What is the Transurethral Resection of the Prostate (TURP) procedure and its post-operative care?

Transurethral Resection of the Prostate (TURP) Procedure and Post-Operative Care

TURP is the gold standard surgical treatment for benign prostatic hyperplasia (BPH), involving endoscopic removal of the prostate's inner portion through the urethra using an electrified loop to resect and cauterize prostatic tissue. 1, 2

Indications for TURP

• TURP is indicated for men with moderate-to-severe lower urinary tract symptoms (LUTS) attributed to BPH who are bothered enough to request intervention 2
• Specific indications include:
  • Renal insufficiency secondary to BPH 2
  • Refractory urinary retention 2, 3
  • Recurrent urinary tract infections 2, 3
  • Recurrent bladder stones or gross hematuria due to BPH 2, 3
  • LUTS/BPH refractory to or unwilling to use medical therapy 2

Preoperative Evaluation

• Medical history and AUA Symptom Index (AUA-SI) score assessment 2
• Urinalysis and post-void residual (PVR) measurement 2
• Prostate imaging (transrectal or transabdominal ultrasound) to determine prostate size and shape 2

TURP Procedure Details

• Performed under general or spinal anesthesia, typically requiring hospital stay 1
• An electrified loop is inserted through a resectoscope to:
  • Resect prostatic tissue 1
  • Cauterize bleeding vessels 1
• No external skin incision is required as the approach is through the urethra 1
• Bipolar TURP has reduced risk of hyponatremia and TUR syndrome compared to monopolar TURP 2

Post-Operative Care

• Urethral catheter placement (typically 20-24 Fr) for continuous bladder drainage 4
• Monitoring for potential complications:
  • Bleeding requiring transfusion (occurs in 8% of cases) 1
  • Urinary tract infections (6-9% of patients) 1, 5
  • TUR syndrome (dilutional hyponatremia from irrigant absorption) 1
• Catheter removal after confirming adequate healing 4
• Follow-up assessment of symptom improvement using standardized measures like IPSS 6

Expected Outcomes

• Significant improvement in urinary flow rates (up to 142% increase) 6, 7
• Reduction in post-void residual volume (up to 75% decrease) 6, 7
• Decrease in symptom scores (up to 77% improvement) 6
• Favorable outcomes in 88.6% of patients at 12-week follow-up 6

Potential Complications

• Sexual dysfunction (65% risk of ejaculatory problems, 10% risk of erectile problems) 1, 2
• Irritative voiding symptoms (15% of patients) 1
• Bladder neck contracture (7% of patients) 1
• Urinary incontinence (approximately 1% risk) 1
• Urethral stricture (5.2% of patients) 5
• Prostate capsule perforation (5.2% of cases) 5
• Need for secondary procedures (5% of patients) 1

Special Considerations

• TURP remains the benchmark for surgical therapies for BPH due to extensive evidence from randomized clinical trials with long-term follow-up 1
• For patients with moderately enlarged prostates and overactive bladder symptoms, TURP has comparable efficacy to newer techniques like HoLEP and PVP 8
• Patients should be counseled about potential sexual side effects, particularly retrograde ejaculation 2
• Alternative approaches may be considered for high-risk surgical patients 2