What are the side effects and longevity of Monopolar Transurethral Resection of the Prostate (M-TURP) for Benign Prostatic Hyperplasia (BPH)?

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Side Effects and Longevity of Monopolar Transurethral Resection of the Prostate (M-TURP)

Monopolar TURP (M-TURP) delivers durable outcomes for up to 22 years but carries significant perioperative mortality (0.1%) and morbidity (11.1%) risks, making it effective but not without important complications. 1

Efficacy and Longevity

M-TURP remains the gold standard surgical procedure for men with prostate sizes between 30-80ml and bothersome moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). Key points about its longevity:

  • Delivers durable outcomes for up to 22 years 1
  • Provides significant improvements in urinary flow rates, symptom scores, and post-void residual volumes 2
  • Reoperation rates are approximately 7.2% compared to 18.4% for TUIP 1
  • Provides the highest decrease in prostate volume (48.8%), best increase in maximum flow rate (75.3%), and highest decrease in residual volume (89.8%) compared to other minimally invasive treatments 2

Side Effects and Complications

Perioperative Complications (Short-term)

  • Mortality rate: 0.1% 1
  • Overall morbidity rate: 11.1% 1
  • Prostate capsule perforation: 5.2% 3
  • Severe bleeding requiring transfusion: 1.7% 3
  • Urethral injury during the procedure 3
  • TURP syndrome (dilutional hyponatremia): unique complication when irrigant solution is absorbed into bloodstream 1
  • Longer catheterization and hospitalization times with preoperative use of oral anticoagulants or antiplatelet medications 1

Post-operative Complications (Medium to Long-term)

  • Urinary tract infections: 7.8% 3
  • Bulbar urethral stricture: 5.2% 3
  • Bladder neck contracture: 1.7% 3
  • Need for repeat TURP: 4% 3
  • Sexual dysfunction (including retrograde ejaculation): 68% in sexually active men 4
  • Irritative voiding symptoms 1
  • Urinary incontinence: approximately 1% 1

According to the Clavien-Dindo complication grading system, the overall complication rate is approximately 29.3%, with about 96% of complications being grade I, II, or III, which can be managed conservatively or with minimally invasive surgery 3.

Comparison with Other Techniques

Bipolar TURP (B-TURP)

  • Achieves comparable short, mid, and long-term results to M-TURP 1
  • Has a more favorable perioperative safety profile than M-TURP 1
  • Similar effects on overall sexual function (IIEF-15) and erectile function (IIEF-5) at 12 months 1

Transurethral Incision of the Prostate (TUIP)

  • Appropriate for smaller prostates (<30ml) 1
  • Similar efficacy and safety to M-TURP for treating moderate-to-severe LUTS 1
  • Significantly lower retrograde ejaculation rate (35% vs 68%) 4
  • Higher reoperation rate (18.4% vs 7.2%) 1

Clinical Decision-Making Algorithm

  1. Prostate Size Assessment:

    • <30ml: Consider TUIP (lower retrograde ejaculation risk but higher reoperation rate)
    • 30-80ml: M-TURP or B-TURP (standard approach)

    • 80ml: Consider open prostatectomy or laser enucleation techniques

  2. Patient Risk Factors:

    • Patients on anticoagulants/antiplatelets: Consider B-TURP or laser techniques over M-TURP
    • High cardiovascular risk: B-TURP preferred over M-TURP due to better safety profile

  3. Sexual Function Considerations:

    • If preserving ejaculatory function is important: Consider TUIP for smaller prostates
    • If erectile function is a major concern: No significant difference between M-TURP and B-TURP at 12 months

Important Caveats and Pitfalls

  • Despite newer technologies, M-TURP remains the benchmark for surgical therapies due to published evidence of efficacy from randomized clinical trials with long-term follow-up 1
  • The perioperative mortality and morbidity of M-TURP have decreased over time but remain significant 1
  • Patients should be informed about the high rate of retrograde ejaculation (68%) which may affect sexual satisfaction 4
  • TURP syndrome, though rare with modern irrigation techniques, remains a unique and potentially serious complication of M-TURP 1
  • Preoperative use of anticoagulants requires careful management to reduce bleeding risks 1

In summary, while M-TURP provides excellent long-term outcomes for up to 22 years, patients must be counseled about the significant complication rate of approximately 29.3%, with most complications being manageable with conservative or minimally invasive approaches.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Transurethral resection versus minimally invasive treatments of benign prostatic hyperplasia: results of treatments. Our experience.

Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica, 2004

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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