A transurethral resection of the prostate, or TURP, is surgical procedure that is most often done to treat benign prostatic hyperplasia, which is also called BPH. Benign prostatic hyperplasia is the enlargement of the prostate gland that often occurs as a man ages. The prostate gland is located in the pelvis just below the bladder. Its main role is to secrete substances into the semen that help sperm fertilize a woman's egg.
The enlarged gland in a man with BPH can press against the urethra, the tube that carries urine from the bladder to the outside of the body. This pressure can interfere with a man's ability to urinate. Medications are usually prescribed to relieve these symptoms. If the man doesn't want to take the medicines or if symptoms aren't relieved, the healthcare provider may recommend a TURP.
TURP is sometimes used when there are urinary problems caused by prostate cancer. The goal of the operation in this case is to treat the blockage, not to manage the cancer. Other treatments are needed for the cancer.
A TURP is done in the hospital by a urologist. A urologist is a surgeon who treats people with diseases of the kidney and urinary tract. The man first goes to the surgery preparation area. There, an IV, or thin tube, is placed into an arm vein. This allows fluids and medicines to be given during the procedure. The anesthesiologist and the surgeon usually see the person just before surgery. The person is then taken to the operating room or a procedure room. The man may be awake or completely asleep during the procedure. This depends on the type of pain control, or anesthesia, used.
Next, the surgeon inspects the urethra and bladder with an endoscope. An endoscope is a special tube with a camera on the end. This scope allows the surgeon to see the inside of the body. The scope is passed through the tip of the penis. It is then passed into the urethra and bladder. This is to double check that the planned operation is correct. It is also to look for any unplanned problems such as bladder tumors or stones in the bladder.
Next, an electrical loop is passed into the urethra. The loop is placed near the part of the urethra that is surrounded by the prostate. The loop is used to cut out pieces of tissue from the prostate that bulge into or block the urethra. This process is similar to coring an apple. Electricity is applied through the same loop to stop bleeding.
After the procedure is over, the pieces of the prostate that were trimmed away are removed. The tissue is sent to the lab to make sure that prostate cancer is not present. A urinary catheter is then inserted through the penis and into the bladder.
The man usually stays in the hospital for at least a day after the procedure. Urine from the bladder is drained through the urinary catheter. The urine contains a fair amount of blood at first. The catheter can be removed when the amount of blood in the urine is minimal. Sometimes, the catheter is irrigated with water to help keep the urine clear. The urine usually clears between several hours to 2 days after the procedure. If possible, the catheter is removed before the man leaves the hospital. Men may need to go home with the catheter still in the bladder. It can be removed later in the office when the swelling from the operation is better.
Once home, the individual should drink plenty of fluids. This helps wash any remaining blood out of the bladder. This is important since clotting of the blood could create a urinary blockage. The man should also avoid heavy lifting for several weeks after this procedure. This activity could result in bleeding. Pain medicine can be used as directed if needed.
The main side effect of TURP is retrograde ejaculation. This is a condition in which semen flows back into the bladder during ejaculation. Normally, semen is ejected out through the end of the penis. For the most part, this problem does not affect a man's ability to have an erection or an orgasm. It does, however, make him infertile. Men who wish to father children should understand this side effect before considering the procedure.
Symptoms such as weak urine stream and inability to completely empty the bladder go away quickly following a TURP procedure. Other symptoms such as the need to urinate frequently and incontinence may take longer to clear up. Sometimes, medicines such as oxybutynin or tolterodine can be used to "calm" the bladder until these symptoms go away. Most of the time these medicines are needed only temporarily. Occasionally, they may have to be taken long term.
Following TURP, a urinary catheter may need to be put back into the bladder temporarily after the procedure. This probably occurs because of swelling at the site. This problem comes up in 4 to 6% of cases. The catheter is usually needed only for a few days.
Other rare complications include urinary incontinence, or the inability to control urine. An abnormal narrowing of the urethra may cause trouble with urination in rare cases. Any new or worsening symptoms should be reported to the healthcare provider.
Author:Stuart Wolf, MD
Editor:Ballenberg, Sally, BS
Reviewer:Adam Brochert, MD