SPENDING A PENNY

In every trade, industry and profession new ideas and techniques are constantly being injected. Indeed, some technical manuals become out of date almost before they come off the press. We don't notice these changes because they are so subtle. It is only when we look at a magazine about ten years old or watch an old movie that we notice the changes in fashion and styles of cars and so on. This situation also applies to the medical profession.

There are several types of surgery for B.P.H. and your urologist will probably explain which one is suitable for your particular needs. However, at the time of writing the majority of B.P.H. surgery uses the transurethral resection of the prostate, or T.U.R.P. as it is known, an outline of the operation will now be given.

The is what is known as a closed operation. which means there is no incision made in the body to get at the problem.

After the use of anaesthesia a surgical instrument is inserted into the penis through the urethra. This instrument is a non-flexible hollow tube which extends into the narrowed portion of the urethra inside the prostate. A fibre optic micro-lens system called a resectoscope will then be inserted into the tube. This device includes a fibre optic light source, a lens and an electric wire element for surgery. The light inside the urethra enables the surgeon to see and determine the severity of the problem.

The electric wire loop emerges from the end of the tube and is used to cut away the prostatic tissue. The electric loop is powered by the use of a foot switch when the surgeon wants to cut.

Whilst doing this the surgeon is watching the procedure through a lens that is located just outside the end of the penis.

When bleeding occurs inside the urethra, another foot pedal is pressed and the bleeding part is sealed off by cauterization so it won't bleed. During surgery the entire area is washed by glycine. ( A common amino acid ).

After the surgeon has decided that enough of the enlarged prostate has been removed, the glycine wash containing the chips and the shavings of the prostate tissue are removed and sent to the pathologist. He will study them to see if there are any beginnings of cancer of the prostate.

The surgeon may decide to remove most or all of the prostate but he will NOT harm the prostate surgical capsule. The new hole that has been created through the overgrown prostate now becomes the urinary canal. This means that the prostate enlargement tissue was growing around the urethra narrowing it and closing it down. The inner walls of the urethra have been cut away carving a new canal through the prostatic tissue growth.

When the cutting is complete, a thin flexible rubber or plastic tube is then passed through the penis and urethra and into the bladder, so that urine can be drawn from the bladder.

This remains in place for a few days because of the possible bleeding that may take place in the prostate. When this tube is removed the patient will be able to urinate normally again.

The catheter used after the T.U.R.P. surgery, consists of three lumens or tubes. One is to send in and remove a wash of saline solution (salt water) into the bladder to clean and irrigate it. This is generally used for twenty-four hours after surgery.

The second tube is used to draw off urine and the third usually has a small balloon attached and is inflated so the catheter will not fall out.

The catheter which draws urine from the body stays in place for two days after surgery.

Most patients feel well enough to get out of bed a day after surgery and feel much better after four days.

It is possible to walk, talk and sit down with a catheter in place and it usually comes out on the second day with no pain involved.The surgeon deflates the balloon and the catheter will simply slide out.Most patients are discharged and sent home the following day so their stay in hospital is normally two days.

A prescription for antibiotics is usually given as a precaution to ward off any infection. This has to be taken by mouth for one or two weeks after surgery.

The urologist will probably advise the patient to take hot baths instead of showers for a while, drink lots of fluids, avoid spicy foods and be careful NOT to become constipated.

Most of the patient's activities can then be resumed including driving, taking walks and sitting at a desk, but there won't be any rock climbing or football games for a while.

If there is any trouble during the first couple of weeks it will be a slight burning when he urinates or perhaps small amounts of blood in his urine. Should this happen the patient, just to be on the safe side, should report this problem to his urologist.

The length of time the patient needs to be off work will depend on his occupation and how quickly he recovers. His doctor will be the best judge to decide this...

One BIG caution. The patient MUST ABSTAIN from any sexual activity for at least SIX WEEKS after surgery to allow the canal through the prostate to heal completely.

A non-surgical treatment for B.P.H. that urologists have borrowed from heart surgeons is the use of a balloon. A small tube about the size of spaghetti is inserted into the urethra by the physician, and on the end of this tube is an un-inflated balloon.

When the balloon is in the correct position in the urethra within the enlarged prostate, the balloon is inflated by the physician. The inflation is held for different periods of time and the pressure of the balloon within the urethra forces the urethra back to its original position.

Many urologists who have used the balloon technique speak very highly of it, They say it is effective, easy to do and has far less worry and stress on the patient. In addition to this there have been no side effects so far, and being non-surgical it is also popular with the patients when contrasted with surgery.

However, not everyone agrees with the balloon method or the use of drugs to reduce B.P.H. symptoms. Some specialists say there is no accurate way of determining who has prostate cancer and who does not. Although a biopsy and ultrasound may help, they say that unless shavings of the gland are examined in a pathology laboratory, the cancer can spread to another part or parts of the body without anyone knowing until it's too late.

This brings me to another touchy question which you might have thought but were too frightened to ask... What if I have cancer?