Prostate operation: pros and cons

Prostate operation: pros and cons

As men reach middle age they experience growth of the prostate. The prostate is a walnut-sized gland situated just under the bladder and is used to make seminal fluid (which is mixed with sperm to make semen).

This article on the prostate operation is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

As it grows, the prostate may press against the urethra and cause symptoms such as difficulty urinating, incomplete emptying of the bladder, and dribbling of urine. The condition is called benign prostatic hyperplasia (BPH) and affects about a third of all men over 50 years.

Non-surgical treatments

If you are diagnosed with BPH, there are a number of treatment options to consider before having a prostate operation:

• Medicines – alpha-blockers such as Doxazosin improve the flow of urine and shrink the prostate by relaxing smooth muscle fibres.
• Heat therapy – transurethral electro vaporisation of the prostate (TUVP) uses microwaves, lasers, or an electric current to destroy excess prostate tissue.
• A stent – a short tube inserted into the urethra to improve the flow of urine, although it can become blocked again over time.
• Herbal remedies – such as saw palmetto may be helpful, although there is conflicting evidence over its effectiveness.

Surgical treatments – prostate operations

If the symptoms are severe or you have serious complications (such as kidney damage caused by urine backing up or the inability to urinate at all), you may be recommended for a prostate operation straight away. There are three main types of prostate operation:

• TURP (transurethral resection of the prostate) - is the most common operation for BPH and is done under a general anaesthetic. A long thin camera, known as a resectoscope, is passed into the urethra to give the surgeon a clear view of the prostate. An electric current is then applied to shave off sections of the enlarged gland.
• TUIP (transurethral incision of the prostate) - is performed on less severe cases, under a general or spinal anaesthetic. Instead of removing a portion of the prostate, small cuts are made in the neck of the bladder and prostate, to improve the flow of urine.
• Open prostatectomy - is only used on men whose prostate is very large. It is a major operation in which an incision is made in the lower abdomen to remove the central part of the prostate.

Benefits of a prostate operation

With a long track record of success, TURP is suitable for all but the largest prostates. Unlike non-invasive treatments, surgery is guaranteed to physically reduce the size of the prostate gland and/or improve the flow or urine, bringing long-lasting relief from symptoms.

Negative Effects of Prostate Surgery

Short-term

There are unwanted, but usually temporary, side-effects after having a successful procedure. For instance, you may feel sick as a result of the general anaesthetic and experience discomfort from the catheter. The following are specific side-effects of prostate surgery which usually clear up after a few days:

• Blood in the urine
• An urgent need to pass urine
• A burning sensation when urinating
• Mild incontinence (urine leakage)

Long-term

Many men suffer from dry orgasm after a prostate operation, known as retrograde ejaculation, where very little, or no, semen is ejaculated. This happens because the muscle that closes the bladder neck during ejaculation has been removed along with the obstructing prostate tissue. As a result, semen enters the bladder instead of being expelled through the penis. Studies estimate that 74% of men experience this condition after having TURP, however most return to normal levels of sexual activity after a full recovery from the operation. Retrograde ejaculation affects fertility but not sexual pleasure.

Prostate surgery has also been linked with erectile dysfunction and urinary incontinence, although it’s possible these conditions would have affected them anyway without undergoing surgery.

Finally, the benefits of surgery are long lasting, but because only part of the prostate is removed some men may eventually need another operation.

Complications

On rare occasions, unexpected complications can occur during or after the prostate operation. These include:

• Excessive bleeding
• A urinary tract infection
• Pain when urinating
• A reaction to the anaesthetic
• The balance of salt of in the blood may be upset, which is harmful for people with existing heart or kidney problems
• A blood clot, known as deep vein thrombosis (DVT), may form in the leg and travel to the lungs – a dangerous but treatable condition