Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems due to an enlarged prostate.
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 prostate surrounds the urethra. Using the resectoscope, your doctor trims away excess prostate tissue that's blocking urine flow.
TURP is generally considered an option for men with moderate to severe urinary problems that haven't responded to medication. Traditionally, TURP has been considered the most effective treatment for an enlarged prostate.
However, a number of other, minimally invasive procedures are becoming more effective, due to improved techniques and surgical tools. These minimally invasive procedures generally cause fewer complications and have a quicker recovery period than TURP. The risk of bleeding is generally higher with TURP, so it might not be the best option for certain men who take blood-thinning medications.
Why it's done
TURP helps reduce urinary symptoms caused by benign prostatic hyperplasia (BPH), including:
- Frequent, urgent need to urinate
- Difficulty starting urination
- Slow (prolonged) urination
- Increased frequency of urination at night
- Stopping and starting again while urinating
- The feeling you can't completely empty your bladder
- Urinary tract infections
TURP might also be done to treat or prevent complications due to blocked urine flow, such as:
- Recurring urinary tract infections
- Kidney or bladder damage
- Inability to control urination or an inability to urinate at all
- Bladder stones
- Blood in your urine
Risks of TURP can include:
- Temporary difficulty urinating. You might have trouble urinating for a few days after the procedure. Until you can urinate on your own, you will need to have a tube (catheter) inserted into your penis to carry urine out of your bladder.
- Urinary tract infection. This type of infection is a possible complication after any prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place. Some men who have TURP have recurring urinary tract infections.
- Dry orgasm. A common and long-term effect of any type of prostate surgery is the release of semen during ejaculation into the bladder rather than out of the penis. Also known as retrograde ejaculation, dry orgasm isn't harmful and generally doesn't affect sexual pleasure. But it can interfere with your ability to father a child.
- Erectile dysfunction. The risk is very small, but erectile dysfunction can occur after prostate treatments.
- Heavy bleeding. Very rarely, men lose enough blood during TURP to require a blood transfusion. 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.
- Low sodium in the blood. Rarely, the body absorbs too much of the fluid used to wash the surgery area during TURP. This condition — known as TURP syndrome or transurethral resection (TUR) syndrome can be life-threatening if untreated. A technique called bipolar TURP eliminates the risk of TURP syndrome.
- Need for retreatment. Some men require follow-up treatment after TURP because symptoms return over time or never adequately improve. Sometimes, retreatment is needed because TURP causes narrowing (stricture) of the urethra or the bladder neck.
How you prepare
Food and medications
Several days before surgery, your doctor might recommend that you stop taking medications that increase your risk of bleeding, including:
- Blood thinners such as warfarin (Coumadin) or clopidogrel (Plavix)
- Nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others)
You'll likely be prescribed an antibiotic to prevent urinary tract infection.
Arrange transportation because you won't be able to drive yourself home after the procedure that day or generally if you have a catheter in your bladder.
You might not be able to work or do strenuous activity for up to six weeks after surgery. Ask your doctor how much recovery time you might need.
What you can expect
TURP generally takes 60 to 90 minutes. Before surgery you'll be given either general anesthesia — which means you'll be unconscious during the procedure — or spinal anesthesia, which means you'll remain conscious. You might also have a dose of antibiotics to prevent infection.
During the procedure
The resectoscope is inserted into the tip of your penis and extended through your urethra and into the prostate area. Your doctor won't need to make any cuts (incisions) on the outside of your body.
Your 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.
After the procedure
You'll likely stay in the hospital for one to two days.
You'll have a urinary catheter in place because of swelling that blocks urine flow. The catheter is generally left in place for at least 24 to 48 hours, until swelling declines and you're able to urinate on your own.
You might also notice:
- Blood in your urine. It's normal to see blood right after surgery. But contact your doctor if the blood in your urine is thick like ketchup, bleeding appears to be worsening or your urine flow is blocked. Blood clots can block urine flow.
- Irritating urinary symptoms. Urination might be painful, or you might have a sense of urgency or frequent need to urinate. Painful urination generally improves in six to eight weeks.
Your doctor is likely to recommend that you:
- Drink plenty of water to flush out the bladder.
- Eat high-fiber foods, to avoid constipation and straining during a bowel movement. Your doctor also might recommend a stool softener.
- Wait to resume taking any blood-thinning medications until your doctor says it's OK.
- Avoid strenuous activity, such as heavy lifting, for four to six weeks or until your doctor says it's OK.
- Hold off on sex for four to six weeks.
- Avoid driving until your catheter is removed and you're no longer taking prescription pain medications.
Contact your doctor if you:
- Are unable to urinate
- Notice bright red blood or an increase in clots in your urine that doesn't become clear after drinking more fluid and resting for 24 hours
- Develop a fever above 100.4 degrees Fahrenheit
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.