Transurethral resection of the prostate (TURP) is an operation for treating enlargement of the prostate gland due to benign prostatic hyperplasia (BPH).
The prostate is a walnut-sized gland that sits beneath the bladder. The urethra, the pipe allowing urine to exit the bladder via the penis, passes through the prostate. As men get older the prostate can enlarge, compressing the urethra and making it difficult to pass urine. These men may develop symptoms such as a weak urinary stream, waking up at night to urinate, or being unable to defer urination when the urge arises.
During TURP the part of the gland causing blockage is bored out using instruments that are passed through a special telescope down the urethra. Depending on the size of the prostate, the operation can take about 40 minutes to 1 hour.
TURP is a useful operation for men who want to avoid taking tablets, are bothered by medication side effects, or in whom medication is no longer effective. It is necessary in men who have developed complications of BPH such as urinary retention, recurrent urinary tract infections, bladder stones or kidney failure.
Before Your Surgery
Certain medications increase the risk of bleeding and need to be stopped prior to surgery. You should tell your surgeon about all prescription medicines, over the counter medicines, vitamins, and herbal supplements that you are taking. Some patients, such as those with artificial heart valves or high blood clotting risk, will need to take blood-thinning injections whilst coming off their tablet medications.
After Your Surgery
After your surgery you will be taken to the Post-Anesthesia Care Unit (PACU) where the recovery room nurse will monitor your condition. When the staff are happy with your initial recovery you will be transferred to the ward.
After the operation has finished, whilst you are still under anesthesia, the surgeon will place a special catheter through your penis into your bladder. This allows constant irrigation into the bladder to prevent clots forming. The irrigation is normally ceased the next morning, although the catheter remains in for another 24 hours. During this time it is normal to have blood in your urine.
Once the catheter is removed you may initially experience some urgency, frequency, stinging and dribbling. Normal urinary control will return over time, usually within a few weeks.
Recovering at Home
The area that has been operated on will be raw for a few weeks. As healing continues, you may notice blood in your urine off and on for several weeks after your operation. When bleeding occurs drink plenty of water until the urine clears.
You may also see tiny particles floating in your urine. These are pieces of prostate tissue and tiny blood clots, and are normal after the operation. Again, this improves with drinking more.
Returning to work is dependent upon the type of work you do and how much blood is in your urine. You should discuss this with your surgeon.
Depending on your pre-existing bladder function, you may have difficulty controlling urination after the operation. This is usually temporary, and can be managed with medication until bladder function returns. There may be some mild urgency and frequency for up to 6 weeks after the operation.
Avoid constipation, as straining may cause bleeding from the operation site. Use your normal diet with added bran and fruits. A mild laxative such as Nulax or Metamucil can be used if necessary.
Avoid heavy lifting, bending, stretching or straining activities for up to four weeks after your surgery. Walking or light exercise can be resumed immediately after your procedure. Ask your surgeon when it will be safe to recommence blood-thinning medications.
You can return to sexual activity once the bleeding in your urine stops, and you and your partner feel comfortable. A dry orgasm (retrograde ejaculation) will occur. You will have normal sensation of orgasms, but there will be much less semen. This is not dangerous. Your semen will go into your bladder and will come out with the urine the next time you urinate.
Specific Risks and Side Effects of TURP
- Heavy bleeding in the urine.
- Inability to pass urine (urinary retention) due to passage of blood clots or swelling after surgery. This may require temporary reinsertion of the urinary catheter.
- No improvement, or deterioration, in urinary symptoms.
- Internal scarring in the urethra (stricture or bladder neck contracture), which may require further surgery.
- Regrowth of prostate tissue over time (usually after more than ten years), which may require repeat surgery.
- Retrograde ejaculation, which means that during orgasm the semen does not pass out of the penis but instead passes into the bladder. The semen then comes out as cloudy urine with the next visit to the toilet. This is an expected outcome that occurs in up to 70-80% of men after TURP.
- Less than 5% of men may experience some deterioration in the quality of their erections after TURP.
- Urinary control usually returns to normal shortly after the surgery. Long-term problems with incontinence, due to permanent injury to the outlet valve from the bladder, occurs in less than 1% of cases.
- An unexpected diagnosis of prostate cancer, which may require further treatment. Your surgeon will discuss your pathology results with you at your postoperative review appointment.
- Excessive absorption of irrigating fluid at the time of surgery. Use of modern technology limits the risk
- Anaesthetic complications, such as heart attack or stroke.
- Infection, for example of the urinary tract, chest, or other sites.
- Bleeding which may occasionally require a blood transfusion.
- Clots forming in the legs (DVT), which may then pass to the lungs.
- Allergic reactions to drugs, antiseptics, or wound dressings.
- Death is extremely rare after any surgical procedure. The risk of death relates to the patient’s general health and the complexity of the surgery, and may arise due to either anaesthetic or surgical complications.
When to contact your surgeon
- Heavy bleeding, with clots in the urine.
- Difficulty emptying the bladder, or unexplained leakage.
- If you develop an infection – this can present with a temperature, smelly urine, or burning and stinging when passing urine.