What is a Transurethral Resection of the Prostate (TURP)?

Transurethral Resection of the Prostate (TURP)

TURP is a surgical procedure that removes the inner portion of the prostate gland through the urethra using an electrified loop to resect prostatic tissue and cauterize blood vessels, requiring no external skin incision. 1

Procedure Details

TURP involves the following key elements:

• Performed through the urethra with an endoscope (resectoscope)
• Uses an electrified cutting loop to remove obstructing prostatic tissue
• Requires general or spinal anesthesia
• Typically requires a hospital stay
• Considered the gold standard for surgical treatment of benign prostatic hyperplasia (BPH) 1, 2

Indications

TURP is primarily indicated for:

• Symptomatic benign prostatic hyperplasia (BPH) not responding to medical therapy
• Urinary retention secondary to BPH
• Recurrent urinary tract infections due to BPH
• Bladder stones or diverticula due to BPH
• Gross hematuria due to BPH
• Renal insufficiency due to BPH 1

In cases of prostate cancer:

• "Channel TURP" may be performed to relieve obstruction in patients with locally advanced or metastatic disease 3

Efficacy

TURP has demonstrated:

• Significant improvement in urinary symptoms
• Increased urinary flow rates
• Reduction in post-void residual urine
• Long-term durability of results
• Superior maximum urinary flow rate (Qmax) compared to newer technologies like Thulium laser transurethral vaporesection (ThuVARP) 4

Complications

Potential complications include:

• Sexual dysfunction (65.4% risk of retrograde ejaculation) 5
• Irritative voiding symptoms
• Bladder neck contracture
• Blood transfusion requirement
• Urinary tract infection
• Hematuria
• TURP syndrome (dilutional hyponatremia from irrigation fluid absorption) 1

Alternatives to TURP

For patients concerned about specific complications or with smaller prostates:

1. Transurethral Incision of the Prostate (TUIP):

   • Appropriate for prostates ≤30g
   • Only 18.2% risk of retrograde ejaculation (vs 65.4% with TURP)
   • Provides equivalent symptomatic improvement to TURP in appropriate patients 1, 5

2. Transurethral Microwave Thermotherapy (TUMT):

   • Minimally invasive alternative
   • Avoids general/regional anesthesia
   • Minimal blood loss and fluid absorption
   • May be suitable for high-risk patients 6

3. Laser Therapies:

   • Various types including holmium laser resection/enucleation
   • May offer advantages in certain patient populations 1

Important Considerations

• Despite newer technologies, TURP remains the benchmark for surgical therapies due to extensive evidence from randomized clinical trials with long-term follow-up 1, 2
• The number of TURPs performed has declined over recent decades due to pharmaceutical therapy options 7
• For younger men concerned about fertility, TUIP should be considered for appropriate prostate sizes to preserve ejaculatory function 5
• Tissue obtained during TURP can be examined for prostate cancer, though this is no longer considered a primary advantage of the technique 1

Special Applications

TURP is also used in bladder cancer management:

• As a primary treatment option for urothelial carcinoma of the prostate with ductal/acini or prostatic urethra pathology
• Followed by intraprostatic BCG therapy in these cases 1