Resection of the prostate is indicated if prostate enlargement is causing blockage of the passage from the bladder to the outside. The male patient would feel symptoms such as urine hesitancy, prolonged time to urinate, needing to push to pee, getting up multiple times at night to pee and having feelings of incomplete emptying after urination. Worsening of prostate obstruction will lead to permanent damage to the bladder so that it will not be able to mount proper contractions in order to expel the urine out, and therefore begin to retain more and more urine. This will lead to higher risk of infections, bleeding, bladder stone formation, and increased back pressure into the kidneys, causing permanent kidney damage.
In order to alleviate the obstruction, a procedure called transurethral resection of the prostate (TURP) is performed. This is a minimally invasive endoscopic procedure in which a patient is brought to the operating room, and either a general or spinal anesthetic is administered by the Anesthesiologist, followed by the Urologist putting a special resectoscope up the urethra into the prostate. Through this special scope, a variety of tools can be manipulated in order to cut the obstructing bits of prostate away and clear a channel to allow urine to flow more easily out of the bladder. An electrified loop of wire, double loop, needle point, Greenlight laser, Holmium red laser, or other forms of energy may be leveraged to resect prostate tissue. The procedure may take anywhere from 20 minutes to 1 hour to complete, and following this, an irrigating catheter is placed into the bladder to rinse out the bladder and prevent clot formation that might block up the foley catheter.
Potential complications of an operation such as this would include: bleeding (either during or after the procedure requiring re-operation), urethral perforation, bladder perforation, urethral stricture formation, urinary tract infection, impotence, and incontinence. One note is the fact that this operation purposefully ablates the internal valve for continence at the bladder neck during the normal course of the procedure. This valve is also responsible for providing the “backboard” by which the ejaculate pushes off of during sex and orgasm. Therefore, without this valve, there is almost 100% chance of temporary or permanent retrograde ejaculation; that is, erections are preserved for sex, normal sensation and orgasm will occur, but little to no ejaculate volume will come out the tip of the penis. Instead, the ejaculate will go into the bladder, and be expelled with the next urination.
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