How do you explain the Transurethral Resection of the Prostate (TURP) procedure to a patient?

How to Explain TURP Procedure to a Patient

When explaining Transurethral Resection of the Prostate (TURP) to a patient, clearly describe it as a surgical procedure that removes the inner portion of the enlarged prostate through the urethra without external incisions, while emphasizing both its effectiveness and potential complications including sexual dysfunction, bleeding, and urinary symptoms. 1

What is TURP?

• TURP is a gold standard surgical treatment for moderate-to-severe lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH) 1, 2
• The procedure involves removing the inner portion of the prostate through an endoscopic approach via the urethra, with no external incisions 1
• It is typically recommended when medical therapy has failed or for patients with specific complications like urinary retention, recurrent infections, bladder stones, or hematuria 1, 3

The Procedure Process

• The surgery is performed under anesthesia (general or spinal) 4
• A resectoscope (thin tube with camera and electrical loop) is inserted through the urethra to view and remove prostate tissue 1
• Irrigation fluid is used during the procedure to maintain visibility and wash away tissue 4
• The procedure typically takes 60-90 minutes depending on prostate size 5
• After surgery, a urinary catheter will remain in place for a short period (typically 1-3 days) 1

Expected Benefits

• Significant improvement in urinary symptoms, flow rate, and quality of life 1, 2
• Long-term durable results (8-22 years) with low rates of requiring additional surgery (1-2% annually) 2
• Immediate relief of obstruction for patients with urinary retention 3, 6

Potential Complications and Risks

• Sexual dysfunction is the most common complication (65%), particularly retrograde ejaculation (where semen goes into the bladder rather than out through the penis) 7
• Erectile dysfunction affects approximately 10% of patients 7
• Bleeding requiring blood transfusion occurs in about 8% of cases 7, 2
• Irritative voiding symptoms (urgency, frequency, burning) affect about 15% of patients, usually temporary 7
• Urinary tract infections occur in approximately 6% of cases 7
• Bladder neck contracture or urethral stricture may develop in about 7% of patients 7
• TURP syndrome (dilutional hyponatremia) is rare (less than 1%) but potentially serious 7, 5
• Short-term urinary incontinence is expected but typically improves within 12 months 1

Recovery and Postoperative Care

• Patients should expect some blood in the urine for several days to weeks 4
• Pelvic floor muscle exercises are recommended after catheter removal to improve continence 1
• Early oral fluid intake is encouraged after the procedure 4
• Patients should avoid strenuous activity, heavy lifting, and sexual activity for 2-4 weeks 1
• If lower urinary tract symptoms persist beyond 6 months, further evaluation may be needed 1

Alternative Options

• For smaller prostates (less than 30mL), Transurethral Incision of the Prostate (TUIP) may be an alternative with lower rates of retrograde ejaculation (18% vs 65%) 7, 2
• Newer technologies like bipolar TURP have reduced risks of certain complications like hyponatremia compared to traditional monopolar TURP 1, 5

Important Points to Emphasize

• TURP remains the gold standard treatment for BPH despite newer alternatives 2, 5
• The 30-day mortality rate is very low (0.1%) 2
• Most patients experience significant improvement in symptoms, but some complications may be permanent 7, 1
• The decision for surgery should be made after medical therapy has been tried or when specific complications of BPH are present 1, 3