Complications of Transurethral Resection of the Prostate (TURP)
TURP has several significant complications including sexual dysfunction (65%), irritative voiding symptoms (15%), bladder neck contracture/urethral stricture (7%), bleeding requiring transfusion (8%), urinary tract infections (6%), and TURP syndrome (dilutional hyponatremia) which occurs in less than 1% of cases. 1
Major Complications
Intraoperative Complications
- TURP syndrome - A unique and potentially life-threatening complication characterized by dilutional hyponatremia that occurs when irrigant solution is absorbed into the bloodstream during the procedure 1
- Bleeding requiring transfusion - Occurs in approximately 8% of cases, representing a significant risk during the procedure 1, 2
- Prostate capsule perforation - Reported in about 5.2% of cases, requiring immediate intervention 3
- Bladder perforation - Can occur in 0.3% of cases, with intraperitoneal perforation requiring surgical repair 4
Early Postoperative Complications
- Clot retention - Occurs in approximately 2-5% of patients, requiring bladder irrigation or surgical intervention 2
- Acute urinary retention - Seen in about 3-9% of cases, often requiring recatheterization 2
- Urinary tract infections - Occur in 1.7-8.2% of patients, with severe infections leading to bacteremia in 0.4% of cases 4, 2
- Transient urge incontinence - Affects up to 30-40% of patients in the early postoperative period 2
Late Complications
- Sexual dysfunction - Retrograde ejaculation occurs in approximately 65% of patients, making it the most common long-term complication 1
- Erectile dysfunction - Affects approximately 10% of patients following TURP 1
- Urethral strictures - Develop in 2.2-9.8% of patients, requiring additional procedures 2
- Bladder neck contracture - Occurs in 0.3-9.2% of cases 2
- Permanent urinary incontinence - Rare but significant complication occurring in less than 0.5% of patients 2
- Need for reoperation - The retreatment rate ranges from 3-14.5% after five years 2
Risk Factors for Complications
- Prostate size - Larger prostates are associated with increased risk of bleeding and longer operative times 1
- Anticoagulation therapy - Patients on anticoagulants have a significantly increased risk of bleeding complications 1
- Comorbidities - Patients with significant comorbidities (ASA III-IV) have higher risk of complications 5
- Duration of procedure - Longer procedures increase the risk of TURP syndrome and other complications 2
Prevention and Management of Complications
Prevention
- Proper patient selection - TUIP may be more appropriate for smaller prostates (<30g) to reduce complication rates 6
- Anticoagulation management - Discontinuation of anticoagulants before TURP is recommended as it is associated with increased bleeding risk 1
- Technological improvements - Microprocessor-controlled units and better equipment have reduced perioperative complications 2
- Surgical technique - Quick recognition of anatomical landmarks ensures effective and safe resection 4
Management
- TURP syndrome - Requires immediate recognition, cessation of the procedure, and correction of hyponatremia 1
- Bleeding - May require transfusion (in 8% of cases) or transurethral fulguration (in 3.5% of cases) 1, 4
- Bladder perforation - Requires placement of a large-caliber urethral catheter and possible surgical repair 7
- Urethral strictures/bladder neck contractures - May require urethral dilation, internal urethrotomy, or reoperation 4
Mortality and Severe Morbidity
- Mortality rate is low at 0-0.25%, despite an increasing age of the patient population 2
- Major complications (Clavien-Dindo grade ≥III) occur in only 2.3-3.4% of patients 5
- Overall complication rate using the Clavien-Dindo grading system is approximately 29.3%, with 96% of complications being grade I, II, or III that can be managed conservatively or with minimally invasive surgery 3