The prostate gland is a thick ring of muscle and gristle that lies between the outlet of the bladder and the penis. It is rather like the bung in the outlet of a home made wine bottle, holding the outflow tube in place. It lies deeply behind the bone in the front of the pelvis (which is the lower part of your abdomen). It makes the fluid that carries sperm. Sometimes the centre of the prostate ring becomes narrow because of overgrowth or scarring. This causes difficulty in passing urine, as well as back-pressure effects on the bladder and kidneys.
The Operation
The back wall of the prostate ring is cut using an instrument passed up the penis. Most patients have a general anaesthetic, so that they are asleep during the operation. It is quite common, however, for patients to be numbed from the waist down with an injection in the back. If this is the case, you will be awake during the operation, but feel no pain. The operation takes about 20 minutes. You will be in hospital for about two days.
Any Alternatives
If you just have a little slowness when passing urine and are having to get up onec or twice at night to pass urine, simply waiting and seeing if you have more trouble is a reasonable idea. If you find your life is being upset by the prostate problem, then treatment is sensible. Drug treatment may be helpful in the short term, but there may be side-effects. A complete blockage definitely needs treatment, at first with a drainage tube (catheter) through the penis or through the lower tummy wall, followed usually with a cut of the back wall of the prostate ring made through the penis.
A formal coring out of the prostate is needed if the gland is over a certain size. Keeping the path through the prostate using short indwelling tubes are experimental. An open operation through the tummy is rarely needed, unless the prostate is very big, or you have some bladder condition such as large bladder stones or a blowout on the bladder wall. Sometimes a permanent catheter with a collecting bag for urine strapped to the leg is the best plan if an operation would be very risky.
Before the operation
Stop smoking and get your weight down. If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
You should be able to return to a light job in one week and a heavy one in two weeks. You may restart sexual relations within a week or two, when the wound is comfortable enough. You may find that at intercourse no liquid comes, and that afterwards you notice milky fluid in the urine. This can happen in up to 80% of cases and is because the widened prostate ring allows the sperm to pass up into the bladder instead of down the penis. You may be sterile. Some men (5-10%) find that after the operation they cannot have sex as well as they could before it.
After - At Home
If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
If you have an anaesthetic injection at the back, there is a very small chance of a blood clot forming on top of your spine which can lead to a feeling of numbness or pins and needles in your legs. Most of the time the clot dissolves on its own and this solves the problem. Extremely rarely, the injections can cause permanent damage to your spine.
In the first 48 hours, bleeding in the urine may be a problem. The medical and nursing staff will deal with this. There is a 5% chance that a blood transfusion may be required because of the blood loss.
Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing an infection. When the catheter is first removed you may notice that you want to pass urine every few minutes. This is normal and passes off in a day or two. Sometimes after removal of the catheter there is difficulty passing urine at all. It may mean replacing the catheter for three days or more. Sometimes after removal of the catheter there is some dribbling or moistness from the penis after passing urine. This improves with time and the improvement can continue gradually for up to three months. However, there is about 1% chance that you may experience mild to moderate urine incontinence in the long term. Ask the surgeon for advice if it is troublesome.
Infection of the urine can give a burning feeling and a need to pass urine every hour or so. This can be tested and treated by the surgical team. Sometimes blood stains the urine again 7 to 10 days after the operation. You should seek medical advice, but the condition settles down.
There is 10-15% chance that the prostate ring becomes narrow again over months or years. If this happens you should seek medical advice. It is most likely you will need another operation to fix the problem.
Possible Complications
If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
If you have an anaesthetic injection at the back, there is a very small chance of a blood clot forming on top of your spine which can lead to a feeling of numbness or pins and needles in your legs. Most of the time the clot dissolves on its own and this solves the problem. Extremely rarely, the injections can cause permanent damage to your spine.
In the first 48 hours, bleeding in the urine may be a problem. The medical and nursing staff will deal with this. There is a 5% chance that a blood transfusion may be required because of the blood loss.
Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing an infection. When the catheter is first removed you may notice that you want to pass urine every few minutes. This is normal and passes off in a day or two. Sometimes after removal of the catheter there is difficulty passing urine at all. It may mean replacing the catheter for three days or more. Sometimes after removal of the catheter there is some dribbling or moistness from the penis after passing urine. This improves with time and the improvement can continue gradually for up to three months. However, there is about 1% chance that you may experience mild to moderate urine incontinence in the long term. Ask the surgeon for advice if it is troublesome.
Infection of the urine can give a burning feeling and a need to pass urine every hour or so. This can be tested and treated by the surgical team. Sometimes blood stains the urine again 7 to 10 days after the operation. You should seek medical advice, but the condition settles down.
There is 10-15% chance that the prostate ring becomes narrow again over months or years. If this happens you should seek medical advice. It is most likely you will need another operation to fix the problem.
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