Transurethral resection of the Prostate (TURP)

BPH Procedures

Background Information

Transurethral Resection of the Prostate (TURP) is the most common surgery for BPH. In the United States, about 150,000 men have TURPs each year. TURP uses electric current to remove tissue and cauterize bleeding.  There are 2 energy sources for TURP, bipolar and monopolar. The bipolar option has been become more widely used because there is a decreased chance of serum electrolyte abnormalities after the procedure.

Indications

TURP is indicated for the treatment of BPH in patients who desire treatment.  It is the gold standard of therapy and all other treatments are compared against TURP when evaluating success.  The indications for TURP are similar to the indications for any treatment and can be done in any patient with the exception of extremely large prostate glands or in patients who are unable to stop anticoagulant or antiplatelet agents.

Testing

You made need the following tests prior to TURP:

  • Cystoscopy
  • Uroflow
  • Prostate Ultrasound
  • Urodynamics (Less common)
  • Urinalysis

Procedure

During this procedure, your urologist passes a resectoscope through the tip of the penis into the urethra. The resectoscope has a light, valves for irrigating fluid, and an electrical loop. The loop cuts tissue and seals blood vessels. The wire loop is guided by the surgeon to remove the tissue blocking the urethra one piece at a time. The pieces of tissue are carried by the irrigating fluid into the bladder and then flushed out.  A catheter is placed through the penis into the bladder at the end of the procedure.

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After the procedure

Typically TURP is done in a hospital facility with at least an overnight stay.  Occasionally TURP can be done as an outpatient, but this is the minority of procedures.  After awakening from the surgical procedure, a catheter will have been placed in the bladder and will likely have irrigation running through the catheter in a continuous fashion to avoid blood clotting.  This catheter may be on gentle traction to minimize bleeding.

You may feel the need to urinate, have pain at the tip of the penis or have bladder spasms/cramps with the catheter in place.   Anti-spasm medication will likely be given to help relieve these symptoms. Postoperatively you will be able to eat, drink and walk.  Discharge from the hospital will be dependent on when the bleeding has stopped enough to allow you to go home. Some patients go home with a catheter for a few days and others will get the catheter out prior to discharge.

Benefits

  • Gold standard to which all transurethral procedures are compared
  • Typically immediate resolution of obstructive symptoms
  • Post-operative irritative symptoms are less common as the effect of this procedure is not coagulative necrosis (heat induced tissue death), but surgical removal
  • Obtain tissue which is sent to pathology to ensure no cancer present
  • Decreased chance of needing retreatment

Results

After TURP men typically see a remarkable improvement in flow rate, symptoms, and quality of life:

  • mean Qmax after TURP increased by 10.15 mL/s, IPSS decreased by 16.7 points, QoL increased by 3.57 points, and PVR decreased by 95.3 mL
  • According to Qmax, the treatment was effective in 74.2%, according to IPSS, in 91%, and according to QoL, in 74.2% of patients

The effect of complete transurethral resection of the prostate on symptoms, quality of life, and voiding function improvement Cent European J Urol. 2015; 68(2): 169–174.Daimantas Milonas, Jone Verikaite, and Mindaugas Jievaltas

Complications

  • Temporary difficulty urinating for a few days after the procedure
  • Urinary tract infection
  • Retrograde ejaculation
  • Erectile dysfunction may occur (less than 5% risk)
  • Heavy bleeding requiring transfusion
  • Urge incontinence
  • Stress incontinence
  • Low sodium in the blood (TUR syndrome)

Contraindications

  • Extremely large prostate glands (Measuring greater than 100 grams)
  • Hereditary bleeding disorders
  • Inability to safely undergo spinal or general anesthesia due to medical problems
  • Inability to stop anticoagulants
  • Inability to stop antiplatelet agents
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