What are the complications of Transurethral Resection of the Prostate (TURP)?

From the Guidelines

Transurethral Resection of the Prostate (TURP) complications include urinary incontinence, decline in sexual function, TURP syndrome, sexual dysfunction, irritative voiding symptoms, bladder neck contracture, need for blood transfusion, UTI, and hematuria.

Common Complications

• Urinary incontinence: 1% risk, similar to watchful waiting group 1
• Decline in sexual function: overall decline identical to watchful waiting treatment group 1
• TURP syndrome: a dilutional hyponatremia that occurs when irrigant solution is absorbed into the bloodstream 1
• Sexual dysfunction: may not be attributable to the surgery in all cases, reported in more than 5% of patients 1
• Irritative voiding symptoms: reported in more than 5% of patients 1
• Bladder neck contracture: reported in more than 5% of patients 1
• Need for blood transfusion: reported in more than 5% of patients 1
• UTI: reported in more than 5% of patients 1
• Hematuria: reported in more than 5% of patients 1 ### Additional Complications
• Ejaculatory dysfunction: 65% of patients experience ejaculatory problems after TURP 2
• Erectile dysfunction: 10% of patients experience erectile problems after TURP 2
• Urethral stricture: similar incidence to other surgical treatments for BPH 3 ### Comparison to Other Treatments
• Bipolar transurethral vaporisation (B-TUVP): comparable efficacy to TURP, but with fewer perioperative complications 3
• GreenLight laser photoselective vaporisation of the prostate (PVP): comparable efficacy to TURP, with shorter catheterisation and hospitalisation times, and lower transfusion and clot retention episode rates 3

From the Research

Complications of Transurethral Resection of the Prostate (TURP)

The complications of TURP can be categorized into short-term and long-term complications.

• Short-term complications include: + Bleeding requiring transfusion 4, 5 + Clot retention 4, 5 + Acute urinary retention (AUR) 4, 6 + Urinary tract infections 4, 6, 5
• Long-term complications include: + Incontinence 4, 5 + Bladder neck contracture 4, 5 + Urethral stricture 4, 5 + Sexual dysfunction 4 + Urge incontinence 5 + Iatrogenic stress incontinence 5

Risk Factors for Complications

Certain factors can increase the risk of complications after TURP, including:

• Preoperative Quality of Life score, which is an independent risk factor for Grade I-II complications 7
• International Prostate Symptom Score, which is an independent risk factor for Grade III-IV complications 7
• Acute urinary retention, which can increase the risk of postoperative complications such as recurrent urinary retention and urinary tract infection 6
• Larger prostate size and more tissue resected, which can increase the risk of postoperative complications 6

Management and Prevention of Complications

Technological improvements, such as microprocessor-controlled units and video TUR, can help reduce perioperative complications 5.

• Adequate prophylactic antibiotic treatment can decrease the risk of urinary tract infection during or after TURP 6
• Urodynamic study may be necessary to rule out concomitant bladder dysfunction before surgery 6