The operation

Please note that the procedures described here are typical. Nevertheless, how they aply to you may depend on your age and condition, the view of your surgeon and the particular hospital routine.

Just before the operation
You will usually be told the day before when your operation is to be performed. Do not be alarmed if there is a sudden change of plan, as sometimes the operating theatre has to be used for an emergency. Your operation will be booked for the morning or afternoon. This will decide when and how much you are allowed to eat prior to the operation. A morning operation means that you will not be allowed to eat or drink from midnight of the night before. For an afternoon operation you will be given a light breakfast and then nothing to eat after 8.00am. The ‘fasting’ ensures that you have no food in your stomach when the anaesthetic starts working. You may be given written instructions which explain this. You may be given a mild laxative the day before if you are constipated.

Shaving
If you are having an open operation, your lower abdomen, groin and scrotal area will be shaved immediately prior to the operation to reduce the risk of infection. This is not necessary for the TURP prostatectomy.

Premedication
Your ‘pre-med’ will be given either in tablet form or by injection. This will relax you and prevent any sickness afterwards. You will begin to feel drowsy and your mouth may become a little dry. You will be advised to remain lying on your bed after your pre-medication as the drugs may make you unsteady on your feet.

From ward to theatre
Shortly before being taken to the theatre on your bed or a special trolley you will be given a cotton or paper gown to wear. An operation theatre department orderly (ODO or ODA) and ward nurse will take you to the theatre, where the surgeon doing the operation will check your identification. Your anaesthetist will describe how your anaesthesia is being given and what you will feel as it takes effect.

If you are having a general anaesthetic
The type of anaesthesia has been chosen for you in advance. The general anaesthetic is administered by injection into the hand or arm. During the whole operation the anaesthetist will look after you. Soon after the operation you will regain consciousness. A nurse will give you something to take away ay nausea you might experience if you need it. Some patients require oxygen by mask to help recover from a general anaesthetic. It may be up to 4 hours or so before you may take sips of water, increasing to fee fluids and the food, according to what you can tolerate. This gradual return to drinking and eating is to prevent nausea or vomiting due to the remaining anaesthetic in your system. The next day you should be able to manage food.

If you are having a spinal or epidural anaesthetic
You may have remained awake during the operation, or requested additional sedation to make you sleep. When you are back on the ward the power and feeling in your legs will return slowly and you will experience pins and needles. By the next day you will be completely normal.

Just after the operation
You will wake up either in the recovery room or on the ward, where a nurse will take your temperature and regularly check your blood pressure and pulse. Most TURP patients are able to sit up an hour or so after the operation. The first thing you will notice is a large bag of clear fluid above your bed. A plastic tube is attached to the catheter inserted up your penis. The drip inserted into your arm is there to provide your body with all the necessary body fluids and nutrients until you are able to eat and drink. This will probably be removed the following day.

The catheter inserted up the penis extends into the bladder. It is held in place by a small balloon in the bladder. It has a bag attached to the end to collect the blood and urine.

During the operation an area inside the body is cut. This has to heal, and while healing the body is likely to bleed. The catheter acts as a flushing system, allowing fluid to be passed up through the bladder to cleanse it. Do not be alarmed if you see blood (coloured like red wine) in the catheter bag; this is normal. The catheter also enables urine to pass out of the system. While the catheter is in place you may feel that your bladder is full. This is also quite normal and you will realise that urine is flowing out of the bladder automatically along the catheter all the time, without any need to strain.

Will it hurt afterwards?
Pain is very unusual. If you experience any your nurse will give you some painkillers. The catheter is not painful bat it is sometimes a little uncomfortable. During the first days a clot of blood may block the catheter. The bladder will be full and you will have an intense desire to empty it, but urine will be unable to flow out. If you think this has happened tell the nurse. A doctor or nurse will then flush the catheter with a syringe to clear it. If your catheter feels uncomfortable it may need to be re-adjusted. Please tell your nurse if this is the case.

If you have had an open prostatectomy
When you return to the ward, you will find that the nurse will check your wound dressing. This is common to all operations and allows the staff to check that everything is in order with your recovery. You may get tablets (usually paracetamol) or a pain-killing injection if you need it. Don’t hesitate to tell the nurse if you are experiencing pain.

Catheter care
Avoid infection by keeping your catheter clean. Wash your penis under the foreskin and around the catheter, where it enters the penis, with soap and water morning and evening. You may bath or shower with your catheter and bag attached.

Removal of the catheter
You should walk around the ward with your catheter on its stand as soon as possible after the operation. It is advisable to keep moving your legs from time to time when lying down.

When the drain bag becomes clear, usually after 2-3 days, the catheter is removed. The balloon inside the bladder is deflated and the tube slides out through the penis. This may cause some discomfort.

It may take a while to control your urine flow immediately after removal of the catheter. You may feel a constant urge to urinate, and may also have leakages. You may also find that you dribble. Do not worry, this is normal and will improve with time. You will still be seeing blood or small clots in your urine. Again this is perfectly normal until the internal wound has healed. You may experience some burning or stinging when urinating.

You will be encouraged to drink 2-3 litres of fluids per day. Do not restrict your fluid intake because you are worried about leaking.

You may be asked to use a bottle to collect your urine so that the volume can be recorded, and to supply a small specimen to check for infection before being sent home.

Leaving hospital
Once you have gained sufficient control over your bladder (usually within 4-7 days) you will be allowed home. Your urine will still be slightly pink. If possible try to arrange for someone to drive you home. If not the hospital can arrange transport.