Is incontinence a long-term side effect after a Transurethral Resection of the Prostate (TURP) procedure?

Is Incontinence a Long-Term Side Effect After TURP?

Incontinence after TURP for benign prostatic hyperplasia is generally minimal (0-2% risk), but the risk increases substantially to 19-32% in patients who have undergone prior pelvic radiation therapy for prostate cancer. 1, 2, 3

Risk in Standard TURP (No Prior Radiation)

For patients undergoing TURP without prior radiation therapy:

• The risk of long-term incontinence is minimal, ranging from 0-2% in appropriately selected patients 1
• A recent 2025 study found a 36.4% incidence of postoperative urinary incontinence following TURP, though this includes both transient and persistent cases 2
• Independent risk factors that increase incontinence risk include:
  • Age ≥65 years (OR 1.94) 2
  • Diabetes (OR 2.49) 2
  • Surgery duration ≥60 minutes (OR 2.00) 2
• Preoperative pelvic floor muscle training is protective (OR 0.60) and should be implemented before surgery 2

Dramatically Elevated Risk After Prior Radiation

The incidence of incontinence increases dramatically to 19-32% when TURP is performed after pelvic radiation therapy for prostate cancer 3, 4:

• New-onset incontinence develops in 27% after first post-radiation TURP and 32% after any TURP including repeat procedures 3
• Only 43% of patients with pre-existing incontinence experience resolution after first TURP, dropping to 25% after repeat procedures 3
• Key predictors of post-TURP incontinence in radiated patients:
  • Older age (OR 2.02 per 10 years) 3
  • Pre-TURP urinary urgency symptoms 3
  • Shorter interval between radiation and TURP (13 months vs 55 months in continent patients) 4
  • Greater amount of tissue resection (19g vs 11.4g in continent patients) 4

Clinical Implications for Brachytherapy Patients

Patients with prior TURP who subsequently undergo brachytherapy also face increased incontinence risk (0-19%) 1:

• The European Association of Urology guidelines state that patients having had previous TURP can undergo brachytherapy without increased urinary toxicity risk if proper technique is used 1
• Specific technical requirements include:
  • Minimal channel TURP leaving at least 1 cm rim of prostate tissue around the post-TURP urethral defect at posterolateral sides 1
  • At least 3-month interval between TURP and brachytherapy to allow adequate healing 1
• Post-brachytherapy complications include urinary retention (1.5-22%), need for post-implantation TURP (8.7%), and incontinence (0-19%) 1

Management Algorithm

For patients developing incontinence after TURP:

• Immediate post-catheter removal: Start pelvic floor muscle exercises immediately, which accelerates continence recovery (94.6% continent by 6 months vs 65% without training) 5
• At 6 months: Perform comprehensive evaluation including history focusing on activities causing leakage, severity patterns, and degree of bother 5, 6
• Consider urodynamic testing if the nature of incontinence cannot be definitively confirmed, particularly to evaluate for urgency component 5, 6
• Surgical intervention timing: Surgery may be considered as early as 6 months if incontinence is not improving, or at 12 months for persistent bothersome incontinence 5, 6
• Artificial urinary sphincter is the gold standard surgical treatment, though effectiveness decreases over time (24% failure at 5 years, 50% at 10 years) 5, 6

Critical Pitfalls to Avoid

• Do not delay pelvic floor muscle training beyond immediate post-catheter removal, as this hinders recovery 5
• Do not assume all post-TURP incontinence is stress-related—evaluate for urgency component, especially in radiated patients 5, 3
• In previously radiated patients, use conservative resection and allow longer intervals between radiation and TURP when possible 4
• Do not wait beyond 12 months for surgical intervention in patients with persistent bothersome incontinence 5