What is Transurethral Resection of the Prostate (TURP)?

Transurethral Resection of the Prostate (TURP): Patient Education

TURP is the gold standard surgical procedure for treating benign prostatic hyperplasia (BPH), involving removal of enlarged prostate tissue through the urethra using an electrified loop to improve urinary flow and relieve symptoms. 1, 2

What is TURP?

• TURP is a minimally invasive surgical procedure that removes excess prostate tissue causing urinary obstruction 1
• The procedure is performed by inserting a resectoscope (a thin tube with a camera and surgical tools) through the urethra without external incisions 1
• An electrified loop systematically removes prostate tissue in strips to create a wider channel for urine flow 1
• TURP remains the most established and effective surgical treatment for BPH despite newer alternatives 2

When is TURP recommended?

• For moderate-to-severe lower urinary tract symptoms not responding to medication 1
• For complications of BPH including:
  • Urinary retention (inability to urinate) 3
  • Recurrent urinary tract infections 3
  • Bladder stones 3
  • Gross hematuria (blood in urine) due to BPH 3
  • Kidney function problems caused by BPH 3

Types of TURP

• Monopolar TURP: Traditional approach using electric current

  • Effective but has higher risk of TUR syndrome (a rare but serious complication) 1, 4
  • Limited resection time to reduce complications 3

• Bipolar TURP: Newer technology with improved safety profile

  • Reduced risk of bleeding and TUR syndrome 4
  • Allows for longer resection times and treatment of larger prostates 3
  • Uses saline irrigation which is safer than glycine used in monopolar TURP 5

The TURP Procedure

1. You'll receive anesthesia (general or spinal) 1
2. A resectoscope is inserted through the urethra 1
3. The surgeon uses an electrified loop to remove prostate tissue in strips 1
4. Continuous irrigation fluid maintains visibility during the procedure 1
5. Blood vessels are sealed to control bleeding 1
6. A catheter is placed to drain urine and allow healing 1

Recovery and Results

• Hospital stay typically 1-3 days 6
• Catheter remains for 1-3 days after surgery 6
• Most patients experience significant improvement in urinary symptoms 3
• Full recovery usually takes 4-6 weeks 1

Potential Complications

• Sexual function changes: Retrograde ejaculation (semen flows backward into bladder) occurs in approximately 65% of patients 7
• Bleeding: About 8% of patients require blood transfusion 7
• Urinary symptoms: Temporary burning or urgency during healing 7
• Urethral stricture/bladder neck contracture: Occurs in about 7% of cases 7
• Infection: Urinary tract infections occur in about 6% of cases 7
• TUR syndrome: A rare but serious complication (<1% of cases) caused by absorption of irrigation fluid 7

Alternatives to TURP

• For smaller prostates (<30g): Transurethral incision of the prostate (TUIP) may be preferred with lower risk of retrograde ejaculation (18% vs 65%) 3
• For very large prostates: Simple prostatectomy (open, laparoscopic, or robotic) may be considered 3
• Newer laser procedures like Holmium Laser Enucleation of the Prostate (HoLEP) are becoming more common, especially for larger prostates or patients on blood thinners 8

Important Considerations

• If you take blood thinners, these typically need to be stopped before surgery 1
• TURP is highly effective but does have a risk of affecting sexual function, particularly ejaculation 7
• The procedure has been refined over decades and remains the standard against which all other BPH surgeries are compared 2, 9