Doctor Answers: What is Transurethral Resection of the Prostate?

Benign prostatic hyperplasia (BPH) causes a range of urinary tract symptoms. Many men with BPH undertake Transurethral resection of their prostate to help treat or relieve their symptoms. 

Transurethral resection of the prostate (TURP) is a surgical procedure that involves cutting away a section of the prostate. The prostate is a small gland in men located between the penis and bladder and surrounds the urethra (the tube that transports urine from the bladder to the penis). 

Resection of the prostate is considered one of the most effective surgical treatment for BPH. However, it carries a risk of urinary and sexual complications. Men have reported both temporary and permanent problems after this surgery, making it a source of reasonable concern. 

Other approaches, including watchful waiting, medication, minimally invasive operations, and enucleation, ablation, are available to treat BPH. However, some of the side effects of these approaches are like the surgical resection of the prostate. 

These treatments do not remove most of the prostate gland. Thus, your symptoms may start again, which may need invasive surgery. Generally, the treatment you receive for your BPH will depend on your symptoms and availability. Your doctor will help you determine the best treatment for your circumstances.

Q: What is TURP and why is it performed?

Dr. Ambardjieva answers: Transurethral resection of the prostate (TURP) is a surgical procedure used to treat urinary problems caused by benign prostatic hyperplasia (BPH). BPH is a non-cancerous enlargement of the prostate that causes lower urinary tract symptoms in men, especially those over 60. TURP involves cutting away a section of the prostate that blocks urine flow through the urethra. Although effective, TURP can cause urinary and sexual complications, both temporary and permanent. Treatment for BPH depends on the severity of symptoms, and options include watchful waiting, medication, and minimally invasive procedures. TURP is considered one of the most effective surgical options for significant cases.

Q: How is TURP surgery performed?

Dr. Ambardjieva answers:  During TURP, a surgeon inserts a resectoscope through the tip of the penis into the urethra. This instrument has visual and surgical components, allowing precise removal of prostate tissue. Prostate enlargement narrows the urethra, and TURP helps restore normal urine flow. The surgery is usually done under regional anesthesia, with spinal blocks being preferred, though general anesthesia is also an option. Electricity is applied through the resectoscope to stop any bleeding, and the removed tissue is flushed into the bladder and drained. A catheter is then inserted to drain urine.

Q: Why is the TURP procedure done?

Dr. Ambardjieva answers: TURP operation is used to treat the urinary complications of benign prostatic hyperplasia (BPH). BPH is a common cause of lower urinary tract symptoms in men over the age of 60 years.

For instance, bladder outlet and benign prostate obstruction often co-occur in men (Teo et al., 2017).

You may undergo TURP (Transurethral resection of the prostate) if you are experiencing one or more of the lower urinary tract symptoms below:

• Frequent urination or the urgent need to urinate.
  
• Urinary retention

• Nocturia
  
• Difficulty passing urine or slow urination.
  
• Recurring urinary tract infections.
  
• Kidney or bladder damage.

The initial treatment of BPH involves the use of prostate shrinking drugs like alpha-blockers and 5-alpha reductase inhibitors. When chemical therapy fails, surgical interventions can remove excess prostate tissue.

Unfortunately, in the balance between symptom relief and side effects, it is an uncomfortable fact that those invasive methods do not work in some men.

Q: What should patients expect before undergoing TURP?

Dr. Ambardjieva answers:  Preparation for TURP includes signing a consent form, reviewing your medical history, checking PSA (prostatic specific antigen), undergoing a physical exam, and avoiding food or drinks for at least 8 hours prior to surgery. Patients should inform their healthcare provider of any allergies or current medications, especially blood thinners. It’s important to stop certain medications that affect blood clotting before the procedure.

Q: What happens during the TURP procedure?

Dr. Ambardjieva answers: TURP requires a hospital stay. Before surgery, you’ll change into a gown, empty your bladder, and have an IV line inserted. Anesthesia is administered, and vital signs are monitored. The surgeon examines the urethra and bladder using an endoscope. Then, a resectoscope is inserted to remove prostate tissue blocking the urethra. After cutting the tissue, bleeding is stopped using electrical current, and tissue fragments are flushed out. A catheter is placed to help drain urine during recovery.

Q: How invasive is TURP compared to other procedures?

Dr. Ambardjieva answers: TURP is an invasive procedure because it involves removing parts of the prostate. While less invasive than a radical prostatectomy (used for cancer), TURP can still lead to complications like bleeding. Modern alternatives such as button TURP and thermal ablation are less invasive, with quicker recovery times. The thermal ablation of prostate tissue relieves BPH symptoms better than chemical agents. Your eligibility for various treatments depends on your prostate size and health. Your doctor will guide you toward the most suitable option.

Q: What are the common side effects of TURP?

Dr. Ambardjieva answers: TURP can lead to side effects, including:

• Urinary incontinence: Loss of bladder control (incontinence) is a long-term complication of TURP.
  
• Difficulty and discomfort during urination: You might have trouble urinating for a few days after the procedure. In such cases, you may have a catheter inserted.
  
• Urinary tract infection: An infection is increasingly likely to occur the longer you have a catheter in place.
  
• Dry orgasm: Also known as retrograde ejaculation, dry orgasm generally doesn’t affect sexual pleasure. Retrograde ejaculation is a common long-term side effect of TURP surgery. There is a 90% chance that you will experience retrograde ejaculation after TURP. During sexual activity, semen flows into your bladder instead of your penis, increasing the risk of fertility complications. You should speak to your medical provider if you plan to have children in the future.
  
• Erectile dysfunction: Erectile dysfunction can occur after prostate treatments. TURP may cause sexual problems, and rarely, you may experience damped libido. A retrospective longitudinal study involving over 250 of BPH patients investigated sexual problems post-TURP. Some participants reported reduced erectile function and sexual satisfaction after TRUP (Pavone et al., 2015).
  
• Heavy bleeding: Men with larger prostates appear to be at higher risk of significant blood loss. Blood in the urine may be experienced for more than five weeks.
  

• Low sodium in the blood: Known as TURP syndrome or transurethral resection (TUR) syndrome, can be life-threatening if untreated. We discuss it in further detail below.
  
• Anesthesia-related complications: Further, you may experience anesthesia-related complications. A spinal block may increase your risk of developing hypotension. Spinal anesthesia causes dilation of blood vessels leading to reduced venous return.
  
• Need for re-treatment. Some men require follow-up treatment after TURP because symptoms don’t improve or they return over time.

The urinary tract effects of TURP usually resolve as the inflammation around the prostate area reduces.

Q: How common are TURP side effects?

Dr. Ambardjieva answers: TURP is a common and generally safe procedure used to treat an enlarged prostate. Thanks to modern technology and better surgical techniques, serious side effects are now much less common. Some patients may experience a temporary urge to urinate suddenly after the procedure, which happens in about 30 to 40 percent of cases. Difficulty urinating right after surgery can occur in around 3 percent of patients and is usually due to the bladder muscle being weak rather than a problem with the surgery itself. Urinary tract infections affect about 1.7 percent of patients, and blood clots in the bladder can happen in around 2 percent of cases.

Serious complications like heavy bleeding or a rare condition called TUR syndrome are now extremely rare. In the long term, some patients may develop scarring in the urethra (the tube that carries urine), which can occur in up to 10 percent of cases, or narrowing at the bladder neck, which affects up to 9 percent. Permanent urine leakage, or incontinence, is very rare and occurs in less than 0.5 percent of patients.

Overall, most patients, even those over the age of 70, recover well from TURP with a very low risk of serious complications or death. However, about 3 to 15 percent of patients may need a repeat procedure within five years.

Q: What can help alleviate common TURP side effects?

Dr. Ambardjieva answers: To reduce side effects:

• Stay hydrated
  
• Eat a healthy diet to aid healing
  
• Avoid alcohol and nicotine
  
• Engage in gentle exercise to promote circulation
  
• Follow all post-operative advice from your medical team
  

Q: What is the recovery process after TURP?

Dr. Ambardjieva answers: Recovery from TURP typically requires a hospital stay of at least two days. Full recovery takes about six weeks. Tiredness is common, and strenuous activities should be avoided. Follow your medical team’s advice on when to resume daily activities.

Q: When can you drive again after TURP surgery?

Dr. Ambardjieva answers: Driving after TURP depends on how quickly you recover and your ability to perform emergency maneuvers safely. Some men can drive within a week, while others may need a month or more. Your surgeon will advise based on your condition and medications.

Q: When can you resume exercise after TURP?

Dr. Ambardjieva answers:  Strenuous activity should be avoided for at least three weeks after TURP. Gentle walking and pelvic floor exercises can help during the initial recovery. Increase activity levels gradually, depending on how you feel, and follow your doctor’s recommendations.

Q: What are the alternatives to TURP?

Dr. Ambardjieva answers: TURP remains the most common surgery for BPH, but several other methods are available to treat BPH. Several alternatives to TURP exist:

Transurethral incision of the prostate (TUIP)

Cuts small grooves at the junction of the prostate and bladder (Foster et al., 2018). Surgeons perform TUIP using a resectoscope inserted through the penis to the urethra.

TUIP is minimally invasive, but side effects, including difficulty urinating and infection, may occur. Many of these side effects are similar to the TURP complications discussed above. You may need to undergo further treatment.

Transurethral needle ablation (TUNA)

TUNA uses heat-induced cell death to ablate excess prostate tissue (Schulman and Zlotta, 1994). Here, a urologist delivers a low radio frequency power through a small urethral catheter inserted through the penis.

Due to reduced tissue damage, TUNA has reduced recovery time as well as treatment complications. It is less effective than TURP and TUIP for treating BPH. Further, TUNA may cause irritation, inflammation, and urinary complications that need invasive surgery.

Laser surgery

Vaporization or holmium laser enucleation is also used to remove excess prostate tissue. These techniques are like TURP, except for cutting the prostate tissue. During the operation, the surgeon delivers laser energy to the prostate gland through a cystoscope inserted into your urethra. Laser surgery causes fewer side effects and complications compared to invasive methods.

Prostatic urethral lifts

In minor BPH presentation, prostatic implants may be used to lift the prostate away from the urethra. The Urolift procedure improves urinary symptoms of BPH, eliminating some of the symptoms of invasive surgeries
(Roehrborn, 2016) .

Open prostatectomy

In severe BPH, your doctor may remove the whole prostate. Conventional surgery is particularly useful when other treatments have failed. The surgeon performs this operation through small cuts made on your body (Djavan and Teimoori, 2018).

Open prostatectomy is effective for hard-to-treat BPH symptoms. But it has a higher risk of treatment side effects and complications. Long-term urinary incontinence, erectile dysfunction, and wound healing complications are frequent. They need extended hospital stays and recovery time compared to other methods used to treat BPH.

What are some nonsurgical alternatives to TURP surgery?

Dr. Ambardjieva answers: For a mild to moderate presentation of BPH symptoms, watchful waiting combined with lifestyle changes may be an effective approach. Some lifestyle changes help you reduce BPH-associated bladder irritation and other urinary symptoms, including:

• Reduce your intake of alcohol and caffeine.
  
• Reducing your fluid intake in the evening and emptying your bladder before long travels.
  
• Bladder exercise.

You may need pharmacological interventions if your symptoms persist with lifestyle changes.

Some of the common medications to treat BPH are:

• Alpha-blockers to relax specific muscles and improve urine flow.
  
• Anticholinergics to reduce bladder movements and improve urinary symptoms.
  
• 5-alpha reductase inhibitors to block androgen activity and shrink the prostate gland.
  
• Diuretics to regulate the volume of night urine.

However, it is important to bear in mind that these medications can have a number of side effects. Before taking medication, be sure to ask your doctor about potential side effects and drug interactions.

Effective treatment of BPH depends on the type and extent of your symptoms. Some men benefit from watchful waiting, lifestyle changes, or medications.

In rare situations, your doctor needs surgical techniques like TUIP to remove the excess prostate tissue. Open surgery is most suitable for prostate cancer compared to BPH.

Patient FAQs on Transurethral Resection of the Prostate

Q: Can TURP affect ejaculation volume or fertility in younger men?

Dr. Ambardjieva  answers: Yes, TURP can affect ejaculation and fertility, especially in younger men.

Most notably, retrograde ejaculation, where semen flows backward into the bladder instead of exiting the penis, occurs in a significant number of cases, typically between 50% and 75% after standard TURP. This results in little to no visible semen during orgasm. While it doesn’t affect the sensation of orgasm, it can impair fertility since sperm do not reach the urethra, making natural conception difficult.

Less commonly, anterograde ejaculation (normal forward ejaculation) may be preserved. Partial ejaculation-sparing TURP techniques have shown success rates of around 50–70%, and specialized approaches that focus on preserving the tissue around the verumontanum have achieved antegrade ejaculation in over 90% of select cases.

For younger men concerned about future fertility, it’s important to discuss goals with a urologist before surgery. Options may include sperm banking beforehand or considering alternative treatments, such as ejaculation-preserving TURP or minimally invasive procedures like UroLift or Rezum, which typically spare ejaculation.

In summary, TURP often leads to retrograde ejaculation in roughly 50–75% of men, reducing visible semen and potentially impacting fertility. However, with careful planning, modern techniques can preserve ejaculation in many cases.

Q: Does prostate size determine TURP eligibility or effectiveness?

Dr. Ambardjieva  answers: Prostate size plays a role in determining the most appropriate treatment for benign prostatic hyperplasia (BPH), but it doesn’t strictly define eligibility for TURP. Traditionally, TURP is considered most effective for prostates between 30 and 80 grams. For very large prostates (typically over 80–100 grams), other procedures such as HoLEP (Holmium Laser Enucleation of the Prostate) or open/laparoscopic prostatectomy may be preferred due to better outcomes and shorter operative times for larger volumes.

That said, TURP can still be performed on larger prostates in select cases, though the procedure may take longer and carry a slightly higher risk of bleeding or incomplete resection. Effectiveness depends more on symptom severity, prostate anatomy, and overall health status, rather than size alone. A thorough evaluation by a urologist—including symptom scoring, imaging, and urodynamic studies—helps guide the decision for the most suitable treatment.

In summary, while prostate size is an important consideration, it doesn’t solely determine whether TURP is appropriate or effective.

Q: Is it safe to have a second TURP if symptoms return years later?

Dr. Ambardjieva  answers: Yes, having a second TURP, also known as a repeat TURP, is generally considered safe and effective if urinary symptoms return after the initial procedure. Over time, some men may experience symptom recurrence due to regrowth of prostate tissue or scarring at the bladder neck or urethra. This happens in approximately 3–15% of patients within five years after the first TURP.

A second TURP can relieve symptoms much like the original procedure, especially when performed by an experienced urologist. The risks are slightly higher compared to the first surgery, particularly regarding bleeding, infection, or urethral strictures, but with modern techniques and good surgical planning, complication rates remain low.

Before repeating TURP, a full evaluation, including imaging, uroflowmetry, and cystoscopy, is usually done to confirm the cause of the symptoms and determine if a second surgery is the best option. In some cases, alternative procedures like laser enucleation (HoLEP) may be recommended.

In summary, a second TURP is usually safe and effective, especially when tailored to the individual’s condition and performed under expert care.

Q: How does TURP impact men with coexisting conditions like diabetes or heart disease?

Dr. Ambardjieva  answers: TURP is generally safe for men who have chronic conditions like diabetes or heart disease, though these health issues can slightly increase the risk of certain complications and may affect recovery.

In men with diabetes, there may be a higher chance of urinary tract infections, delayed healing, or temporary difficulty emptying the bladder after surgery. This is often related to nerve or bladder changes caused by diabetes itself. Similarly, men with heart disease may require extra care with anesthesia and fluid balance during surgery to avoid putting stress on the heart. With proper planning and monitoring, TURP can still be safely performed in these patients.

It’s also important to know that not all urinary symptoms may improve after TURP. For example, frequent urination (polyuria), getting up often at night to urinate (nocturia), or urgency may continue after surgery if they are caused by other conditions like poorly controlled diabetes or heart failure, rather than prostate enlargement. In these cases, managing the underlying condition is key to improving symptoms.

In summary, TURP can be a safe and effective treatment even for men with other health issues, but a thorough evaluation is essential. A personalized approach, often involving other specialists, helps ensure the best possible outcome.

Q: Can lifestyle changes delay or reduce the need for TURP?

Dr. Ambardjieva  answers: Yes, certain lifestyle changes can help manage urinary symptoms caused by an enlarged prostate (BPH) and may delay or even reduce the need for TURP, especially in the early stages of the condition.

Simple steps such as limiting fluid intake in the evening, reducing caffeine and alcohol, and avoiding bladder irritants (like spicy foods or artificial sweeteners) can help decrease urgency and frequency. Maintaining a healthy weight, staying physically active, and managing chronic conditions like diabetes or high blood pressure also contribute to better bladder function.

Practicing bladder training, such as scheduled voiding, and doing pelvic floor exercises may also improve urinary control and reduce symptoms.

While lifestyle changes won’t shrink the prostate itself, they can help control symptoms and delay progression. In mild to moderate cases, these strategies, often combined with medications, may be enough to avoid or postpone surgery. However, if symptoms become severe or significantly affect quality of life, TURP or another surgical option may still be necessary.

In summary, a healthy lifestyle can play a valuable role in managing BPH and may reduce the urgency for surgical treatment like TURP.

Conclusion

Most men fully recover within 4 to 6 weeks after TURP. Though effective, the procedure carries risks, so it’s essential to monitor symptoms and seek medical help if complications like pain, blood in urine, or sexual dysfunction occur. 

TURP doesn’t remove the entire prostate, so recurrence of symptoms or development of other conditions is possible. Lifestyle changes remain crucial in managing BPH long-term.

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