How TURP Will Help Your Condition
TURP will directly relieve your bladder outlet obstruction by surgically removing the enlarged prostate tissue that is blocking urine flow, which should improve your urinary symptoms and protect your kidney function from further deterioration. 1, 2
The Mechanism: How TURP Works
Physical removal of obstructing tissue: A resectoscope is inserted through your urethra (no external incision), and an electrified wire loop systematically cuts away strips of the enlarged prostate tissue that is compressing your urethra. 1 This creates a wider channel for urine to flow from your bladder through the urethra. 3
Direct decompression: By removing the physical obstruction at the bladder neck and prostatic urethra, TURP immediately reduces the resistance your bladder must overcome to empty. 1 This is particularly critical in your case given the impaired renal function—the back-pressure from chronic obstruction can damage kidneys, and TURP provides urgent surgical decompression. 2
Why This Addresses Your Specific Problems
For Bladder Outlet Obstruction
- TURP is the gold standard surgical treatment for relieving obstruction caused by BPH, with the most robust long-term evidence of efficacy. 1
- The procedure typically improves maximum urinary flow rates (Qmax) and significantly reduces symptom scores. 4, 5
- Most patients experience substantial relief of obstructive symptoms within the first few weeks. 2
For Impaired Renal Function
- Renal insufficiency secondary to BPH is an absolute indication for surgical intervention because bladder outlet obstruction causing kidney damage requires urgent surgical decompression. 2
- By relieving the obstruction, TURP prevents further deterioration of kidney function from chronic back-pressure (hydronephrosis). 2
- This is one scenario where surgery should not be delayed for medical therapy trials. 1
For Prostatitis Considerations
- While TURP primarily addresses the mechanical obstruction from BPH, removing obstructing tissue can improve bladder emptying, which may reduce urinary stasis that contributes to recurrent infections. 2
- However, active prostatitis should ideally be treated with antibiotics before elective TURP to reduce infection risk. 2
Expected Outcomes
Symptom improvement: You should expect significant improvement in both obstructive symptoms (weak stream, hesitancy, incomplete emptying) and irritative symptoms (frequency, urgency, nocturia). 1, 4 Studies show 15-20% improvements in symptom scores and flow rates. 6
Durability: TURP provides durable long-term results, with 8-22 year follow-up data showing sustained benefit. 4 The need for secondary intervention increases by only 1-2% annually. 4
Recovery timeline: Full recovery typically takes 4-6 weeks, though most patients notice urinary improvement much sooner. 2, 7
Important Risks to Understand
Sexual function changes: Retrograde ejaculation (semen goes into bladder instead of out) occurs in approximately 65% of patients. 2, 3 This does not affect erectile function or orgasm sensation, but does affect fertility. 1
Bleeding: About 8% of patients require blood transfusion. 3 If you're on anticoagulation, this risk increases significantly—23% of patients on anticoagulation require early postoperative transfusion. 7
TURP syndrome: This dilutional hyponatremia from irrigant absorption occurs in less than 1% of cases with modern techniques. 1, 3 Bipolar TURP has even lower risk than monopolar. 2
Other complications: Urinary tract infections, temporary irritative voiding symptoms, bladder neck contracture (7%), urethral stricture, and a 1% risk of urinary incontinence. 1, 3
Technical Considerations for Your Case
Prostate size matters: TURP is specifically recommended for prostates ≤80 grams. 2 If your prostate is larger, alternative procedures like simple prostatectomy or holmium laser enucleation (HoLEP) may be more appropriate. 1, 2
Monopolar vs. bipolar TURP: Both are acceptable, but bipolar TURP has reduced risk of TURP syndrome and hyponatremia, which may be particularly important given your renal impairment. 2, 4
Anticoagulation management: If you're on blood thinners, these must be discontinued before TURP to reduce bleeding risk, and resumption should be delayed until bleeding subsides. 3, 7
Common Pitfalls to Avoid
Don't delay surgery for medical therapy trials when you have renal insufficiency from obstruction—this is an absolute indication for surgery. 2
Ensure active infection is controlled before elective TURP, though emergency TURP can be performed if necessary. 2
Plan for catheter management: You'll have a urinary catheter for several days post-operatively with continuous bladder irrigation initially. 7