A surgical procedure (also called a transurethral prostatectomy) in which obstructing prostate tissue is removed via the penis. A transurethral resection of the prostate is the most common type of surgery for an enlarged prostate, or benign prostatic hypbrplasia (): nine of 10 men who undergo prostate surgery have this procedure. benign prostatic hyperplasia requires treatment only for symptoms that are severe enough to disrupt a man’s life or threaten his health. During an annual prostate examination, if the doctor finds significant symptoms and an enlarged prostate gland, the patient and his doctor may decide to try a program of watchpue waiting. During this time, the physician examines the patient periodically (usually once a year) and may prescribe medication to lessen symptoms. If urination problems become difficult, a prostatectomy may be suggested.

In this type of surgery, no external incision is needed, because the surgeon reaches the prostate by inserting a resectoscope through the urethra, allowing removal of all of the prostate tissue that is bulging into the urethra and blocking the flow of urine. The prostate tissue is removed through the scope and sent to the pathologist for examination.

Recovery

Recovery can require two to eight weeks. During the first weeks after the operation, the patient may experience some of the same symptoms that he had before surgery. Sometime during the first postoperative month the scab inside the prostatic urethra may loosen and cause bleeding. The bleeding usually subsides if the patient increases fluid intake and decreases physical activity. However, if bleeding persists and blood clots are passed, the patient should consult a doctor.

By six to eight weeks after the operation, urination should be easier and less frequent, although nighttime urination may still occur. Generally, the longer the patient had the problem before it was treated, the longer the recovery time. Overall, patients should eat a balanced diet and try to prevent constipation. Straining to have a bowel movement can cause bleeding from the prostate. Patients should not resume sexual activity until the surgeon approves it.

Risks

There is a small chance that a transurethral resection of the prostate may cause conditions that require additional treatment, including uncontrolled urine leakage (very small risk), constriction of the urethra, or the necessity for a second operation at a later date. There is also a small risk of impotence after surgery. However, patients in good health who were capable of having an erection before the operation whose nerves were not affected by the procedure have a good chance of resuming normal sexual activity.

If There Are Cancer Cells

If the pathologist finds cancer cells in the tissue, the cells are graded and the percentage of cells with cancer is assessed. Normally if less than 5 percent of the tissue contains cancer and the Gleason score is low (below 6), the prostate cancer is considered to be insignificant. In this case, patient follow-up requires only an annual digital rectal exam (DRE) and prostate-specific antigen (prostate-specific antigen) level tests. However, if more than 5 percent of the tissue is malignant or the Gleason score is high, the cancer is considered to be potentially aggressive and may warrant further treatment.

Because not all of the prostate tissue is removed during a transurethral resection of the prostate, a man still needs annual prostate cancer screening. Prostate cancer is still a possibility, since surgical procedures such as transurethral resection of the prostate do not remove all of the prostate. A transurethral resection of the prostate does not make prostate cancer spread faster or more easily, but it can affect the risks of future treatment for prostate cancer. Patients who have had a transurethral resection of the prostate have more problems with interstitial seed radiation therapy, and there is a much higher risk of urinary incontinence. However, a radical prostatectomy (removal of the prostate) and external beam radiation treatment can be performed after transurethral resection of the prostate without increased risks.

See also transurethral incision of the prostate (TUIP).

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