From the Guidelines
Complications after Transurethral Resection of the Prostate (TURP) include urinary incontinence, decline in sexual function, TURP syndrome, sexual dysfunction, irritative voiding symptoms, bladder neck contracture, the need for blood transfusion, UTI, and hematuria, with the most significant risks being TURP syndrome and sexual dysfunction. According to the study by 1, the most definitive published study of TURP, the Veterans Affairs Cooperative Study, demonstrates a 1% risk of urinary incontinence and an overall decline in sexual function that was identical to the watchful waiting treatment group. Some of the key complications of TURP include:
- TURP syndrome, a dilutional hyponatremia that occurs when irrigant solution is absorbed into the bloodstream
- Sexual dysfunction, which may not be attributable to the surgery in all cases
- Irritative voiding symptoms
- Bladder neck contracture
- The need for blood transfusion
- UTI
- Hematuria These complications can have a significant impact on the patient's quality of life, and it is essential to carefully weigh the risks and benefits of TURP before making a decision. The study by 1 highlights the importance of considering these complications when evaluating treatment options for symptomatic BPH. In terms of management, it is crucial to monitor patients closely for signs of complications and to provide prompt treatment when necessary. Overall, while TURP can be an effective treatment for symptomatic BPH, it is essential to be aware of the potential complications and to take steps to minimize their impact on the patient's quality of life.
From the Research
Complications of Transurethral Resection of the Prostate (TURP)
The complications after TURP can be categorized into early and late complications. Early complications include:
- Recurrent urinary retention and urinary tract infection, which are more common in patients with acute urinary retention 2
- Transfusion rate, TUR syndrome, clot retention, and urinary tract infection, which have decreased over time due to technological improvements 3
- Non-surgical bleeding, which can be caused by high concentrations of urokinase and tissue plasminogen activator (tPA) in the urine 4
Late complications include:
- Urinary incontinence, which occurs in up to 18% of patients who undergo TURP after brachytherapy 5
- Urethral strictures (2.2-9.8%) and bladder neck contractures (0.3-9.2%) 3
- Retreatment rate, which ranges from 3-14.5% after five years 3
Management and Prevention of Complications
To manage and prevent complications, the following measures can be taken:
- Urodynamic study to rule out concomitant bladder dysfunction before surgery 2
- Adequate prophylactic antibiotic treatment to decrease the risk of urinary tract infection during or after TURP 2, 6
- Monitoring of patients' coagulation profiles and electrolytes after TURP to prevent severe acute hyponatremia, TURP syndrome, fibrinolytic changes, and non-surgical bleeding 4
- Use of antifibrinolytic agents, such as Tranexamic acid, to prevent post-TURP bleeding 4