WHAT DOES THE SURGERY INVOLVE?
Once the patient is under anaesthetic, the procedure involves performing a digital examination followed by inserting the ultrasound probe into the rectum via the anus. The probe is a similar size to the finger. The ultrasound probe allows visualisation of the prostate and three fiducial markers can then be guided in using a special needle. The needle is passed through the perineum (skin between the scrotum and the anus) using a special grid that acts as a guidance template. Please see the possible locations of the fiducial markers:
A needle is then passed through the perineum into the space between the rectum and the prostate and the correct space is confirmed with injection of saline. The SpaceOAR gel is then delivered via this needle and correct placement is confirmed on ultrasound and with a repeat digital examination. The patient generally wakes up a few minutes after the procedure has been completed and will have no memory of the procedure-taking place. After an hour or so in recovery and provided they have passed urine, the patient will be discharged home. Follow-up has typically already been arranged by the radiation oncologist and a review with the urologist in their rooms is also arranged for after the radiotherapy course is complete.
WHAT CAN I EXPECT AFTER THE PROCEDURE?
- Urethral bleeding – most men do pass a small amount of blood in the urine or leak blood from their penis after this procedure for up to 4-6 weeks.
- Haematospermia – blood in the semen or dark staining of the semen can persist for up to 3 months after the procedure. There is nothing to be concerned about and sexual activity can continue as normal.
WHAT ABOUT DIET?
- Drink plenty of fluids (8-10 glasses or 2-3 litres)
- Eat a diet high in fibre to prevent the need for straining when using your bowels
WHAT ABOUT EXERCISE/ACTIVITY?
- Avoid strenuous activity, heavy lifting or engage in sports for the next day unless otherwise instructed by your doctor
- Avoid driving a car, motorcycle or ride a bike for 24 hours after your procedure and do not walk home or travel alone by public transport
- Sexual activity can resume as normal (see Haematospermia above)
WHAT ABOUT MEDICATIONS?
- You can resume your usual medications
- If your blood thinning medication was stopped, your Doctor will let you know when to recommence
- You can take 1-2 paracetamol every 4-6 hours for pain and discomfort (no more than 8 in a day)
WHAT ARE THE POSSIBLE COMPLICATIONS?
- Urinary retention – occasionally patients will have difficulty passing urine after the procedure. It may be due to temporary swelling of the prostate or blood clots. Symptoms consist of abdominal pain, poor flow or frequent small urination. This usually occurs in older men with larger prostates. If this happens go to your closest Emergency Department.
- Tenesmus – feeling of rectal fullness or faecal urgency, which usually resolves within the first week after injection of SpaceOAR
- Infection (bladder or prostate) – this is rare with the TP approach. Symptoms include difficulty urinating, burning on urination, frequent urination or fevers. If this occurs contact GM Urology, your GP or the Emergency Department.
- Sepsis – is a severe form of infection and is otherwise known as blood poisoning. This is extremely rare (less than 1 in 1000) after a TP biopsy and is the major advantage over a TRUS Biopsy of the prostate. The symptoms consist of fevers, chills, shaking, lethargy, warm skin, shortness of breath, rapid heartbeat, drowsiness and a general feeling of being unwell. If this occurs you need to seek immediate medical attention at an Emergency Department.
- Erectile dysfunction – as the nerves for erections run close to the prostate, problems with erections can may occur post-biopsy. This is uncommon and usually temporary, but very rarely it may persist.
- Rectal ulceration – this extremely rare, but if it occurs may require postponing of the radiotherapy to avoid formation of a fistula
NOTIFY GM UROLOGY or your GP if you experience any of the following:
- You have difficulty passing urine, can only pass small amounts the flow stops completely.
- The bleeding is so heavy the urine looks like pure blood.
- The bleeding is accompanied by a fever or an increase in the discomfort when passing urine.
- You experience symptoms such as fevers, chills, shaking, lethargy, warm skin, shortness of breath, rapid heartbeat, drowsiness or a general feeling of being unwell.