The prostate gland is part of the male reproductive system. Along with other smaller glands, it produces fluid (also known as semen) that carries sperm and provides them with nutrition.

• The prostate gland is located at the base of a man's bladder. It surrounds the tube that drains urine to the outside of the body (the urethra). It also carries semen, which is released during sexual relations.
• The prostate gland is normally the size of a walnut. Its size usually increases with age. This non-cancerous enlargement is called benign prostatic hyperplasia/hypertrophy (BPH). Infections or tumors can also increase the size of the prostate.
• Because of its location, an enlarged prostate can block the flow of urine from the bladder. This can affect a man's ability to urinate normally.
• Nerves that control erectile function are located on both sides of the gland. These nerves can be damaged by some of the treatments for an enlarged prostate.

A prostate biopsy is needed to determine whether prostate enlargement is due to cancer. BPH is not considered a risk factor for prostate cancer. However, it can cause an elevated level of PSA, which is used to screen for prostate cancer.

A transurethral resection of the prostate (TURP) is the removal of part or all of the prostate gland using a thin tool called a resectoscope. The resectoscope is inserted into the opening at the end of the penis. It allows your doctor to see the prostate tissue that is blocking the flow of urine. The tool can then be used to cut away the prostate tissue.

• A thin, wire loop at the end of the resectoscope is used to cut away prostate tissue. Tissue samples are sent to the lab to be examined for abnormalities, such as cancer.
• An electrical current is used to heat up the wire. This makes the tissue removal easier. It also helps control bleeding by sealing, or closing off, the blood vessels.
• A special catheter (a small, flexible tube) is inserted through the penis into the bladder. This tube drains urine and is also used to irrigate the bladder. The irrigation helps flush out excess tissue, blood clots and fluid. The catheter is usually needed for two to three days after surgery.

There are other less invasive methods of destroying small amounts of prostate tissue. Some of these can be done in a physician office as an alternative to a TURP. Although they may help relieve symptoms of BPH, the procedures are not appropriate for all men with BPH.

BPH is due to a noncancerous (benign) growth of the prostate gland. It is very common in men over the age of 50, and its occurrence increases with age.

• The exact cause of BPH is unknown, but it is felt that hormones are an important factor.
• Men who have a family history of BPH appear to have an increased risk.

There may be no symptoms in the early stages of an enlarged prostate. Some of the symptoms that can develop as the prostate enlarges include:

• Difficulty starting urination or a urine flow that is slower than normal
• Leaking of urine, especially after urinating
• Having to strain to push urine out or difficulty emptying the bladder
• Urinary tract infections

The American Urological Association (AUA) developed the American Urological Association Symptom Score Questionnaire. The questionnaire scores a man's symptoms in order to evaluate their severity. The score can be used to determine the best treatment option and evaluate the response to treatment.

BPH progresses slowly and remains stable in many men. Therefore, your healthcare provider may elect to monitor your symptoms rather than recommend a specific form of treatment, such as medications or surgery.

• Your doctor may schedule yearly exams to monitor the size of your prostate and your symptoms.
• Medications may be added if the symptoms become more bothersome.
• Surgery may be needed if symptoms are severe. Minimally invasive surgery may be an option.

Men with BPH should usually avoid taking decongestants (such as pseudoephedrine), antihistamines (such as diphenhydramine) or any medications that contain a decongestant or antihistamine. Other medications may also make symptoms of BPH worse, so tell your doctor or pharmacist about your BPH before taking prescription or over-the-counter medications.

If you have been diagnosed with BPH, your healthcare provider may recommend a TURP if you have moderate to severe symptoms that are not well controlled with self-care and medication OR you have:

• Inability to urinate (blockage of flow of urine from the bladder)
• Frequent urinary tract infections
• Repeated episodes of a large amount of blood in the urine
• Bladder stones
• Kidney damage

If your healthcare provider recommends a TURP, or other minimally invasive surgery, prior to the surgery you should tell them about any medications you are taking (including over-the-counter medications and supplements). You should also ask about specific instructions you should follow before and after the surgery. These include:

• Medications you should not take before the surgery, such as blood thinners
• Regular medications you should continue to take on the day of your surgery
• What diet should follow the weeks before surgery
• What medicine or prep you will take to clean out your colon for surgery
• How many hours you should stop eating and drinking before the surgery

If you are a smoker, you should quit smoking, as it can interfere with your recovery.

During your surgery, you will receive anesthesia to keep you comfortable and pain free. General anesthesia is the most common type of anesthesia for a TURP. With this type of anesthesia, you are put into a deep sleep and are unable to see, hear or feel anything.

• After surgery, a catheter will be placed into your penis. The catheter allows urine and blood clots to drain from your bladder. It will remain in place for a few days.
• It is normal for urine to be very bloody for several days after the surgery. Large clots are also possible. When you are first out of surgery, the catheter may need to be flushed continuously. As your body heals, it will only need to be flushed every so often as needed.

After discharge, you may need pain medication and help at home while you recover.

Contact your healthcare provider if you have symptoms of BPH. Be prepared to discuss your symptoms and how long you have had them.

• Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
• Make a list of your medications (including over-the-counter).
• Write down any questions, symptoms or concerns you want to talk about.
• If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

What should I ask my healthcare provider before having prostate surgery?

• What is my AUA symptom score and what does it mean?
• Do I need any special tests? What are the benefits and risks of having the tests? Will the tests change your treatment recommendations? If not, is there a need for the test?
• Is observation an option for me? What are my non-surgical treatment options and their side effects?
• What different types of prostate surgery are available? What are the advantages and disadvantages of each one? What is the chance that I'll need a second surgery in the future?
• What are the possible complications to the different surgeries?
• Looking at my age, medical history, personal preferences and other factors, what do you recommend?
• What can I expect if I decide not to have this surgery?
• How will I feel after the surgery? Will I have to modify my activity?
• What is your experience in doing this type of surgery? What is your complication rate?
• Is there any special preparation for the surgery? (If so, get clear instructions on what you need to do.)
• If your healthcare provider wants you to take a medication, ask if an over-the-counter product is right for you.
• If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

Do not forget to arrange for transportation to and from the facility and for help at home.

Before you go home, make sure you understand all home care instructions (including medications and side effects), what symptoms you should report to your healthcare provider after discharge and follow-up plans. Your surgeon should also communicate with your primary care physician.

Source UHC.com

Also known as:

TURP

Transurethral Resection of the Prostate

Removal of Prostate

Prostatectomy

Prostate Removal

Prostate Health

Prostate Enlargement

Large Prostate

Enlarged Prostate Surgery - TURP

Difficulty Urinating

BPH

Benign Prostatic Hypertrophy

Benign Prostatic Hyperplasia