Transurethral Resection of the Prostate (TURP)

Updated: Dec 5, 2022

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What is a TURP?

Transurethral Resection of the Prostate (TURP) is one of the most common surgical procedures used in the treatment of Benign Prostatic Hyperplasia (BPH). BPH only affects men and is characterized by the non-cancerous enlargement of the prostate gland. A common symptom of BPH is urinary retention (the inability to urinate).
Figure 1 shows a normal prostate whereas Figure 2 shows a prostate with BPH. The physician may recommend a TURP if the patient's BPH symptoms have not improved after treatment with medications or if the patient has urinary retention, recurrent infection, bladder stones, recurrent bleeding from the prostate, or kidney failure caused by BPH. Figure 3 illustrates a resectoscope being used during a TURP.

A TURP procedure is done under general or spinal anesthesia (where the patient is numbed from the waist down). The doctor will insert a small instrument called a resectoscope through the urethra and into the bladder (Video 1).
The resectoscope has an electric wire loop that cuts the prostate. It can also seal the bleeding blood vessels. Figure 4 shows a picture of the prostate and urethra before a TURP whereas Figure 5 shows a picture of the prostate and urethra after a TURP.

Video 1: Video of resectoscope and wire loop as it cuts the prostate

Retrograde ejaculation: when semen does not come out of the urethra during ejaculation. Instead, the semen goes into the bladder and is voided out during urination. This risk, though very common, does not affect erectile function and does not cause harmful effects to your health.
Erectile Dysfunction (ED): rare and may not in all cases be attributable to the surgery. Men who had a TURP appeared to have no greater risk of ED than men who did not have a TURP.
Urinary Incontinence: loss of the ability to control urination. This risk is rare, occuring in about 1% of cases
Bleeding: There is bleeding during and after a TURP. However, the risk of severe bleeding that requires a blood transfusion is rare and usually happens when the prostate is very large.
TUR Syndrome: This occurs rarely. This occurs when too much fluid used to wash the prostate during TURP gets absorbed into the body. This syndrome usually lasts temporarily and can be treated with medication that removes excess water from the body. This syndrome does not happen when saline is used with a bipolar resectoscope.
Scarring of the urethra (urethral stricture) or the bladder neck (bladder neck contracture): This risk is rare. If this occurs however, further treatment or surgery may be required to fix it.
May need a repeat TURP: about 8 out of 100 men need to have another TURP after 5 years.
Infection: This is a rare occurrence.

TURP is effective in improving the voiding symptoms caused by an enlarged prostate (88% overall improvement).
It is considered the gold standard for the surgical management of BPH.
Tissue from TURP can be examined for cancer.

Let your physician know of any allergies you may have and of all the medications you are taking including over the counter medications. If you are taking blood thinning medications such as aspirin, motrin, ibuprofen, naproxen, plavix, or warfarin, ask your physician when you should stop taking these medications.
Do not eat or drink anything after midnight or at least 8 hours prior to surgery. Usually, it is ok to take your regular medication with small sips of water.

Alternatives to TURP include watchful waiting, treatment with medication, transurethral microwave therapy (TUMT), transurethral needle ablation (TUNA), transurethral incision of the prostate (TUIP), and open prostatectomy (an open surgery to remove the inside part of the prostate).

An anesthesiologist will administer general anesthesia or spinal anesthesia to keep you from experiencing discomfort during the procedure.
Your doctor then inserts a resectoscope through your urethra and towards the bladder. A wire loop is then used to scrape off the obstructing prostate tissue. The pieces of the prostate will then be washed out with irrigation fluid and tested for the presence of cancer.

Your doctor will insert a flexible tube called a Foley catheter into your bladder and put you on continuous bladder irrigation to watch the color of your urine and to prevent any blood from clotting (Video 2). Intermittently, you may feel the urge to urinate. If the urge to urinate is strong or you have pain, you should call the nurse to check your catheter and give you medication.

Video 2 : This video depicts a patient with a three way Foley catheter under continuous irrigation

Your doctor will usually remove the Foley catheter after 1-2 days in the hospital. You will be able to urinate with a strong stream. For the rare instance in which you cannot urinate, a thinner Foley catheter will be inserted to drain the urine from your bladder. In that case, you can go home with the catheter and a small urine bag hidden underneath your pants and have it removed in your doctor's office.

For the first few weeks after TURP, you may expect to have the following symptoms (which will gradually get better with time):
- Some burning on urination
- Frequent urination
- Urgent urination with occasional leakage when needing to use the bathroom
- Some bleeding in urine off and on which may last for a month or so

Avoid: straining, strenuous exercises, heavy lifting (over 10lbs), and constipation
You should: drink plenty of water, eat more fruit and vegetables
Ask your doctor when you can: have sex, return to work, and resume your over the counter pain relievers such as aspirin, and ibuprofen