How to Explain TURP Procedure to a Patient
Transurethral Resection of the Prostate (TURP) is the gold standard surgical treatment for benign prostatic hyperplasia (BPH) that should be explained to patients as a procedure where excess prostate tissue is removed through the urethra without external incisions to improve urinary flow and reduce symptoms. 1
What is TURP?
TURP is a surgical procedure that:
- Removes the inner portion of an enlarged prostate gland
- Is performed through the urethra (the tube that carries urine from the bladder)
- Requires no external skin incisions
- Uses an electrified loop to cut away prostate tissue and stop bleeding
- Is typically performed under general or spinal anesthesia
- Usually requires a hospital stay
Why TURP is Recommended
When explaining to patients, emphasize that TURP is indicated for:
- Moderate to severe urinary symptoms not responding to medications
- Urinary retention (inability to urinate)
- Recurrent urinary tract infections due to BPH
- Kidney problems caused by BPH
- Recurrent bladder stones or gross blood in urine due to BPH 1
The Procedure Process
Break down the procedure into simple steps for the patient:
- Anesthesia will be administered (general or spinal)
- A resectoscope (thin tube with camera, light, and cutting tool) is inserted through the urethra
- The surgeon uses an electrified loop to cut away excess prostate tissue
- The removed tissue is flushed into the bladder and then out through the urethra
- A urinary catheter is placed to drain urine and wash out blood clots
- The catheter typically remains for 1-3 days after surgery
Expected Outcomes
Patients should understand the benefits:
- Significant improvement in urinary flow rate
- Reduction in urinary symptoms (frequency, urgency, weak stream)
- Decreased post-void residual urine volume
- Long-term durability of symptom relief 1
Potential Risks and Complications
Be transparent about possible complications:
- Sexual side effects:
- Retrograde ejaculation (most common, occurs in 65-70% of men)
- Possible worsening of erectile dysfunction (though not directly caused by TURP)
- Bleeding (may require blood transfusion in rare cases)
- Urinary tract infection
- Temporary urinary incontinence
- Bladder neck contracture or urethral stricture
- TURP syndrome (dilutional hyponatremia from absorption of irrigation fluid) 1, 2
Post-Operative Care
Explain what to expect after surgery:
- Hospital stay typically 1-2 days
- Urinary catheter for 1-3 days
- Initial burning or urgency when urinating after catheter removal
- Blood in urine that gradually clears over 2-3 weeks
- Need to avoid heavy lifting, straining, or strenuous activity for 4-6 weeks
- Follow-up visits at 2-4 weeks and 3 months 2
Recovery Timeline
Provide a realistic recovery timeline:
- First few days: Catheter in place, possible blood clots in urine
- 1-2 weeks: Gradual improvement in urinary symptoms, though frequency and urgency may temporarily worsen
- 4-6 weeks: Return to normal activities
- 3 months: Full assessment of procedure outcomes 2
Alternative Procedures
While explaining TURP, briefly mention alternatives:
- For very large prostates (>80g): Open or laparoscopic prostatectomy may be considered
- For smaller prostates (≤30g): Transurethral incision of the prostate (TUIP) may be an option
- Newer laser procedures like HoLEP (Holmium Laser Enucleation of the Prostate) 1, 3
Important Cautions for Patients
Emphasize these key points:
- Follow post-operative instructions carefully to prevent complications
- Report any fever, inability to urinate, or bright red bleeding immediately
- Take all prescribed medications as directed
- Attend all follow-up appointments to ensure proper healing
- Be patient with the recovery process as full benefits may take several weeks to realize