Things to watch out for after transurethral resection of the prostate

Author: Wang Weifu, Chief Physician, Hainan Provincial People's Hospital

Reviewer: Zhao Shanchao, Chief Physician, Nanfang Hospital, Southern Medical University

Prostatic hyperplasia is a common disease in middle-aged and elderly men. Transurethral resection of the prostate has the advantages of less bleeding, quick recovery after surgery, and significant effect. It is a commonly used surgical method to treat this disease. However, it is very easy to have a variety of complications after surgery. If not handled properly, it may affect the patient's quality of life. So, what common complications will patients experience after this operation? What are the precautions?

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1. Beware of these three postoperative complications

In general, patients need to be alert to the following three common complications after surgery:

1. Postoperative bleeding

After transurethral resection of the prostate, patients are prone to hematuria, and the causes of postoperative bleeding are:

(1) Bladder spasm: After transurethral resection of the prostate, factors such as compression by the three-chamber balloon catheter, coagulation in the bladder, and surgical trauma can stimulate the bladder and cause bladder spasm. If it is not relieved for a long time, it will cause congestion and edema of the blood vessels in the bladder wall mucosa, and then cause bleeding.

(2) Constipation: For patients suffering from diseases such as constipation, hemorrhoids, dry stools, and difficulty in defecation, if they exert too much force during defecation, squat or sit for too long, the prostate will become overly congested and abdominal pressure will increase. The blood vessels in the prostate wound will reopen after surgery, which will induce bleeding.

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(3) Urinary and reproductive system infection: Patients may suffer from retrograde infection due to urine reflux after surgery, resulting in complications such as cystitis and epididymitis, which will increase wound healing time and induce delayed bleeding.

(4) Excessive activity: If the patient moves too early or too much after surgery, the wound will be stretched and squeezed, causing the eschar on the prostate wound to fall off and cause bleeding.

(5) Other situations: Some elderly people with poor immunity (over 60 years old) and patients with some underlying diseases (diabetes, coagulation dysfunction, etc.) are prone to postoperative bleeding.

2. Difficulty urinating

Some patients will experience urination difficulties after the catheter is removed after surgery, while others will experience urination difficulties about 1 month after surgery. There are several reasons for urination difficulties.

(1) Urethral stenosis/obstruction: This is related to the physiological structure of the human body. The urethra has two main narrow parts, namely the external urethral orifice and the membranous urethra. If the patient has a urinary tract infection or diabetes after surgery, as well as a history of long-term indwelling catheter, it will aggravate local urethral tissue edema and urethral mucosal injury and bleeding.

In addition, 2 to 3 weeks after the operation, the glands that were cut during the operation will become necrotic, the coagulated tissue will fall off, and eventually lead to urethral obstruction.

(2) Bladder neck edema and contracture: If the patient has an indwelling catheter for too long, the balloon is compressed too tightly, or the urethra is inflamed, it will cause bladder neck edema. Bladder neck contracture may be caused by postoperative scar contracture or combined with bladder neck fibrosis.

(3) Glandular residue: During surgery, the surgeon may be afraid of cutting through the capsule or damaging the external sphincter, so a small amount of glandular residue may be left in the prostate capsule or at the apex of the gland.

(4) Dysfunction or loss of bladder contraction function: such as abnormal bladder function, detrusor muscle weakness, long-term chronic urinary retention, recurrent cystitis, and connective tissue replacing bladder muscle tissue.

3. Retrograde ejaculation and "dry sperm syndrome"

After the operation, some patients will feel that their sexual life is not as good as before or even that no semen is ejaculated. This is because when treating the hyperplastic glands, transurethral resection of the prostate will also remove the annular fibrous tissue of the internal urethral sphincter of the bladder neck, thereby destroying the integrity of the bladder neck and causing abnormal closure of the bladder neck during ejaculation. Therefore, when patients who undergo transurethral resection of the prostate ejaculate, the semen is not ejaculated through the urethra, but retrogradely ejected into the bladder. If the patient feels that there is a problem with his sexual life after the operation, it is recommended to take the first urine after ejaculation during sexual intercourse for testing to check whether there are sperm in the urine. If no sperm is found after three consecutive tests, it is considered to be "dry sperm syndrome."

2. Be careful about prostate cancer after surgery

Some patients may be found to have concurrent prostate cancer in postoperative pathological examinations, or develop prostate cancer several years later. The reasons may be:

Prostate hyperplasia and prostate cancer both occur in the prostate gland and are more common in older men, so some patients have both. Clinically, doctors call it "incidental prostate cancer."

2. Both prostate hyperplasia and prostate cancer occur in the prostate, but the main lesions are located in different locations. The prostate is divided into the peripheral zone, central zone and transitional zone. Prostate hyperplasia is more likely to occur in the transitional zone, while prostate cancer is more likely to occur in the peripheral zone. The prostate tissue removed during prostate hyperplasia surgery is mostly transitional zone tissue, not peripheral zone tissue.

3. Pathological samples after prostatectomy for prostate hyperplasia are limited, and examinations often use non-continuous sections, which may lead to missed diagnosis of prostate cancer that already exists in the transition zone.

3. What should you pay attention to after surgery?

After being discharged from surgery, patients with prostatic hyperplasia should pay attention to the following matters:

1. After the urinary catheter is removed and the patient is discharged from the hospital, the patient may experience transient urinary incontinence, which generally recovers on its own in 1 to 3 months, so there is no need to worry. If the patient has severe urinary overflow or urinary incontinence, pelvic floor muscle exercises can be performed under the guidance of a doctor to restore urinary control function as soon as possible.

Pelvic floor muscle exercise method: The patient can lie down, stand or sit, and try to urinate or defecate. First, slowly tighten the anus, then contract the urethra to lift the pelvic floor muscles, and keep the thigh and abdominal muscles relaxed. Each contraction should be no less than 5 seconds, and the relaxation time should be 10 seconds. Repeat 10 times, 5 times a day.

2. 1 to 3 months after surgery, patients should avoid sitting for long periods of time, lifting heavy objects, and strenuous activities such as running and cycling, and should also avoid sexual intercourse. In addition, if patients experience constipation after surgery, it will cause increased abdominal pressure and lead to bleeding. Therefore, in addition to dietary adjustments, patients can use laxatives (such as enema) to keep bowel movements smooth when necessary to prevent secondary prostate bleeding.

3. Patients may have a small amount of hematuria when urinating after surgery, so there is no need to worry too much. However, if there is a large amount of hematuria, accompanied by blood clots, or even blood clots blocking the urethra and causing urinary retention, you must go to the hospital for treatment in time.

4. Patients may experience urethral stenosis/obstruction after surgery. If the urine stream gradually becomes thinner or even difficulty urinating occurs, they should go to the hospital for treatment in time.

To sum up, prostate patients should pay close attention to changes in their bodies after surgery. If they feel unwell, they must seek medical attention in time.