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Transurethral Resection of the Prostate

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Transurethral Resection of the Prostate

(TURP)

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Definition

Transurethral resection of the prostate (TURP) is a surgery to remove part of the prostate gland.
The prostate gland is part of the male reproductive system. It makes and stores a milky fluid that forms part of semen. The prostate is below the bladder and in front of the rectum. It also wraps around a tube called the urethra. The urethra allows urine to flow out of the body.

Reasons for Procedure

A TURP is done when a man has an enlarged, noncancerous prostate. This is called benign prostatic hyperplasia (BPH). In BPH, the prostate grows and presses against the urethra and bladder. The pressure can cause problems with the normal flow of urine. A TURP is done to improve the flow of urine.
A TURP may also be done when a man has prostate cancer. It may be done if the doctor thinks that a complete prostate removal surgery is too risky. In this case, TURP is also done to relieve urine blockage and lessen symptoms. It is not done to treat the cancer itself.

Possible Complications

TURP syndrome, also known as TUR syndrome, occurs in about 2% of patients. It will usually occur within the first 24 hours after the procedure. Symptoms may include:
  • Increase or decrease in blood pressure
  • Abnormal heart rhythm
  • Increased breathing rate
  • Nausea or vomiting
  • Blurred vision
  • Confusion
  • Agitation
Other complications may include:
  • Urinary tract infection—most common complication
  • Bleeding, which may require blood transfusion
  • Incontinence—inability to control urine
  • Retrograde ejaculation
    • Sperm goes into the bladder rather than out the end of the penis
    • If you plan on having children in the future, talk to your doctor about this surgical side effect before surgery.
  • Reaction to anesthesia
Some factors that may increase the risk of complications include:
Some factors that may increase the risk of complications include:

What to Expect

Prior to Procedure

Your doctor may do the following:
  • Physical exam
  • Review of medicines and supplements
  • Blood tests, urine tests, and a urine culture
  • Ultrasound—a test that uses sound waves to visualize the kidney, bladder, and/or prostate
  • Urine flow studies
  • X-rays
Leading up to your procedure:
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • The night before, eat a light dinner. Do not eat or drink anything after midnight.

Anesthesia

TURP surgery requires general or spinal anesthesia. You will sleep through the surgery with general anesthesia. Spinal anesthesia will make your lower body numb but you may be awake.
TURP surgery requires general or spinal anesthesia. You will sleep through the surgery with general anesthesia. Spinal anesthesia will make your lower body numb but you may be awake.

Description of Procedure

A special scope that looks like a thin tube with a light on the end will be used. The scope will be passed through the hole at the tip of the penis where urine comes out and sent to the bladder. The bladder will then be filled with a solution. The solution will let the doctor see the inside of your body better.
The prostate gland is examined through the scope. A small surgical tool will be inserted through the scope. This tool will be used to remove a part of the enlarged prostate.
A catheter will be placed in the bladder. Urine will flow out the catheter to give the area time to heal. Your catheter may also be used to flush the bladder and to remove blood clots.
Transurethral Resection of the Prostate (TURP)
Transurethral Resection of the Prostate (TURP)
Copyright © Nucleus Medical Media, Inc.
Transurethral Resection of the Prostate (TURP)
Transurethral Resection of the Prostate (TURP)
Copyright © Nucleus Medical Media, Inc.

Immediately After Procedure

Removed tissue will be sent to a lab for testing.

How Long Will It Take?

About 60-90 minutes

Will It Hurt?

For several days after the surgery, you may feel some pain. The catheter may also cause some discomfort. Talk to your doctor about medicine to help you manage pain.

Average Hospital Stay

An overnight stay is typically planned for a TURP. In some cases, the stay can be up to 2 days.

Post-procedure Care

At the Hospital
  • There will be a catheter in your bladder to drain urine. The catheter is left in place overnight. The urine may be bloody, but do not be alarmed. This is normal. Water may be flushed through the catheter into your bladder to wash out blood and clots.
  • Always keep the catheter drainage bag below the level of your bladder.
  • You will be shown some breathing and coughing exercises after surgery. Do these regularly as you recover.
  • Rest in bed until the next morning. The nurse can help you the first time you get out of bed.
At Home
When you return home, do the following to help ensure a smooth recovery:
  • You may be sent home with a catheter still in place. Clean the area where the catheter enters the urethra several times a day. Use soap, water, and a washcloth. The catheter will be removed once you heal.
  • Drink lots of fluids, especially during the day. This will help to flush your bladder.
  • Avoid heavy lifting or exertion for 3-4 weeks.
  • Avoid sexual activity for 4-6 weeks after surgery.
  • Avoid alcohol, caffeine, and spicy foods.
  • Be sure to follow your doctor's instructions.
Recovery from surgery should take about three weeks. Symptoms such as frequent or painful urination may continue for a while. They should lessen in the first six weeks. If there is blood in your urine, lie down, and drink a glass or two of fluid. The next time you urinate the bleeding should stop. If it does not, call your doctor.
The surgery should not affect your sex drive or ability to have sex. Retrograde ejaculation is likely to occur. This should not be relied on as birth control.

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occur:
  • Difficulty or inability to urinate
  • Pain, burning, urgency or frequency of urination, or persistent blood in the urine—This may be normal during the first few days. If the symptoms persist or are getting worse, contact your doctor.
  • Signs of infection, including fever and chills
  • Pain that you cannot control with the medicines you have been given
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Impotence for longer than three months after surgery
In case of an emergency, call for medical help right away.

RESOURCES

American Cancer Society http://www.cancer.org

National Cancer Institute http://www.cancer.gov

CANADIAN RESOURCES

Men's Health Centre http://www.menshealthcentre.net

The Prostate Centre http://www.prostatecentre.ca

References

BPH. National Kidney Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/#treatment. Updated March 23, 2012. Accessed September 14, 2012.

BPH. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated August 27, 2012. Accessed September 14, 2012.

Griffith HW, Moore S, Yoder K. Complete Guide to Symptoms, Illness & Surgery. New York, NY: Putnam Publishing Group; 2000.

Leocádio DE, Frenkl TL, Stein BS. Office based transurethral needle ablation of the prostate with analgesia and local anesthesia. J Urol. 2007 Nov;178(5):2052-4; discussion 2054.

Lynch M, Anson K. Time to rebrand transurethral resection of the prostate? Curr Opin Urol. 2006;16:20-4.

Michielsen DP, Debacker T, De Boe V, Van Lersberghe C, Kaufman L, Braeckman JG, et al. Bipolar transurethral resection in saline—an alternative surgical treatment for bladder outlet obstruction? J Urol. 2007 Nov;178(5):2035-9; discussion 2039.

Nakagawa T, Toguri AG. Early catheter removal following transurethral prostatectomy: a study of 431 patients. Med Princ Pract. 2006;15(2):126-30.

Medical Management of BPH. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=09&topic=101. Updated January 2011. Accessed September 14, 2012.

Tan A, Liao C, Mo Z, Cao Y. Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg. 2007 Oct;94(10):1201-8.

Wendt-Nordahl G, Bucher B, Hacker A, Knoll T, Alken P, Michel MS. Improvement in mortality and morbidity in transurethral resection of the prostate over 17 years in a single center. J Endourol. 2007 Sep;21(9):1081-7.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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