Transurethral resection of the prostate (TURP)

A TURP (transurethral resection of the prostate) is a minimally invasive surgical procedure to cut away a section of the prostate gland, for men who have developed problems with their prostate.

The prostate is a small gland located below the bladder, and wrapped around the urethra (water pipe). It manufactures some of the semen in the male body, and probably has a significant role in making a man fertile. As men age, the prostate gets larger which can make urinating difficult. The symptoms of prostate cancer may also include difficulty in urination or high levels of prostate-specific antigen (PSA) in the bloodstream.

Men who have trouble passing urine, a slow flow of urine or who have the urge to go to the toilet constantly day and night but with a feeling that they haven't emptied their bladder when they go, may have a benign enlargement of the prostate which can be treated with a TURP operation.

Your doctor will look at all the reasons you have a problem passing urine by giving you an examination, asking you to complete a questionnaire to calculate your International Prostate Symptom Score (IPSS) and asking you to keep a bladder diary.

Further tests include a bladder scan and uroflowmetry, which involves passing water into a meter when the bladder is comfortably full, to measure bladder volume and flow speed.

At this point, the doctor will be able to offer you a management plan, tell you whether a prostate blood test and kidney function test are needed and then depending on your IPSS, recommend either tablets or lifestyle changes or a TURP operation.

Alternative treatments to a TURP for patients with benign enlargement of the prostate include:

  • active monitoring or watchful waiting
  • tablets to allow better passing of water or to shrink the prostate
  • transurethral incision of the prostate (TUIP), involving cutting grooves in the area where the prostate joins the bladder, which can be conducted as an outpatient procedure and carries less risk of retrograde ejaculation as a side-effect
  • or new procedures which are even less invasive than a TURP, including operations with a laser or a urolift.

You will be provided with information describing the different methods for dealing with your prostate problem.

Your consultant will come and discuss with you what to do next.

At your pre-operative assessment, your heart and lungs will be tested, and blood taken for a test and also to put some blood in reserve in the event you require a blood transfusion. If necessary your blood pressure will be checked.

You will be given instructions about what time to come for the operation and told not to eat or drink for six hours beforehand. You should bring a change of clothes to hospital as you will be there for at least one night.

A TURP is a minimally invasive operation performed through the urethra (water pipe). It does not involve any cut through the abdomen.

A thin metal tube called a resectoscope containing a camera, a light and a loop of wire is inserted into your urethra and passed along until it reaches the prostate.

The loop of wire is heated up with an electric current and is used to cut away in small sections parts of the prostate that are causing the symptoms.

Next, a catheter is inserted into your urethra to pump fluid into the bladder, flushing away the sliced-off pieces of prostate.

It takes around an hour to perform a TURP. At the end of the operation, the catheter is left inside your urethra to undertake fluid irrigation to clear the blood. Very often, the fluid is blood-stained.

Irrigation continues until the fluid is clear – this can take 12-24 hours. After this, the catheter is removed and the amount of urine you pass is measured to make sure you are emptying your bladder completely. A nurse will perform a scan to check what remains in the bladder after you have urinated.

If you are unable to pass water after the catheter is removed, you will be re-catheterised and discharged home for a week before a retrial.

Patients normally stay in hospital for one or two days after having a TURP.

It’s common for men who have just had a TURP to feel tired and under the weather for a week or two after the operation. The date when it is appropriate to return to work will depend on the physical demands of your job.

You should take it easy for 4-8 weeks after the operation, avoiding lifting heavy objects, driving and having sex for a few weeks at least.

It’s normal to experience some difficulties urinating and to find some blood in the urine for a few weeks after having a TURP. These problems should go away as you recover fully.

By the end of the recovery period following a TURP, you will be able to pass urine better than before the operation and should experience relief from associated discomforts. As a keyhole operation, it involves a minimal hospital stay.

General side effects:

  • Bleeding – the presence of some blood in the urine is to be expected after a TURP. Bladder washouts can be performed to clear blood and blood clots. If there is a lot of blood in your urine, your haemoglobin level will be checked. If your haemoglobin level is greater than 8, you require a blood transfusion and, rarely, further surgery; your bladder will be irrigated with fluid to flush it out.
  • Infection – This occurs in around one in ten cases following a TURP and can be treated with antibiotics. The risk is higher if you have a catheter inserted before surgery. Sepsis, the condition where the body’s response to infection causes injury to its own tissues and organs, occurs very rarely.
  • Blood clots in the legs (deep vein thrombosis, DVT) – these can be prevented by wearing stockings or with anti-coagulation medicine or with injections. Getting out of bed soon after your operation minimises the risk of a DVT forming.

Specific side effects of the procedure:

  • Loss of fertility as a result of retrograde ejaculation – this is the most common long-term complication of a TURP. Due to damage to nerves that control the bladder opening, semen passes back towards the bladder rather than out through the penis during orgasm, although the sensation of physical pleasure is maintained. The effects are usually permanent and cannot be reversed. It is not a harmful phenomenon – semen continues to leave the body via urination. It is possible to have partial retrograde ejaculation, where some semen leaves the body via the penis and some returns to the bladder. Some men find that ejaculating with a full bladder helps semen exit the penis, as a full bladder helps keep the bladder opening closed. Men experiencing retrograde ejaculation following a TURP who want to father a child can have sperm removed from their urine by a urologist, and men concerned about retrograde ejaculation as a possible outcome of a TURP can freeze their sperm before the procedure.
  • Erectile dysfunction – this is a rarer occurrence than retrograde ejaculation, and tends to happen in older men who have already had impotence problems before the operation
  • Urinary incontinence – this may happen for a short while after the operation, but is permanent only in rare circumstances
  • Narrowing of the urethra or the bladder neck due to scar tissue forming – this can lead to urinary symptoms deteriorating after an initial improvement and may require further surgery to address.

 

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