What are the alternatives?

• Observation (watchful waiting)

• Medications to improve urine flow

• Permanent catheterisation – especially in patients who, for any reason, are not considered suitable for surgery

• Other surgical procedures

  • Robotic-assisted simple prostatectomy

  • The Urolift™ procedure

  • Rezum steam ablation

  • Laser prostatectomy

  • Prostate arterial embolisation (PAE)

What happens on the day of the procedure?

Dr. Ashrafi will meet with you and discuss the surgery again to confirm your consent. An anaesthetist will see you to discuss the options of a general anaesthetic or spinal anaesthetic. The nursing team will check your details and perform a safety checklist prior to your surgery.

Details of the procedure

• We will do a final safety check

• We will give you an injection of antibiotics before the procedure,

• We put a cystoscope into your bladder through the urethra

• We will remove (“shave”) the central portion of the prostate using electrical energy

• The prostate is removed in small pieces preserving vital anatomical structures

• The tissue is evacuated from the bladder

• Once the prostate has been removed, we carefully cauterise any bleeding points in the prostate cavity

• The prostate tissue will be sent for histopathology

• A catheter will be inserted into your bladder at the end of the procedure

• Bladder irrigation will be used in and out of the catheter to flush through any clots or bleeding

• On average, the procedure takes between 45 & 60 minutes to complete

• You should expect to be in hospital for one to three nights

• We will remove your catheter at an appropriate time after the operation, usually between one day to one week afterwards.

• After the catheter is removed, you may experience the following things

  • You may find it painful to pass urine at first

  • You may urinate more frequently than normal

  • You may feel you can’t hold the urine as well.

  • You may not be able to pass urine temporarily and another catheter may be inserted for a temporary period of time

  • You can have blood in the urine intermittently for up to 6 weeks

Are there any after-effects?

The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not.

• Temporary mild burning, bleeding and frequent urination (almost all patients)

• Retrograde ejaculation: no semen is produced because it passes back into your bladder on ejaculation (70%)

• Treatment may not relieve all your symptoms (10-50%)

• Bleeding requiring transfusion (5%)

• Possible need to repeat the treatment at a later date due to re-growth of the prostate (2-10%)

• Urethral stricture: narrowing of the urethra pipe (2-4%)

• Bladder neck contracture: narrowing of the bladder and prostate junction (2-4%)

• Inability to pass urine after surgery requiring a temporary catheter (2-10%)

• Loss of urinary control which may be temporary or permanent (2-5%)

• Finding incidental prostate cancer in the removed tissue which may need further treatment (2-10%)

• TUR syndrome: irrigating fluid getting into the blood stream and causing confusion, heart problems and/or seizures (<2%)