Transurethral resection of the prostate (TURP)

Definition

Transurethral resection of the prostate (TURP) is a type of prostate surgery done to relieve moderate to severe urinary symptoms caused by an enlarged prostate. During TURP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The urethra is surrounded by the prostate. Using the resectoscope, your doctor trims away excess prostate tissue that's blocking urine flow.

TURP is one of the most effective options for treating an enlarged prostate, a condition also known as benign prostatic hyperplasia (BPH). To determine whether TURP or another treatment is the best choice for you, your doctor will consider how severe your symptoms are, what other health problems you have, and the size and shape of your prostate.

Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow.

Why it's done

TURP helps reduce urinary symptoms in most men with BPH. It's best suited for men who have larger prostate glands and moderate to severe urinary symptoms. It has better long-term results than do medications and many other treatments for enlarged prostate.

Urinary symptoms caused by BPH can include:

• A frequent, urgent need to urinate
• Difficulty starting urination
• Slow (prolonged) urination
• Increased frequency of urination at night (nocturia)
• Stopping and starting again while urinating
• The feeling you can't completely empty your bladder
• Urinary tract infections

TURP may also be done to treat or prevent complications due to blocked urine flow, such as:

• Recurring urinary tract infections
• Kidney malfunction or kidney damage
• Bladder damage, which can result in an inability to control urination (incontinence)
• Blood in your urine
• Bladder stones

Men who have TURP are less likely to need retreatment later than are men who opt for other, less invasive prostate procedures. But TURP is more likely to cause complications and generally requires a longer recovery period.

Other enlarged prostate procedures include transurethral needle ablation (TUNA), transurethral microwave therapy (TUMT), transurethral incision of the prostate (TUIP), laser surgery such as holmium laser enucleation of the prostate (HoLEP) or laser photovaporization of the prostate (PVP), and open prostatectomy.

Less invasive treatments generally don't provide the long-lasting results that TURP and open prostatectomy do. But a number of other prostate procedures are becoming more effective with the development of improved techniques and surgical tools. Some men opt for a less invasive procedure first, and then have TURP done later if symptoms don't improve or they get worse over time. Even with TURP, some men need additional procedures, typically five to 10 years following TURP.

Risks

TURP is a safe procedure for most men. Risks can include:

• Temporary difficulty urinating. You may have trouble urinating (urinary retention) for a few days after the procedure. Until you can urinate on your own, you will need to have a tube inserted through your penis to carry urine out of your bladder (urinary catheter).
• Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place and may require antibiotics or other treatment. In some cases, men who have TURP have recurring urinary tract infections.
• Heavy bleeding. Some men lose enough blood during TURP to require a blood transfusion. This is rare. Men with larger prostates appear to be at higher risk of significant blood loss.
• Difficulty holding urine. Rarely, loss of bladder control (incontinence) is a long-term complication of TURP.
• Dry orgasm. TURP can cause retrograde ejaculation, which means semen released during sexual climax (ejaculation) enters your bladder rather than exiting the penis. Retrograde ejaculation isn't harmful and generally doesn't affect sexual pleasure. But it can interfere with your ability to father a child. This long-term side effect occurs in about 75 percent of men who have TURP.
• Erectile dysfunction. The inability to keep or maintain an erection is a possible long-term side effect of TURP. While this isn't common with TURP, it can occur.
• Low sodium in the blood. This rare complication is called TURP syndrome or transurethral resection (TUR) syndrome. It occurs when the body absorbs too much of the fluid used to wash (irrigate) the surgery area during the procedure. TUR syndrome is rare, but can be life-threatening if it isn't treated. A technique called bipolar TURP allows the use of a salt (saline) solution for irrigation, which lessens the risk of TURP syndrome.
• Need for retreatment. Some men require follow-up treatment after TURP, either because symptoms return over time or because they never adequately improve. This is less common with TURP than with less invasive office-based prostate treatments. In some cases, further treatment is needed because TURP causes narrowing (stricture) of the urethra or the bladder neck.

How you prepare

Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:

• Ask about blood-thinning medications. Your surgeon may ask you to stop taking medications that increase your risk of bleeding several days prior to the surgery. These include warfarin (Coumadin), clopidogrel (Plavix), and nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to the doctor who prescribed your medication before you make any changes.
• Don't eat before your procedure. Your doctor will likely ask you to not eat or drink anything after midnight. On the morning of your procedure, take only the medications your doctor tells you to with a small sip of water.
• Arrange a ride home. You won't be able to drive yourself home after the procedure.
• Plan for time off work. You may not be able to work or do strenuous activity for several weeks after surgery (typically three to six weeks). Ask your doctor how much recovery time you may need.

Your doctor may also give you other steps to follow.

What you can expect

TURP generally takes 60 to 90 minutes. You'll be given either a spinal anesthetic, which allows you to be awake during the procedure but unable to feel pain in the surgical area, or a general anesthetic, which will put you to sleep. The doctor may also give you a dose of antibiotics to prevent infection.

During the procedure
Once the anesthetic is working, a combined visual and surgical instrument (resectoscope) is inserted into the tip of your penis and extended through your urethra and into the prostate area. By accessing the prostate through your penis, your doctor won't need to make any cuts (incisions) on the outside of your body. The resectoscope is about 12 inches (30.5 centimeters) long and 1/2 inch (1 centimeter) in diameter. It has a light, valves for controlling irrigating fluid, and an electrical loop to cut tissue and seal blood vessels.

The doctor will use the resectoscope to trim tissue from the inside of your prostate gland, one small piece at a time. As small pieces of tissue are cut from inside your prostate, irrigating fluid carries them into your bladder. They're removed at the end of the operation.

BPH usually isn't a symptom of prostate cancer, and it doesn't increase your risk of prostate cancer. But your doctor may recommend the prostate tissue from your procedure be sent to a lab to check for hidden cancer cells.

After the procedure
After surgery, you'll need to stay in the hospital for one to two days. Talk to your doctor about what you can expect, and any precautions you need to take after you go home.

• You'll have a catheter in place that enters through the tip of your penis and goes into your bladder to drain your urine into a collection bag. The catheter is generally left in place for four to seven days, until you're able to urinate on your own. In some cases, a catheter is needed for a longer period of time — especially if you have a relatively large prostate. You may urinate around the catheter, which is normal because your bladder may try and squeeze out more urine than the catheter can accommodate.
• Urination may be painful, or you may have a sense of urgency as urine passes over the surgical area. You may also need to urinate frequently. Painful urination generally improves in one to four weeks.
• Expect some blood in your urine right after surgery. If you have clots or so much blood in your urine that you can't see through it, contact your doctor.

These steps can help you recover after your procedure.

• Drink plenty of water to flush out the bladder.
• Avoid constipation and straining during a bowel movement. Eat fiber-containing foods and avoid foods that can cause constipation. Ask your doctor if you should take a laxative if you do become constipated.
• Don't take blood-thinning medications until your doctor says it's OK.
• Don't do any strenuous activity, such as heavy lifting, for four to six weeks or until your doctor says it's OK.
• Don't have sex. You'll likely be able to resume sexual activity in about four to six weeks.
• Don't drive until your doctor says it's OK. Generally, you can drive once your catheter is removed and you're no longer taking prescription pain medications.

Transurethral resection of the prostate (TURP)

Transurethral resection of the prostate (TURP)

In transurethral resection of the prostate (TURP), a combined visual and surgical instrument (resectoscope) is inserted through the urethra where it's surrounded by prostate tissue. An electrical ...

Results

TURP typically relieves symptoms quickly. Most men experience a significantly stronger urine flow within a few days. Follow-up treatment to ease symptoms is sometimes needed, particularly after several years have passed.

After TURP, it's important to have a digital rectal exam once a year to check your prostate and screen for prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an appointment to see your doctor.