From the Guidelines
Transurethral Resection of the Prostate (TURP) is a moderately painful procedure during recovery, but its effects are generally permanent, though some symptoms may recur over time, as supported by the most recent guideline from 2018 1.
Overview of TURP
TURP involves the surgical removal of the prostate's inner portion via an endoscopic approach through the urethra, with no external skin incision. The procedure is typically performed under general or spinal anesthesia, which means patients do not feel pain during the surgery itself. Post-operative discomfort usually includes burning during urination, urinary urgency, and occasional bladder spasms for 1-2 weeks, managed with oral medications like acetaminophen, NSAIDs, and occasionally short-term opioids if needed.
Permanence and Risks
The procedure permanently removes prostate tissue that was blocking urine flow, with most patients experiencing significant improvement in urinary symptoms. However, about 10-15% of patients may need additional treatment within 10 years as remaining prostate tissue can continue to grow. TURP carries risks including retrograde ejaculation (occurring in 65-75% of men), erectile dysfunction (5-10%), and urinary incontinence (less than 2%) as noted in earlier studies 1.
Recovery and Recommendations
Recovery involves 1-2 days in hospital with a catheter, which is uncomfortable rather than painful, followed by 2-4 weeks of limited activity. Given the current evidence, TURP should be offered as a treatment option for men with LUTS/BPH, as recommended by the 2018 AUA guideline 1. The choice between monopolar and bipolar TURP may depend on the clinician's expertise and the patient's specific situation, considering the reduced risk of hyponatremia and TUR syndrome with bipolar TURP. Overall, the permanence of symptom relief makes the temporary discomfort of TURP worthwhile for most patients with significant urinary obstruction.
From the Research
Pain and Permanence of TURP
- The pain associated with Transurethral Resection of the Prostate (TURP) can be managed with various types of anesthesia, including general, spinal, or local anesthesia, as well as sedation 2, 3, 4.
- Studies have shown that regional anesthesia, such as spinal anesthesia, may offer advantages over general anesthesia for TURP, including lower morbidity 3.
- The permanence of TURP is generally high, with a low rate of recurrence of benign prostatic hyperplasia (BPH) symptoms, ranging from 2-7% within 8-22 years after the procedure 5.
Complications of TURP
- Common complications of TURP include bleeding, transurethral resection syndrome, and urethral strictures, although these can be minimized with advances in technology and techniques, such as bipolar TURP and laser surgery 6, 5.
- Other potential complications include clot retention, bladder perforation, primary fibrinolysis, bacteremia, and septicemia, which can be associated with significant morbidity and mortality, but are amenable to early and aggressive therapeutic intervention 3.
- The use of proper resection techniques can help avoid many complications of TURP 5.
Efficacy of TURP
- TURP has been shown to be an effective treatment for BPH, with a significant improvement in symptoms and quality of life, and a high success rate in relieving urinary obstruction 6, 5.
- The procedure has a robust and simple technique, and is considered to have a low morbidity rate, making it a popular choice for treating BPH patients 5.