Where and what is the prostate gland?

The prostate gland is at the base of the bladder and surrounds the urinary passage (urethra). Have a look at the diagram. The function of the gland is to produce some of the fluid which is expressed with ejaculation.

How does the gland cause trouble?

With increasing age the prostate gland enlarges slowly. The increase in size occurs because the gland is stimulated by the male sex hormone (testosterone). Testosterone is produced by the testicles and enlargement of the prostate gland begins at puberty. This slow growth continues in most men as they get older, but only causes trouble when it narrows the urinary passage. The narrowing can become so marked that a man is unable to pass urine at all. In this situation, admission to hospital is usually necessary, and a catheter is passed to empty the bladder. Often however, the obstruction caused by the gland is diagnosed earlier because the man has increasing difficulty in passing urine.

What does a prostate operation do?

The operation removes some of the gland, and thus allows free passage of urine from the bladder to the urethra. If the enlargement of the gland is very marked then it is sometimes necessary to remove the gland by an operation through the lower abdomen. If this is necessary, the skin incision is in the lower abdomen and the stay in hospital will be between 7 and 14 days. After the operation a catheter is left to drain the bladder for 5 to 8 days. There is also another drainage tube through the skin wound, and there will of course be some skin stitches.
However, in most instances, where the prostate is not very large, the operation can be done using a special instrument (called a resectoscope), which is passed along the penis, down the urinary passage. There are no cuts in the skin and therefore healing after the operation is quicker. It is still necessary however, to leave a catheter to drain the bladder for 3 to 4 days. The stay in hospital is usually between 6 and 8 days.

After the operation

There may be bleeding from the prostate cavity after the operation. This results in red discolouration of the urine coming down the catheter. This usually stops after a day or two, but occasionally takes longer. In the first 24 hours after the operation the bladder is continuously washed out, through the catheter. If the urine becomes infected, antibiotics may also be given. It helps to drink plenty of fluids after the operation, to get a good wash-through of the bladder. A common fear is that there will be leakage of urine after the operation. Serious leakage is very rare. It is common for there to be minor leakage for a day or two after the catheter is removed, but this soon stops. There may also be the feeling of a need to pass urine frequently. These problems occur because there is a raw area inside which has to heal up. If there has been long standing blockage of the bladder, the bladder itself may be damaged and take longer to recover. In this case recovery of normal urinary fun ction may take several weeks, but this situation is rare.
It is not uncommon to notice some blood in the urine some 10 to 14 days after the operation. This is caused by the internal healing process and may be aggravated by constipation. This bleeding usually clears up quickly and it helps to drink plenty. In order to try and minimize this bleeding, we recommend that constipation should be avoided and it may be necessary to take a mild laxative.

How soon will the urinary stream improve?

Following the operation there is usually an immediate improvement in the urinary stream, and this improvement may continue for up to 6 months thereafter. You may find that the frequency of urination does not settle down for 2 to 3 months after the operation.

Will the operation affect my sex life?

Sexual intercourse becomes less frequent with increasing age but there is no reason for the prostate operation to end sex life. Removing the prostate gland does not alter erections of the penis or the sensation of orgasm. There is however, one aspect of sex life that is sometimes changed after the operation: Sperm no longer come out with ejaculation but might instead pass back into the bladder. This is nothing to worry about, as it does no harm. Once the operation has healed up having sex will not cause any damage, but it is best to wait for 3 to 4 weeks.

How long before I can go back to work or become fully active?

This depends on how fit you are before the operation. After going home we recommend at least a further 2 weeks of rest and convalescence. It may take 3 months before you feel fully yourself again, so do not be surprised if you feel tired in the first few weeks after getting home.