TURP: trimming an enlarged prostate through the urine tubeTURP: peshab ki nali ke raaste barhi hui prostate ko chhota karna

Yeh kya hai aur kyun kiya jata hai

Jab prostate barhti hai to woh urethra ko, yani us nali ko jo bladder se peshab bahar le jati hai, dabati hai aur peshab karna mushkil ho jata hai. TURP mein aik patli doorbeen jise resectoscope kehte hain, urethra se guzar kar prostate tak pohanchayi jati hai. Us ki nok par bijli wala taar ka halqa rukawat dalne wale tissue ko thora thora kaat kar nikalta hai aur peshab ke liye chora raasta ban jata hai.

TURP aam tor par us waqt tajveez ki jati hai jab dawayein kaam na karein ya munasib na hon, ya jab barhi hui prostate se masail paida ho jayein jaise peshab bilkul na aana (retention), baar baar peshab ka infection, bladder ki pathri, prostate se khoon aana, ya gurdon par zor (dekhein barhi hui prostate ki guide aur urinary retention ki guide).

Aap ka urologist pehle rukawat ki tasdeeq ke liye tests kar sakta hai, jaise peshab ke bahao ka test (uroflowmetry). Laser operation isi masle ka doosra ilaaj hain (dekhein laser prostate surgery ki guide).

Procedure se pehle

• Pehle peshab ka test hota hai. Peshab ke infection ka operation se pehle ilaaj hota hai (dekhein peshab ke tests ki guide).
• PSA aur doosre tests: pehle PSA khoon ka test, aur kabhi scan ya camera test, ho sakta hai. Pehle ke nateeje saath layein (dekhein PSA test ki guide).
• Khoon patla karne wali dawayein aur kisi bhi allergy ke baare mein team ko batayein. Apne taur par koi dawa band na karein. In dawaon ko operation ke aas paas ehtiyaat se tay karna padta hai.
• Bay-hoshi: TURP spinal anaesthetic (kamar mein injection jo jism ka neeche ka hissa sunn kar deta hai) ya poori bay-hoshi mein hota hai. Team batayegi ke aap ke liye kaun si behtar hai. Khaane peene ke baare mein jo hidayaat milein un par amal karein.
• Aap se razamandi (consent) maangi jayegi. Faisla karne se pehle manyi (ejaculation), khaas hissay ki sakhti aur peshab par qaboo par asar ke baare mein zaroor poochhein.
• Qeemat, operation kahan hoga aur kitni raatein hospital mein rehna hoga, yeh bhi poochh lein.

Procedure ke dauran

Anaesthetic ke asar ke baad resectoscope urethra se guzar kar prostate mein jati hai. Nazar saaf rakhne ke liye saaf paani musalsal chalta rehta hai. Surgeon prostate ko andar se kaat'ta hai, rukawat dalne wala tissue nikalta hai aur kaam ke dauran chhoti khoon ki nalion ko seal karta hai.

Tissue ko bladder se dho kar nikala jata hai aur aam tor par laboratory bheja jata hai taake us ka muaina ho. Aakhir mein urethra ke raaste bladder mein catheter (patli nali) rakhi jati hai. Khoon dhone aur nali saaf rakhne ke liye aik din ke qareeb us se paani chalaya ja sakta hai.

Procedure ke baad aur recovery

Hospital mein

• Catheter aik do din rehti hai, aur kabhi zyada. Peshab shuru mein gulabi ya surkh hota hai, aur pehle aik do din mein aam tor par saaf ho jata hai.
• Bladder ke spasm (aithan aur peshab ki hajat ka ehsaas) catheter ke dauran aam hain. Nurses ko batayein, woh madad kar sakti hain.
• Zyadatar mard aik do raatein hospital mein rehte hain. Team aap ko batayegi ke aap kab ghar ja sakte hain.

Ghar par

• Bohat paani peeyein, siwaye is ke ke aap se kam karne ko kaha gaya ho. Is se peshab saaf rehta hai.
• Peshab mein jalan, zyada baar peshab aana aur achanak hajat kuch haftay tak aam hai jab tak prostate theek hoti hai. Peshab mein kabhi kabhi khoon aata jata rehta hai.
• Qabz aur zor lagane se bachein. Is se khoon shuru ho sakta hai. Rayedar ghiza khayein aur zaroorat ho to qabz ki halki dawa ke baare mein poochhein.
• Khurand (scabs) aik se teen haftay baad alag ho kar naya khoon la sakte hain. Aaram karein aur paani peeyein. Agar khoon zyada ho ya peshab na aaye to fauran madad ka dabba dekhein.
• Sargarmi: roz chalein, lekin kayi haftay tak bhaari wazan uthane aur zor wali kasrat se parhez karein, jaisa mashwara ho. Gaari, kaam aur jinsi taluq ke baare mein team se poochh lein.
• Fayda aahista aahista barhta hai. Soojan utarne ke saath peshab ki dhaar aam tor par kuch haftay mein behtar hoti hai.

Mumkina khatrat

• Aam: peshab mein khoon, kuch haftay tak jalan aur zyada baar peshab aana, aur khushk manyi (dry ejaculation) jise retrograde ejaculation kehte hain. Zyadatar mard isay mehsoos karte hain: manyi bahar aane ke bajaye bladder mein chali jati hai, aur yeh nuqsandeh nahi hai. Is ka matlab hai ke aap aam tareeqe se aulad paida nahi kar sakte, is liye agar aap mazeed bachon ki khwahish rakhte hon to pehle se baat karein.
• Kam aam: peshab ka infection, khoon jis ke liye dobara dhulaayi ya catheter zyada der rakhni pare, khoon ka lothra jo catheter band kar de, aur thori der ke liye peshab ka reesna.
• Ghair aam: baad mein peshab ki nali ya bladder ki gardan ka tang ho jana, khaas hissay ki sakhti mein masla, aur prostate dobara barhne ya pehla operation kaafi na hone par doosre operation ki zaroorat.
• Bohat kam: dhone wala paani zyada jism mein jazb ho jana (TUR syndrome), peshab par qaboo ka lambay arsay ke liye khatam hona, taang ya phephre mein khoon ka lothra, ya anaesthetic ke khatrat.

Follow-up aur nateeje

• Tissue ka nateeja: nikala gaya tissue laboratory bheja jata hai. Bohat kam kabhi koi chhota cancer nikal aata hai jis ki kisi ko umeed nahi hoti. Poochh lein ke nateeja kab aur kaise bataya jayega, aur yaqeeni banayein ke aap ko mile (dekhein prostate cancer ki guide).
• Follow-up visit: aam tor par kuch haftay baad dekha jata hai ke aap kaisay peshab kar rahe hain. Bahao ka test ya bladder scan dobara ho sakta hai (dekhein uroflowmetry ki guide).
• Agar alamaat dobara aayein mahinon ya saalon baad to apne urologist ko dikhayein. Tangi ya dobara barhne ka kabhi ilaaj ho sakta hai.

Aam sawalaat

What it is and why it is done

As the prostate enlarges it can squeeze the urethra, the tube that carries urine out of the bladder, and make it hard to pass urine. In TURP a thin telescope called a resectoscope is passed along the urethra to the prostate. A wire loop at its tip, carrying an electric current, trims away the blocking tissue a little at a time, leaving a wider channel for the urine to flow.

TURP is usually offered when medicines have not worked or are not suitable, or when the enlarged prostate has caused complications such as being unable to pass urine (retention), repeated urine infections, bladder stones, bleeding from the prostate, or strain on the kidneys (see the enlarged prostate guide and the urinary retention guide).

Your urologist may do tests first to confirm the blockage, such as a flow test (uroflowmetry). Laser operations are an alternative way of treating the same problem (see the laser prostate surgery guide).

Before the procedure

• A urine test is done first. A urine infection is treated before the operation (see the urine tests guide).
• PSA and other tests: a PSA blood test may be checked first, and sometimes a scan or camera test. Bring your earlier results (see the PSA test guide).
• Tell the team about blood thinners and any allergies. Please do not stop any medicine on your own. These medicines usually need careful planning around the operation.
• Anaesthetic: TURP is done under a spinal anaesthetic (an injection in the back that numbs the lower body) or a general anaesthetic. The team will explain which is best for you. Follow the instructions about eating and drinking.
• You will be asked for consent. Please ask about the effect on ejaculation, erections and bladder control before you decide.
• Ask about the cost, where it will be done and how many nights you will stay.

During the procedure

With the anaesthetic working, the resectoscope is passed along the urethra into the prostate. Clear fluid runs through it continuously to keep the view clear. The surgeon trims the prostate from the inside, cutting away the tissue that blocks the flow and sealing the small blood vessels as the work goes on.

The tissue is washed out of the bladder and is usually sent to the laboratory to be examined. At the end, a catheter (a thin tube) is placed in the bladder through the urethra. Fluid may be run through it for a day or so to wash out blood and keep it clear.

After the procedure and recovery

In hospital

• The catheter stays in for a day or two, and sometimes longer. The urine is pink or red at first, and usually clears over the first day or two.
• Bladder spasms (cramping and a feeling of needing to pass urine) are common while the catheter is in. Tell the nurses, as they can help.
• Most men stay in hospital for a night or two. The team will tell you when you can go home.

At home

• Drink plenty of water unless told otherwise. This keeps the urine clear.
• Burning, passing urine more often and urgency are common for some weeks while the prostate heals. Some blood in the urine may come and go.
• Avoid constipation and straining. This can start bleeding. Eat fibre and ask about gentle stool softeners if needed.
• Scabs can come away about one to three weeks later and cause some new bleeding. Rest and drink water. See the urgent help box if the bleeding is heavy or you cannot pass urine.
• Activity: walk daily, but avoid heavy lifting and strenuous exercise for several weeks, as advised. Ask the team about driving, work and sex.
• The benefit builds up gradually. The stream usually improves over a few weeks as the swelling settles.

Possible risks

• Common: blood in the urine, burning and passing urine more often for some weeks, and dry ejaculation (called retrograde ejaculation). Most men notice this: the semen goes back into the bladder instead of out, and it is not harmful. It means you cannot father a child in the usual way, so please discuss this beforehand if you may want more children.
• Less common: a urine infection, bleeding that needs a washout or a longer catheter stay, a blood clot blocking the catheter, and temporary leaking of urine.
• Uncommon: a narrowing (stricture) of the urethra or bladder neck later on, a problem with erections, and the need for another operation if the prostate grows back or the first operation is not enough.
• Rare: absorbing too much of the washing fluid into the body (called TUR syndrome), long-term loss of bladder control, a blood clot in the leg or lung, or the risks of the anaesthetic.

Follow-up and results

• Tissue result: the tissue removed is sent to the laboratory. Very occasionally a small cancer is found that nobody expected. Ask how and when you will be told, and make sure you receive the result (see the prostate cancer guide).
• Follow-up visit: you will usually be seen a few weeks later to check how you are passing urine. A flow test or bladder scan may be repeated (see the uroflowmetry guide).
• If symptoms come back months or years later, see your urologist. Narrowing or regrowth can sometimes be treated.

Common questions