Transurethral Resection of Prostate (TURP)

What is a TURP?

Transurethral resection of the prostate (TURP) is a surgical procedure to treat moderate to severe symptoms of benign prostatic hyperplasia (BPH). BPH is also known as the enlargement of the prostate.

How it works

During TURP, the surgeon inserts a resectoscope (a visual and surgical instrument) into the urethra. The resectoscope allows your surgeon to see and scrape away excess prostate tissue that is blocking urine flow. After the procedure, your urine flow from the bladder will return to normal.

Bipolar TURP vs laser prostatectomy

TURP and laser prostatectomy are similar procedures for treating BPH. The two differ in that laser prostatectomy:

• Does not yield any tissue samples for further examination
• Does not require the stoppage of blood thinners.

Why do you need a TURP?

TURP is an effective surgical procedure that reduces urinary symptoms associated with an enlarged prostate, such as:

• Frequent urge to urinate
• Feeling of incomplete urination
• Slow or long duration of urination
• Difficulty when trying to start urination
• Disrupted flow while urinating
• Increased urination at night

Your doctor may recommend TURP if your urinary symptoms are moderate to severe and medications fail to ease your symptoms.

TURP can also treat complications due to an inability to completely empty your bladder, such as:

• Bladder stones
• Incontinence (inability to control urination)
• Kidney failure resulting from loss of normal kidney function
• Urinary tract infections (UTIs)
• Recurring blood in the urine

What are the risks and complications of a TURP?

Undergoing a TURP may put you at risk of:

• Difficulty in urination, which may last for a few days after the procedure. In the meantime, your doctor will insert a tube (catheter) into your penis for urine to drain out.
• Heavy bleeding, which may occur in rare circumstances, especially for men with a larger prostate.
• Incontinence (difficulty holding urine), though this is a rare complication.
• Low sodium in your blood, which can occur if the body absorbs too much of the fluid used for washing during the TURP surgery. This condition can be life-threatening if untreated.
• Sexual dysfunction, including erectile dysfunction or retrograde ejaculation. Retrograde ejaculation (dry orgasm) refers to semen ejecting into your bladder instead of out from your penis.
• Urinary tract infection (UTI), which is a risk that increases the longer you have a catheter in place.

Some patients may need further treatment if:

• Symptoms return post-treatment
• TURP causes the urethra or bladder neck to narrow
• TURP does not improve symptoms.

How do you prepare for a TURP?

Your doctor may ask you to stop taking certain medications a few days before the procedure. These medications, which may increase your risk of bleeding, include:

• Blood thinners such as warfarin
• Non-prescription pain relievers such as aspirin

To prevent urinary tract infections, your doctor may prescribe a course of antibiotics.

What can you expect in a TURP?

TURP is a minimally invasive procedure, which does not require any incisions on the outside of your body.

Estimated duration

The TURP surgery takes about 60 – 90 minutes.

Before the procedure

You will be given general anaesthesia or spinal anaesthesia. If you are given spinal anaesthesia, you will remain conscious during the procedure but will not feel any pain.

During the procedure

Your surgeon will insert a resectoscope into the tip of your penis, through the urethra and into the prostate area.

Your surgeon will use the resectoscope to cut tissue from the inside of your prostate gland, one small piece at a time. Irrigating fluid will carry these cut pieces into your bladder, where they will be removed at the end of the surgery.

After the procedure

After the procedure, your surgeon will remove the resectoscope and cut tissue, and insert a urinary catheter into your penis. The catheter will allow your urine to drain out, as swelling from the surgery is likely to block urine flow temporarily.

You may need to use the catheter for up to 48 hours until the swelling has decreased and you are able to urinate on your own. During this time, you will stay in the hospital to recuperate. You may also experience:

• Blood in your urine. This is normal, unless bleeding worsens, thickens or blocks urine flow.
• Painful or frequent urination, or an increased sense of urgency to urinate.

Care and recovery after a TURP

You may take 6 – 8 weeks to recover after a TURP procedure. To help you recover faster, your doctor may recommend:

• Drinking more water to flush out the bladder.
• Eating high-fibre foods to avoid constipation and straining during bowel movements.
• Not taking blood-thinning medications until your doctor advises otherwise.
• Avoiding strenuous activities, such as heavy lifting.
• Avoiding driving until you stop taking prescription pain medications.
• Avoiding sex.

Contact your doctor if you notice any of these symptoms:

• You are unable to urinate.
• You develop a fever higher than 38°C.
• Your urine contains bright red blood or an increase in clots.
• Your urine does not become clearer after drinking more fluids and resting for 24 hours.