Benign prostatic hyperplasia (BPH) is a common condition in older men. As the prostate grows, it can squeeze the urethra and make it hard to pee. You might feel like you need to go all the time, or you might have a hard time starting or stopping your stream. BPH can be a real nuisance.
When medications don’t help, doctors sometimes recommend transurethral resection of the prostate (TURP) surgery. During TURP, a surgeon removes the part of your prostate that’s blocking your urethra. It’s generally effective, but it’s not without risks.
While most men who get TURP surgery for BPH find relief from their urinary symptoms, it’s important to be aware of the potential for long-term problems after TURP surgery. This article explores some of those potential complications and what you can do about them.
Some of the long-term issues that can arise after TURP include retrograde ejaculation (semen flowing backward into the bladder), urinary incontinence (leaking pee), erectile dysfunction (trouble getting or keeping an erection), and urethral strictures (narrowing of the urethra). Fortunately, there are solutions for most of these issues.
Retrograde Ejaculation
One of the most common long-term problems after TURP surgery is retrograde ejaculation. Let’s break down what that means.
What is Retrograde Ejaculation?
Normally, during orgasm, semen travels forward through the urethra and exits the penis. Retrograde ejaculation is when semen flows backward into the bladder instead. Think of it like a train switching tracks at the last minute and going the wrong way.
So, how does TURP cause this to happen? Well, during a TURP procedure, the surgeon shaves away excess prostate tissue to relieve pressure on the urethra. In doing so, they can sometimes damage the bladder neck. The bladder neck is a ring of muscle that normally acts like a gatekeeper, preventing semen from entering the bladder during ejaculation. If that gatekeeper is damaged, the semen can flow backwards.
Impact and Management
The biggest impact of retrograde ejaculation is on fertility. Since the sperm isn’t being released externally, it can make it difficult or impossible to conceive a child through intercourse. That can be a major concern for men who are planning to start or expand their families.
It’s important to note that retrograde ejaculation isn’t physically harmful. It won’t cause any pain or other health problems. However, it can be psychologically distressing for some men. The sensation of orgasm might feel different, and the knowledge that they’re not ejaculating “normally” can affect their self-esteem and sexual satisfaction.
If fertility is desired, there are treatment options available. One common approach is sperm retrieval. This involves collecting sperm from the bladder after ejaculation and then using assisted reproductive techniques like in-vitro fertilization (IVF) to achieve pregnancy.
Prevalence
Retrograde ejaculation is a very common side effect of TURP. Studies show that up to 90% of men experience it after the procedure. That’s a pretty significant number, so it’s important to be aware of this risk before undergoing TURP surgery.
Urinary Incontinence
One of the more common long-term problems after TURP surgery is urinary incontinence. Let’s take a closer look at what that means.
Types of Urinary Incontinence
Urinary incontinence means you leak urine when you don’t intend to. It can be frustrating and embarrassing, but it’s important to understand that it’s a recognized potential complication of TURP.
There are a few different types of incontinence that can happen after TURP:
- Stress incontinence: This is when you leak urine when you do things that put pressure on your bladder, like coughing, laughing, sneezing, or exercising.
- Urge incontinence: This is when you have a sudden, strong urge to pee, and you can’t make it to the bathroom in time.
- Overflow incontinence: This happens when your bladder doesn’t empty completely, leading to frequent dribbling.
Causes and Risk Factors
So, how can TURP lead to incontinence? Well, the surgery can sometimes damage the urinary sphincter, which is the muscle that controls the flow of urine from your bladder. If that muscle is weakened, it can be harder to hold your pee. Sometimes, the surgery can also irritate the bladder or damage nerves that control bladder function.
Some things can make you more likely to develop incontinence after TURP, such as:
- Having bladder problems before the surgery
- Being older
- Having a large amount of prostate tissue removed
Management and Treatment
The good news is that there are things you can do to manage and treat incontinence after TURP.
Sometimes, simple lifestyle changes can make a big difference. These include:
- Pelvic floor exercises (Kegel exercises): These exercises help strengthen the muscles that support your bladder, but for a more advanced solution you can explore an Emsella Chair Alternative to regain control naturally.
- Bladder training: This involves gradually increasing the amount of time between trips to the bathroom to help increase your bladder capacity.
- Lifestyle modifications: Cutting back on caffeine and alcohol can help reduce bladder irritation.
If those measures aren’t enough, your doctor may recommend medications to relax your bladder or tighten the urinary sphincter. In some cases, surgery may be necessary to implant a sling or artificial urinary sphincter to improve bladder control.
Erectile Dysfunction
Erectile dysfunction is one of the possible long-term complications of TURP surgery. Let’s take a closer look at what it is and what you can do about it.
What is Erectile Dysfunction?
Erectile dysfunction (ED) means a man has trouble getting or keeping an erection firm enough for satisfying sex. It’s a pretty common problem, and there are lots of reasons why it might happen.
Potential Causes After TURP
So, how might a TURP procedure lead to ED?
- Nerve damage: Nerves in the area can be damaged during the surgery, and these nerves play a big role in getting an erection.
- Blood flow: The surgery might affect blood flow to the penis, and you need good blood flow for an erection.
- Psychological factors: Dealing with any kind of surgery can be stressful. Anxiety or even depression can sometimes affect your ability to get an erection.
Management and Treatment Options
The good news is, there are things you can do to manage ED.
You might want to start with some lifestyle changes:
- Exercise: Regular physical activity can improve blood flow and overall health.
- Healthy Diet: Eating well can also help with blood flow and overall health.
- Quit Smoking: Smoking can damage blood vessels, so quitting is a good idea.
If lifestyle changes aren’t enough, there are medical treatments:
- Oral medications: Drugs like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can help increase blood flow to the penis.
- Injection therapy: Injections can also help increase blood flow.
- Vacuum erection devices: These devices can help draw blood into the penis.
And, as a last resort, there are surgical options:
- Penile implants: These are surgically implanted devices that can help you get an erection.
Urethral Strictures
Even though TURP surgery is designed to improve the flow of urine, in some instances, it can inadvertently lead to problems with it. One of these is urethral stricture.
What are Urethral Strictures?
Urethral strictures are a narrowing of the urethra. The urethra is the tube that carries urine from your bladder out of your body.
Causes After TURP
So, how could TURP cause this problem? It’s generally due to one of two things:
- Scar tissue formation. The surgery itself can sometimes cause scarring, which then narrows the urethra.
- Inflammation or infection. These can also lead to scarring and subsequent strictures.
Symptoms of Urethral Strictures
If you’re experiencing a urethral stricture, you might notice:
- Decreased urine flow
- Straining when you try to urinate
- Frequent urination
- Urinary urgency (feeling like you really need to go, right now)
- Urinary tract infections
Diagnosis and Treatment
How do doctors figure out if you have a urethral stricture, and what can they do about it?
Diagnosis often involves:
- Urethroscopy. This is where a doctor uses a small scope to look at the urethra.
- Uroflowmetry. This test measures the rate of your urine flow.
Treatment options include:
- Dilation. This involves stretching the urethra with special instruments.
- Urethrotomy. A surgical incision is made to widen the urethra.
- Urethroplasty. This is a surgical reconstruction of the urethra and is usually reserved for more severe cases.
Other Potential Long-Term Complications
While TURP is generally safe and effective, some men may experience long-term complications. Let’s take a look at some of these potential issues:
Bladder Neck Contracture
A bladder neck contracture refers to scarring and narrowing of the bladder neck. The bladder neck is the area where the bladder connects to the urethra. This scarring can lead to urinary obstruction, making it difficult to pass urine.
Symptoms of a bladder neck contracture include difficulty urinating, urinary retention (being unable to empty the bladder completely), and frequent urinary tract infections (UTIs).
Treatment options typically involve incision or resection (surgical removal) of the scar tissue to widen the bladder neck and improve urine flow.
Urinary Tract Infections (UTIs)
UTIs can become a recurring problem after TURP for some men. This is often due to altered urinary flow and incomplete bladder emptying, which can increase the risk of bacteria building up in the urinary tract and causing infection.
Prevention strategies include drinking plenty of fluids to help flush out the urinary system and practicing good hygiene. If a UTI does develop, it’s usually treated with antibiotics.
Prostate Re-Enlargement
Although TURP removes a significant portion of the prostate tissue, there’s a possibility that the remaining tissue can regrow over time. This prostate re-enlargement can lead to a return of urinary symptoms, such as frequent urination, difficulty starting urination, and a weak urine stream.
Management options for prostate re-enlargement include medical therapy with medications to shrink the prostate or relax the bladder muscles, or exploring natural supplements such as Cordyceps for prostate enlargement. In some cases, a repeat TURP procedure may be necessary to remove the excess tissue and alleviate the symptoms.
Frequently Asked Questions
What drinks should I avoid after TURP surgery?
Post-TURP, it’s generally recommended to avoid alcoholic beverages, caffeinated drinks (like coffee, tea, and soda), and acidic juices (such as orange or grapefruit juice). These can irritate the bladder and worsen urinary symptoms.
How do you stop dribbling after TURP?
Dribbling after TURP is common and usually temporary. Pelvic floor exercises (Kegels) can help strengthen the muscles that control urination. Your doctor or a physical therapist can teach you the proper technique. You can also try double voiding (urinating, waiting a few minutes, and then urinating again) to empty the bladder completely.
How to avoid TURP syndrome?
TURP syndrome is a complication that can occur during or after TURP surgery. It’s caused by the absorption of irrigation fluid into the bloodstream. Surgeons minimize the risk by carefully monitoring fluid balance during the procedure and using isotonic irrigation fluids. Newer techniques, like bipolar TURP, also reduce the risk.
What is the gold standard prostate surgery?
While TURP has been considered a gold standard for many years, newer techniques are challenging that notion. Options like laser prostatectomy (HoLEP, GreenLight) and Aquablation are increasingly popular due to their safety profiles and effectiveness. The best option depends on the individual patient and the size/shape of their prostate.
At what age should you not have prostate surgery?
There’s no strict age limit for prostate surgery. The decision is based on the patient’s overall health, the severity of their symptoms, and their life expectancy. Older patients with significant health problems may be better suited for less invasive options or medical management.
Final Thoughts
While TURP surgery is designed to relieve the symptoms of BPH, it’s important to be aware of potential long-term issues, and explore options like Beta-Sitosterol & Saw Palmetto for synergistic BPH relief. These can include retrograde ejaculation, urinary incontinence, erectile dysfunction, urethral strictures, bladder neck contracture, urinary tract infections, and even the prostate growing larger again.
Before you decide to move forward with TURP, it’s essential to have an open and honest conversation with your healthcare provider about these risks and how they can be managed. Understanding what to expect and having a plan for addressing any complications that may arise is crucial for a positive outcome.
The good news is that many of these long-term problems are manageable with the right treatment and lifestyle adjustments. Although complications can occur, TURP can still provide significant and lasting relief from the bothersome symptoms of BPH, ultimately improving your quality of life. Don’t hesitate to discuss your concerns and work closely with your doctor to ensure the best possible results.