What does the procedure involve?
Transurethral Incision of Prostate (TUIP) – also known as Bladder Neck Incision, involves making one or two incision in the neck of the bladder and adjacent prostate to relieve obstruction from a tight bladder neck which can occur due to muscular spasm or scar tissue from previous prostate surgery.
What are the alternatives to this procedure?
Alternatives to this procedure include drugs to relax the neck of the bladder (alpha-blockers), use of a catheter or stent, laser prostatectomy or transurethral resection of the prostate (TURP).
What should I expect before the procedure?
If you regularly take strong blood thinning medication such as Plavix, Brilinta, Iscover, Eliquis, Xarelto, Pradaxa, etc, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. Stopping them may reduced the risk of bleeding but this can result in increased clotting, which may also carry a risk to your health. You will need to discuss the risks and benefits of the treatment with your GP or your urologist.
You will usually be admitted on the same day as your surgery.
You will be asked not to eat and drink for six hours before surgery. Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed and pleasantly sleepy.
Please tell your surgeon (before your surgery) if you have any of the following:
- An artificial heart valve.
- A coronary artery stent.
- A heart pacemaker or defibrillator.
- An artificial joint.
- An artificial blood-vessel graft.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for a blood thinner e.g. Warfarin, Coumadin Xarelto®, Pradaxa®, Clopidogrel (Plavix®), Brilinta®, or Aspirin.
- Previous or current infection with an antibiotic resistant organism such as MRSA, VRE, etc.
What happens during the procedure?
Either a full general anaesthetic (where you will be asleep) or a spinal anaesthetic (where you are awake but feel nothing from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.
You will usually be given an injection of antibiotics before the procedure, after you have been checked for any allergies.
The procedure takes approximately 30 minutes. A telescope is passed up the urethra. One or two incision are made in the bladder neck and prostate with diathermy or laser. A catheter is normally placed for 24-48 hrs.
What happens immediately after the procedure?
Some bleeding from the prostate area is common after the operation and you will have a catheter draining the bladder with fluid running through it (irrigation) to wash out the bladder and prevent the formation of clots.
The urine usually clears of blood within 12 hours, although some patients lose blood for longer. It is unusual to require a blood transfusion after bladder neck incision.
You will be able to eat and drink on the same day as the operation when you feel able to. The catheter is generally removed 24 to 48 hours after surgery. It is not unusual for your urine to turn bloody again for the first 24 - 48 hours after catheter removal. Some blood may even be visible in the urine several weeks after surgery.
At first, passing urine may be painful and frequent. Any discomfort can be relieved by tablets or injections and the frequent passage of urine usually improves within a few weeks. In some patients, however, passing urine frequently, urgency and waking at night to pass urine may take several months to settle completely. This is because these symptoms are due to bladder over-activity; by contrast, the symptoms of obstruction (hesitancy and poor flow) improve almost immediately.
You should let your named nurse know if you cannot pass urine and you feel uncomfortable. Some patients are unable to pass urine at all after the operation and, if this happens, we normally insert another bladder catheter. This allows the internal swelling to resolve and the bladder to recover. If this happens, you will go home with the catheter in place, and return after a week for a second catheter removal, which is usually successful.
The average hospital stay is 1-2 days.
Are there any side-effects?
Most procedures have possible side-effects. But, although the complications listed below are well recognised, most patients do not suffer any problems.
- Temporary mild burning, bleeding and passing urine too frequently.
- 20% of men produce no semen during orgasm.
- Treatment may not relieve all the symptoms.
- Infection of the bladder, testicles or kidneys requiring antibiotics.
- Repeat treatment later due to re-obstruction (approx. 10%).
- Intermittent self-catheterisation to empty the bladder if you fail to pass urine satisfactorily.
- Failure to pass urine after surgery requiring a new catheter.
- Injury to the urethra causing delayed scar formation.
- Loss of urinary control (incontinence) which may be temporary or permanent (1%).
- Poor erections (impotence).
- Perforation of the bladder requiring a temporary urinary catheter or open surgical repair.
- Bleeding requiring return to theatre and/or blood transfusion (less than 2%).
What should I expect when I get home?
You may experience a mild burning when you urinate, and feel the need to urinate frequently. Small amounts of blood in the urine is normal.
What else should I look out for?
If you experience increasing frequency, burning or difficulty on passing urine or worrying bleeding, contact your GP.
About 1 man in 5 experiences bleeding some 10 - 14 days after getting home due to scabs separating from the incision in the bladder neck. Increasing your fluid intake should stop this bleeding quickly. If it does not, you should contact your GP who may prescribe some antibiotics for you. If the bleeding is severe with clots or sudden difficulty in passing urine, you should contact your Surgeon or GP immediately. Sometimes, it may be necessary for you to be re-admitted to hospital.
Are there any other important points?
Incision of your prostate should not adversely affect your sex life as long as you get normal erections before the surgery. Sexual activity can be resumed as soon as you are comfortable, usually after three to four weeks.
It is helpful to start pelvic floor exercises as soon as possible after the operation because this improves your control when you get home. If you need any specific information on these exercises, please contact the ward staff or the Specialist Nurses. The symptoms of an overactive bladder (frequency & urgency) may take three months to resolve although the urine flow improves immediately.
Most patients require a recovery period of two to three weeks at home before they feel ready for work. We recommend three to four weeks’ rest before resuming any job, especially if it is physically strenuous. You should avoid heavy lifting during this time.
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.