Prostrate Surgery

Prostrate Gland:

Prostate gland is an exocrine gland of the male mammalian reproductive system. Its main function is to store and secrete a clear, slightly basic fluid that constitutes up to one-third of the volume of semen. The prostate differs considerably between species anatomically, chemically, and physiologically. A healthy human prostate is slightly larger than a walnut. It surrounds the urethra just below the urinary bladder and can be felt during a rectal exam. The prostate gland represents the modified wall of the proximal portion of the male urethra and develops by the 9th week of embryonic life.

In older men, the prostate often enlarges to the point where urination becomes difficult. This is known as benign prostatic hyperplasia and can be treated with medication or with surgery that removes part of the prostate. The surgery most often used in such cases is called transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine.

Prostrate cancer:
Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. Cancer occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms.

Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hypertrophy. These include frequent urination, increased urination at night, difficulty starting and maintaining a steady stream of urine, blood in the urine, and painful urination. Prostate cancer may also cause problems with sexual function, such as difficulty achieving erection or painful ejaculation. Advanced prostate cancer may cause additional symptoms as the disease spreads to other parts of the body. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis or ribs, from cancer which has spread to these bones. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.

Prostate cancer can be treated with surgery, radiation therapy, hormone therapy, occasionally chemotherapy, or some combination of these. The age and underlying health of the man as well as the extent of spread, appearance under the microscope, and response of the cancer to initial treatment are important in determining the outcome of the disease.

Benign prostatic enlargement
The prostate tends to grow as men get older. In some cases, it becomes large enough to put pressure on the urethra, causing problems with urination, such as incomplete emptying of the bladder or dribbling of urine. The condition is known as benign prostatic hyperplasia (BPH). It is not cancer and there is no evidence that it leads to cancer. See the separate BUPA factsheet on Enlarged prostate for further information.

There are a range of treatments for BPH. This leaflet focuses on TURP, which is an operation to remove some or all of an enlarged prostate gland so that urine can flow more freely.

The TURP operation:
A TURP is usually performed under a general anesthetic so that the man is asleep and feels no pain throughout the procedure. Typically, no food and drink is allowed for about six hours before a general anesthetic. However, some anesthetists allow a few sips of water until two hours beforehand. Once the anesthetic has taken effect, the surgeon inserts a thin, tube-like telescope (a resectoscope) into the urethra. The resectoscope includes a camera and specially adapted surgical instruments. This allows the surgeon to see the prostate clearly. A wire loop attachment that carries an electric current is used to "chip away" at the prostate. The same instrument, with a different type of electric current, is used to stem any bleeding.

During the operation, the bladder is flushed with a sterile solution to remove the chippings of prostate tissue. A catheter is then inserted through the urethra into the bladder.

Complications
Complications are unexpected problems that can occur during or after the operation. Most people are not affected. The complications of this operation include excessive bleeding, a urinary tract infection or an unexpected reaction to the anaesthetic. It is also possible for too much water to be absorbed from the fluid used to flush the bladder during the operation. This can temporarily upset the balance of salts in the blood, which can be harmful, particularly for people who already have heart or kidney problems. The condition is sometimes known as TURP syndrome.

Rarely, it is also possible to develop a blood clot (known as a deep vein thrombosis or DVT) in the veins of the leg. This clot can break off and travel to the lungs to cause a blockage. In the majority of cases, this is treatable, but it can be a dangerous condition. People having surgery are routinely given medicines or compression stockings to wear during the operation to help prevent a DVT.

Radical prostatectomy
Radical prostatectomy is surgery that attempts to cure prostate cancer. It is used most often if the cancer is not thought to have spread outside of the gland