Prostate Surgery

Guide to Transurethral Resection of the Prostate (TURP)

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 retreat 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 the most effective surgical treatment for BPH. However, it carries a significant 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 and minimally invasive operations 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 circumstances.

How TURP is performed

Transurethral resection of the prostate (TURP) is a prostate operation used to treat urinary problems that are caused by an enlarged prostate.

During TURP surgery, the doctor inserts a resectoscope through the tip of your penis and into the urethra.

Prostate enlargement blocks the normal flow of urine by narrowing the urethra. The urethra connects the bladder to the penis through the center of the prostate gland.

Resectoscopes have both visual and surgical components, facilitating precise surgical movements. This instrument is used for the removal of prostate tissue. TURP surgery is performed under regional anesthesia. A spinal block is a preferred technique in TURP, but you may receive general anesthesia.

Why is the TURP procedure done?

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:

The initial treatment of BPH involves the use of prostate shrinking drugs like alpha-blockers. 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.

What to expect before TURP?

Preparing for TURP surgery may vary depending on the patient. Your doctor will provide you with information on how to prepare for the procedure. Some guidelines may include:

  1. Signing a consent form. Read the form carefully and ask questions if anything isn’t clear.

  2. Your healthcare provider will review your medical history, and do a physical exam.

  3. You will be asked not to eat or drink anything for 8 hours before the procedure, generally after midnight.

  4. Tell your healthcare provider if you are sensitive to or allergic to any medicines, latex, iodine, tape, contrast dyes, or anesthesia.

  5. Make sure your healthcare provider has a list of all medications that you are currently taking.

  6. Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or any other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

What happens during TURP?

A TURP procedure generally requires a hospital stay. Before going into surgery you will be asked to follow certain guidelines, including:

  1. Removing any objects that might get in the way during surgery.

  2. Removing your clothing and will be given a gown to wear

  3. You’ll be asked to empty your bladder.

  4. An IV line will be put in your arm or hand.

  5. You will be given anesthesia to put you to sleep for the procedure. Your legs will be placed in stirrups.

  6. Your heart rate, blood pressure, breathing, and blood oxygen level will be monitored

  7. The surgeon may first inspect the urethra and bladder with an endoscope. This allows the healthcare provider to examine these areas for any tumors or stones in the bladder.

  8. Next, the resectoscope is passed into the urethra. It is used to cut away the pieces of prostate tissue that are blocking the urethra.

  9. Electricity will be applied through the resectoscope to stop any bleeding. The pieces are flushed into the bladder and then drained out through the urethra.

  10. The resectoscope is removed and you will be provided with a catheter into your bladder to drain urine.

How invasive is TURP surgery?

TRUP is an invasive technique as it involves removing parts of the prostate gland. The surgical injuries take time to heal compared to modern minimally invasive methods.

TURP is less invasive than radical prostatectomy that is used for prostate cancer treatment. Wound healing complications like bleeding may occur.

With modern technologies, your surgeon can direct thermal energy to the prostate through a small cut. The thermal ablation of prostate tissue relieves BPH symptoms better than chemical agents. They are also less painful and have faster recovery times compared to cutting into the prostate.

Your suitability for each procedure depends on your prostate size and health. But your doctor will help you decide the best approach for your circumstances.

Common side effects of TURP

TURP is a safe and effective method for treating the lower urinary symptoms due to BPH.

You may experience one or more genitourinary side effects after your TURP surgery.
Some of the most typical sides effects are;

  • 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 cause 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.

How common are side effects of after TURP surgery?

TURP is generally safe, with most men making a full recovery within eight weeks after surgery. Like all types of invasive surgical procedures, there are potential effects.

Generally, experiencing one or more TURP side effects is common. Some side effects last for weeks, while others persist for many years after TURP surgery.

Most patients will experience some level of urinary incontinence after TURP. Urge incontinence is typical, but it usually improves with four weeks. Rarely, TRUP induced urinary incontinence may become a long-term problem.

Long-term retrograde ejaculation is also frequent, occurring in 90% of cases. Also, more than 10% of men develop erectile dysfunction after TURP, which may be either temporary or permanent. 5% of cases will experience urinary tract infection (UTI), while 4% will have a narrow urethra due to damage to the scarring of the urethra.

TURP syndrome

Rarely, your body may absorb too much fluid used for surgical flushing. This situation leads to electrolyte and fluid imbalances.

Symptoms of TURP syndrome associated with fluid imbalances may include:

  • Nausea.

  • Dizziness.

  • Pain.

  • Vision problems.

  • Confusion, seizure, and coma.

What can help alleviate the common side effects of TURP?

You can take some steps to reduce the severity of urinary side effects of TURP.

Common approaches include:

  • Hydration to help your urine flow.

  • No sexual intercourse up to 2 months post-surgery to avoid damage to the urethra and surrounding area.

  • No stimulants (alcohol and nicotine) to reduce abnormal wound healing.

  • Gentle exercise helps with normal blood circulation and reduce the risk of blood clotting in the legs.

  • Following post-surgery advice.

Recovering from a TURP procedure

Adhering to the expert advice given by your medical team and following some of the tips above helps you make a swift TURP recovery.

Expect to spend two or more days in the hospital before going home to recover. In the absence of any significant complication, it takes about six weeks to make a full recovery after a TURP procedure.

Feeling tired is expected during recovery, and you need to avoid strenuous activities. Your medical team will tell you when to resume your full daily activities.

How long after TURP surgery can you drive?

Your surgeon will advise you when it is safe to drive again. Driving will usually depend on how comfortable you are with performing emergency maneuvers.

Speak to your doctor about the potential visual and cognitive side effects of any medications you are currently taking. Some men can drive again after a week of TURP. Depending on your unique case, you may need one or more months before you can start driving.

How long after TURP surgery can you exercise?

Strenuous exercise can increase your risk of developing wound healing complications post TURP. You should avoid hard tasks in the first three weeks and follow precautions after the TURP surgery.

After the initial three weeks, you should aim to increase the extent of exercise based on how you are feeling. Start with gentle activities like walking and some pelvic floor exercises to help improve your blood circulation and bladder control.

Alternatives to the TURP procedure

TURP remains the most common surgery for BPH, but several other methods are available to treat BPH. Your doctor will help you decide if they are suitable for you and access the risk of complications.

Transurethral incision of the prostate (TUIP)

Cuts small groves 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 like 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?

For mild to a 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:

  • Reducing 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.

Conclusion

Most people make a full recovery four to six weeks after TURP surgery. There are fewer risks of serious complications, but like all surgeries, there are some side effects.

You should seek medical help if you experience persistent pain, reduced urine flow, blood in your urine or sexual disturbances.

TURP leaves most of the prostate gland untouched, increasing the risk of developing other prostate conditions. Lifestyle changes are a critical nonsurgical technique to treat BPH.

Sources

  1. Djavan, B., Teimoori, M., 2018. Surgical Management of LUTS/BPH: TURP vs. Open Prostatectomy, in: Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia. Elsevier, pp. 241–255.
  2. Foster, H.E., Barry, M.J., Dahm, P., Gandhi, M.C., Kaplan, S.A., Kohler, T.S., Lerner, L.B., Lightner, D.J., Parsons, J.K., Roehrborn, C.G., 2018. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J.Urol. 200, 612–619.
  3. Pavone, C., Abbadessa, D., Scaduto, G., Caruana, G., Gesolfo, C.S., Fontana, D., Vaccarella, L., 2015. Sexual dysfunctions after transurethral resection of the prostate (TURP): evidence from a retrospective study on 264 patients. Arch. Ital. Urol. E Androl. 87,8–13.
  4. Roehrborn, C.G., 2016. Prostatic urethral lift: a unique minimally invasive surgical treatment of male lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urol. Clin. 43, 357–369.
  5. Schulman, C., Zlotta, A., 1994. Transurethral needle ablation of the prostate (TUNA): pathological, radiological and clinical study of a new office procedure for treatment of benign prostatic hyperplasia using low-level radiofrequency energy. Arch. Esp. Urol. 47, 895–901.
  6. Teo, J.S., Lee, Y.M., Ho, H.S.S., 2017. An update on transurethral surgery for benign prostatic obstruction. Asian J. Urol. 4, 195–198.

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