What is Transurethral Resection of the Prostate (TURP)?

From the Guidelines

Transurethral Resection of the Prostate (TURP) is a recommended surgical procedure for men with moderate to severe urinary symptoms caused by benign prostatic hyperplasia (BPH) that haven't responded to medication therapy, as it provides significant improvement in urinary flow and reduced symptoms. The procedure involves removing excess prostate tissue through the urethra using a resectoscope, which eliminates the need for external incisions 1. TURP is typically performed under spinal or general anesthesia, with a hospital stay of 1-3 days. Patients usually have a urinary catheter for 1-3 days post-surgery. Recovery involves avoiding strenuous activity for 4-6 weeks, staying well-hydrated, and taking prescribed antibiotics to prevent infection.

Some key points to consider when recommending TURP include:

• The patient's prostate size, with TURP being recommended for prostates between 30-80 ml in size 1
• The patient's overall health and medical comorbidities, which may influence the choice of surgical approach and energy source 1
• The potential risks and side effects of TURP, including retrograde ejaculation, temporary urinary incontinence, and rarely, erectile dysfunction 1
• The availability of alternative surgical treatments, such as laser resection or enucleation of the prostate, which may be recommended for patients with specific characteristics or preferences 1

According to the most recent guidelines, TURP is considered a strong recommendation for the surgical treatment of moderate-to-severe lower urinary tract symptoms (LUTS) in men with a prostate size of 30-80 ml 1. Other surgical options, such as laser resection or enucleation of the prostate, may be considered as alternatives to TURP, but the choice of procedure should be based on the individual patient's characteristics and preferences, as well as the surgeon's experience and expertise.

From the Research

TURP Overview

• TURP (Transurethral Resection of the Prostate) is a surgical procedure used to treat urinary problems caused by an enlarged prostate 2.
• The procedure involves removing a portion of the prostate tissue that is blocking urine flow 3.

Alternatives to TURP

• TUIP (Transurethral Incision of the Prostate) is a viable alternative to TURP for patients with prostatic size of 30g or less 2.
• TUIP has several advantages over TURP, including reduced operative time, less bleeding, and decreased risk of complications such as impotence and retrograde ejaculation 2.

Complications of TURP

• The most frequent complication of TURP is intra- and perioperative bleeding 3.
• Preoperative use of 5-alpha-reductase inhibitors (finasteride or dutasteride) can reduce surgical bleeding 3.
• Other complications of TURP include dilutional hyponatremia (TUR syndrome), and decreased length of hospitalization 2.

Diagnostic Yield of TURP

• The diagnostic yield of TURP is low in patients with previously negative transrectal prostate biopsies 4.
• TURP is not recommended for diagnostic purposes only, but can be useful in patients with an abnormal digital rectal examination and obstructive symptoms 4.

Post-TURP Treatment

• 5-alpha-reductase inhibitors (5αRIs) can be effective in reducing prostate volume and improving symptoms after TURP 5.
• Long-term use of 5αRIs can postpone urine retention and prostate surgery in patients with prostate enlargement and a maximum uroflow rate of less than 15 ml/sec 6.