INTRODUCTION TO THE PROSTATE GLAND

What is a prostate gland?

Your prostate gland is situated at the base of the bladder and surrounds your urethra (water pipe). The easiest way to imagine your prostate is to compare it to an apple which has had its core removed. The purpose of the prostate gland is to produce substances which assist with the passage of sperm.

Why do you need an operation?

The prostate gland often enlarges as you get older. Indeed it is estimated that one in three men over 50 will develop symptoms of an enlarged prostate or Benign Prostatic Hyperplasia (BPH) to give it its medical name. As the prostate gland enlarges it presses more and more onto the urethra making urination difficult. Your symptoms are likely to have included at least some of the following:-

• A weak stream when you urinate.
• A frequent desire to urinate.
• A feeling of urgency to urinate.
• Incomplete emptying of the bladder.
• Frequent night time urination.
• Dribbling of urine after passing water.
• Not being able to get to the toilet in time.
• Complete inability to urinate (obstruction).

In order to improve your symptoms and enable you to regain control of your waterworks, you doctor has decided that you need an operatic to remove the prostatic tissue which is blocking the urethra. The whole of your prostate will not be removed if you imagine your prostate as cored apple again, the operation will remove the flesh of the apple but leave the skin intact.

Why are the doctors using a laser?

Your operation is being done with a relatively new technique using a laser. This has several advantages over traditional methods which used a "hot wire" to cut away the offending tissue.

• The laser operation is very quick - usually taking less than half an hour. Traditional surgery often takes up to an hour to complete.
• The laser technique causes little or no bleeding and is therefore thought to be very safe. One of the commonest problems with the "hot wire" type of treatment is bleeding after the operation - some patients even require blood transfusions.
• Patients who have the laser treatment are usually able to go home either later on the same day as their operation, or the following morning. Patients who have traditional surgery may have to stay in hospital for 4 to 6 days - sometimes longer.

One of the most important things to remember is that the laser treatment will not make you better immediately because no part of your prostate is actually removed during the operation (see The Operation Section of this booklet). You are likely to experience a gradual improvement in your symptoms during the weeks after your operation. Most patients are noticeably better 6 weeks after treatment and this improvement will continue until about 6 months after your operation when you will feel the full benefit.

Before the operation

On either the night before, or the morning of, the day of your operation you will be admitted to hospital. A doctor will examine you and ask you questions about your health. It is likely that you will have a blood test and possibly other tests depending on your age and fitness.

All these tests and questions will help the doctors look after you and ensure that the operation goes well - this is the normal procedure for all operations and is nothing to worry about.

When it is time for your operation the nurse will ask you to have a bath or shower and will help you put your theatre gown on.

You will be asked to remove any dentures, and also to remove all jewellery, watches etc. (these will be locked away in a safe place).

You may be given a tablet or injection shortly before your operation to relax you and it may make you a little sleepy. This is called pre- medication (or pre-med for short).

You are now ready to go to the operating theatre.

The anaesthetic

For this operation you will have either a general anaesthetic or a spinal anaesthetic and this choice will be made by the anaesthetist who will come and discuss the matter with you before your operation.

A general anaesthetic means you will be fully asleep for the entire operation whilst a spinal anaesthetic will cause only your lower body to be anaesthetised. Under a spinal anaesthetic you will lose all sensation in your legs and lower body and therefore feel no discomfort, but you will be awake and aware of what is going on around you.

Whichever anaesthetic type you have, you will feel no discomfort whatsoever during the operation.

Once the surgeon has finished treating you he will place a catheter (a long, flexible, hollow tube) to drain your bladder. This catheter will be placed either through a small cut just below your tummy button, or through your urethra.

This catheter is placed to empty your bladder without you going to the toilet and is usually left in for about a week while everything in your waterworks settles down after the operation.

Once the catheter is placed, the operation is over.

After the operation

After your operation you will be taken back to the ward. Some patients will still be feeling sleepy after the anaesthetic whilst others feel quite bright and awake.

The nurses on the ward will check on you regularly to make sure your blood pressure, pulse etc. are normal. When you are properly awake you will be able to have a drink and you should drink as much as possible to wash through your bladder.

You will notice that the catheter coming out of your tummy or urethra is attached to a small bag. This is to collect the urine as it drains from the bladder. When you are up and about and dressed the bag can be strapped to your leg under your trousers so it will not be noticeable to anyone else.

If you are in any discomfort after your operation please ask one of the nurses to give you something to relieve it. Please do not worry about "bothering" the nurses - their main concern is that you are comfortable and will be happy to help.

Going home

Once the doctors have visited you on the ward and are happy with your progress you will be allowed to go home. This may be later on the same day as your operation, or the following morning.

Before you go home the nurses will explain to you how to look after your catheter and bag and you will be given an appointment to return to the hospital to have these removed (usually 5-7 days after your operation).

You may be given some tablets to take at home and these will be explained to you, together with when you should take them.

Once you get home, if you should be worried about anything at all, please do not hesitate to contact either your G.P. or the hospital.

Common questions and answers
How long will I be in hospital?

Some patients are allowed home on the same day as their operation, some stay in hospital overnight. Occasionally patients will need to stay in hospital longer. Your surgeon will be able to advise you when you go into hospital how long you are likely to stay.

Will I be in pain after the operation?

This varies enormously from patient to patient. Some patients feel no pain at all whilst others experience quite severe discomfort. If you are in pain after your operation ask the nursing staff for assistance they will be happy to help.

Will my symptoms get better immediately after the operation?

No, because no tissue is actually removed during your operation (see The Operation section of this booklet). You will probably first notice an improvement in your urine stream at between 4 and 6 weeks after your operation and this improvement will continue until about 6 months after your operation when you will feel the full benefit.

What happens to the "dead" prostate tissue?

Gradually, over a period of time, the tissue exposed to the laser energy will die off and fall away from the healthy tissue underneath (a little like a scab falling off a wound).

These dead tissue fragments are then flushed out of your body each time you pass urine. Many patients do not notice the passage of these fragments while others do. The fragments may look like thick mucus or may look like "small pieces of pipe tobacco". The passage of any fragments is painless.

Passing such fragments is a very healthy sign as it means your prostate is getting smaller and therefore your symptom will be getting better.

This process also explains why it usually takes 6-12 weeks after the operation before you notice your symptoms improving.

If at any stage you are concerned about passing fragments or feel that they are "blocking you up" please contact your GP or hospital for advice.

Will I still be able to have sex?

If you were sexually active before your operation you should find that nothing has changed. A few patients find after their operation that when they have sex the ejaculatory fluid passes into the bladder at orgasm, rather than out of the penis in the normal fashion. This will not do you any harm as the ejaculate will be flushed out of your body next time you urinate, and as such is unimportant unless you wish to father a child.

When will I be able to go back to work?

The short answer to this is - when you feel well enough. Most patients take a few days off after their operation to recuperate and then return to work.

Remember! If at any time, either in hospital or at home, you are concerned or worried about anything to do with your treatment please ask either your GP or a member of hospital staff for help. Do not be shy or embarrassed - they are there to help you.