur as the result of either scar tissue, regrowth of prostate tissue or the development of prostate cancer.
Side Effects
- Approximately 80% of men will find that at the time of ejaculation no sperm comes out. They get much the same feeling but it is a so-called dry ejaculation. This is because a portion of the prostate has been removed and the muscle controlling ejaculation is affected by the surgery. The sperm usually passes out when the man empties his bladder.
This is not harmful. It reduces ability to become a father and is not a guaranteed method of contraception. - Generally a man's potency (ability to get and hold an erection) is the same after the operation as it was before. Only five to 10% of men may have more difficult getting erections after the operation and many treatments available for this.
- Occasionally after the operation urination may become urgent after catheter removal. This usually settles down within the first 24 to 48 hours.
- In some patients, thickening of the healing tissue occurs and this can narrow the opening to the bladder. In such cases, it may be necessary to make a further cut in that scar tissue at a later date. This only occurs in approximately three percent of patients.
TURPS can be carried out in day surgery or as an inpatient.
The sling implant is an innovative, safe and effective surgical solution for mild to moderate stress urinary incontinence in men resulting from prostatectomy.
A sling made of synthetic mesh is placed completely inside your body. The sling places pressure on the urethra, reducing the possibility of urine leakage and providing simple, discreet urinary control. There is nothing for you to manipulate or operate - it works on its own.
Most patients are continent immediately following the procedure and can resume normal, non-strenuous activities within a few days.
The Procedure
Placing the sling is usually performed as an outpatient procedure, which generally lasts approximately 30 to 45 minutes. The procedure may be performed under local or general anesthesia.- - A small incision is made below the scrotum in the perineum
- - Three miniature titanium screws are placed into the pubic bone on both sides of the urethra
- - The sling is positioned so that it places pressure on the urethra and is secured to the screws in the pubic bone
- - The incision is closed.
What to Expect After the Procedure
Recovery from the surgery is usually quick and most men report immediate improvement after the catheter is removed.
Urinary incontinence may occur after any treatment for prostate cancer particularly after surgery. Fortunately it is usually temporary, but occasionally it is permanent. There is less than 1% chance of severe incontinence after surgery and less than 3% chance of mild to moderate incontinence requiring pads after surgery.
The factors that predict the likelihood of urinary incontinence after prostate cancer surgery depend on the technique and experience of the surgeon, the age of the patient and the length of the urethra.
The treatment of incontinence after prostate cancer surgery includes pelvic floor exercises, collagen implants, the use of a proact device at the bladder neck or finally the use of the artificial urinary sphincter.
Pelvic floor exercises are used to increase the speed of recovery by strengthening the pelvic floor muscles. It is important to be shown how to perform these exercises correctly as over exercising tends fatigue the muscle.
Collagen implants have been successful but require multiple injections, often between three and seven and only result in approximately 50% improvement. Implants are not suitable if there is severe incontinence, scarring, a very low leak point pressure or previous radiotherapy.
The proact device is a recent treatment, which involves a minor surgical procedure to place two balloons next to the neck of the bladder. This is undertaken as a day only or overnight stay procedure and often takes up to six months of treatment.
Advance sling is a day procedure that alleviates incontinence. The artificial urinary sphincter is useful for severe incontinence and remains the gold standard for controlling urinary incontinence.
Key aspects
From diagnosis and treatment to rehabilitation and research, I believe my highly experienced team and I bring a multifaceted approach to understanding and helping our patients. A summary of these key aspects of that approach is available here in PDF format. If you are suffering from prostate cancer or have reason to believe you might be, you are welcome to contact us or, intially, complete our comprehensive second opinion form.
