Benign enlargement of the prostate affects a large proportion of men over 50, and in many of them it is well controlled with medication. There comes a point, however, when medicines are not enough: the stream stays weak, the bladder does not empty completely, and sometimes there is complete urinary retention and a catheter. The solution then is an operation that removes the overgrown tissue and frees up the urethra.
Modern operations are most often endoscopic – through the urethra, without a cut in the abdomen and with a short hospital stay. Dr Penev performs them at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv, where he has been part of the team since 2017, while the assessment before surgery and the follow-up take place at his private practice.
When it is recommended
Surgery is considered when an enlarged prostate leads to:
- urinary retention that comes back after the catheter is removed;
- a large amount of residual urine, putting the kidneys at risk;
- repeated infections or blood in the urine caused by the prostate;
- bladder stones or bladder diverticula;
- symptoms that reduce your quality of life despite correctly chosen medicines, or unacceptable side effects from those medicines.
Acute urinary retention – being unable to pass urine despite a strong urge, with a painful swelling above the pubic bone – is an emergency: do not wait for a planned appointment; go to an emergency department, where the bladder will be relieved with a catheter.
How it is done
Types of operation
- TURP (transurethral resection of the prostate). For a medium-sized prostate, an instrument with an electric loop is passed through the urethra and removes the enlarged tissue in small pieces; the bipolar technique is gentler on the body.
- Laser techniques. The laser removes the tissue by enucleation (shelling out the adenoma) or vaporisation, with minimal bleeding – an advantage for men on anticoagulants and with large glands; they are used depending on the equipment available and an individual assessment.
- Other methods. For a small prostate, a transurethral incision is enough – a cut in the bladder neck without removing tissue; for very large glands the tissue is removed through a small incision or laparoscopically (adenomectomy).
The choice depends on the size of the prostate, your other medical conditions and medicines, and your priorities – Dr Penev discusses the advantages and limitations of each option with you.
In the operating theatre
The operation is performed under spinal or general anaesthetic and takes approximately 60–90 minutes; the tissue removed is always sent for histological examination. At the end a urethral catheter is inserted, through which the bladder is rinsed until the urine clears – usually for one to three days. The hospital stay is most often two to four days.
Preparation
Before the operation Dr Penev carries out a full assessment: a prostate check with ultrasound and residual urine measurement, PSA, uroflowmetry, a urine test with culture and blood tests and, if needed, cystoscopy; any suspicion of cancer is clarified beforehand. This is followed by a consultation with an anaesthetist and a review of your medicines: blood thinners are stopped or replaced only as instructed by the doctor who prescribed them, and any urine infection is treated in advance. On the day of the operation you must not eat or drink (nil by mouth).
After the operation and results
During the first weeks after the catheter is removed, you will often pass urine more frequently, with sudden urges and burning, and the urine may be pink – sometimes bloodier again around the second or third week, when the scab comes away. Drink enough fluids and avoid lifting heavy objects, cycling and straining due to constipation for 4–6 weeks; you can resume sex after about a month. If you go home with a catheter, the advice on living with a urinary catheter is useful.
Seek emergency help if you cannot pass urine, if you have a fever and shivering, or if there is heavy bleeding in the urine with clots.
In most men the stream becomes stronger, the bladder empties more completely and getting up at night becomes less frequent; the final result is assessed around the third month. It is also important to know about the side effects: retrograde ejaculation is common and permanent after TURP and enucleation; erections are usually preserved; temporary leakage with urgency in the first weeks is common, while permanent incontinence is rare; a small proportion of men develop a narrowing of the urethra or the bladder neck that needs a further procedure.
Where it is done
The consultation before surgery and the follow-up take place at Dr Penev’s practice in Plovdiv (5 Anri Barbyus St) and at Vita Med Medical Centre, Karlovo, by appointment. The operation is performed at the Department of Urology at Kaspela University Hospital, 64 Sofia St, Plovdiv.
Price
Initial consultation – €50, follow-up consultation – €30. The price of the operation is confirmed at the consultation.
If medication is no longer helping you or you have had urinary retention, book an appointment with Dr Penev – together you will decide whether an operation is right for you, and which one.
Frequently asked questions
Is the whole prostate removed during the operation?
No. Only the inner, overgrown part that presses on the urethra is removed; the outer part and the capsule remain. This is why the operation does not protect against prostate cancer, and preventive check-ups continue.
Will I have erection problems after TURP?
In most men erections stay the same as they were before the operation. A common consequence is retrograde ejaculation – orgasm with little or no semen, which is then passed out with the urine. It is not dangerous, but it matters for men who are planning to have children.
Do I need to stop my prostate medicines before the operation?
Do not stop them yourself. Prostate medicines are usually continued until the operation and stopped afterwards as Dr Penev instructs, while decisions about medicines for blood pressure, diabetes and blood thinning are made together with the doctors who prescribed them.
When can I go back to work?
With a desk job usually after two to three weeks, with physical work after four to six. You can drive when there is no pain and no blood in the urine, most often after one to two weeks.
Can the prostate grow again?
The remaining tissue can grow again over the years, and a small proportion of men need a second procedure, usually much later. Regular check-ups allow this to be noticed in time.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.