Transurethral Resection of the Prostate (TURP)

The prostate is a walnut-sized gland below the bladder that surrounds the urethra. With age its inner part often grows, a condition called benign prostatic hyperplasia or benign prostatic enlargement, and it can squeeze the urethra like a clamp on a hose. TURP removes this inner tissue from the inside. A thin telescope called a resectoscope is passed along the urethra, and an electrical wire loop shaves away the obstructing tissue in small pieces while the surgeon watches on a screen. The outer shell of the prostate is left in place, a little like hollowing out an orange while keeping the peel. Monopolar TURP uses one type of electrical current with a non-salt rinsing fluid; bipolar TURP uses saline, which lowers the risk of a fluid absorption problem. Laser alternatives, such as holmium laser enucleation (HoLEP), thulium laser and photoselective vaporisation, are offered in some centres, especially for large glands or for men on blood thinners.

TURP is offered to men whose urinary symptoms from benign prostatic enlargement interfere with daily life and have not improved enough with lifestyle changes and medicines, such as alpha blockers or 5-alpha reductase inhibitors, or who cannot tolerate those medicines. Typical symptoms are a weak or interrupted stream, straining, a feeling that the bladder has not emptied, urgency, and getting up several times a night to pass urine. Surgery is also advised when enlargement causes complications: sudden or long-standing inability to pass urine (urinary retention), repeated urinary infections, stones in the bladder, recurrent bleeding from the prostate, or back pressure that affects kidney function. Very large glands may be better treated by laser enucleation or by robotic or open surgery, while men who wish to preserve ejaculation may consider options such as a prostatic urethral lift or water vapour therapy. Your urologist compares these options with you.

TURP is usually done under spinal anaesthesia, which numbs the lower body while you stay awake or lightly sedated, or under general anaesthesia. You lie on your back with your legs supported. The surgeon passes the resectoscope through the tip of the penis along the urethra, with no external cut, and fills the bladder with rinsing fluid to give a clear view. The bladder is inspected first for stones or other problems. The wire loop then removes the obstructing prostate tissue piece by piece, and bleeding points are sealed with the same current. The chips of tissue are washed out of the bladder and sent to the laboratory, where they are examined for any unexpected cancer. At the end, a catheter with three channels is placed so that the bladder can be rinsed continuously for the first hours to stop clots forming. The operation usually takes about an hour, depending on the size of the prostate.

Candidates are men with bothersome symptoms or complications from a benign enlarged prostate who are fit for anaesthesia; age alone is not a barrier. Before surgery, the urologist confirms the diagnosis and checks that the symptoms come from obstruction rather than from an overactive or weak bladder. Typical tests include a symptom questionnaire, a urine test, a PSA blood test, which helps look for prostate cancer, kidney function blood tests, an ultrasound of the prostate and bladder with a measurement of the urine left after voiding, and a flow test. Some men need urodynamic studies or a cystoscopy. Blood thinners usually have to be stopped or adjusted on medical advice, which needs planning before travel, and any urinary infection is treated first. You fast for about six hours before the operation. International patients can usually send test results and medication lists in advance for a remote review.

After the operation the catheter stays in for about 1 to 3 days, often with bladder irrigation for the first day, and the urine is usually pink at first. When it clears, the catheter is removed and you are watched to make sure you pass urine well before going home, typically after 1 to 3 nights. For the next few weeks, burning, urgency and passing urine often are common, and a little blood may reappear, especially around 10 to 14 days when small scabs inside the prostate come away. Drinking plenty of water, avoiding constipation and avoiding heavy lifting, cycling and strenuous exercise for about 4 to 6 weeks helps healing. Sexual activity can usually resume after about 3 to 4 weeks. For travel, plan to stay about 1 to 2 weeks after surgery, so that the catheter is out, you are voiding comfortably and the tissue report is often available before a long flight.

TURP is a well-established operation with predictable results, but it has side effects you should weigh. Retrograde ejaculation is common: after TURP, semen usually passes backwards into the bladder at orgasm rather than out of the penis, and is then passed in the urine. The sensation of orgasm is usually preserved, but this change is generally permanent and reduces natural fertility. Bleeding that needs a return to the operating theatre or a transfusion, urinary infection and clot retention are less common. A short-term problem with fluid absorption, called TUR syndrome, is now rare, especially with bipolar equipment. Some men have urgency or leakage for a few weeks; lasting incontinence is uncommon. A minority report new erection problems. Over the years, narrowing of the urethra or bladder neck can occur, and some men need a repeat procedure because the prostate regrows. For most men, urine flow and night-time symptoms improve clearly and the benefit lasts for many years.