Transurethral Resection of the Prostate (TURP)

Procedure overview

What is a transurethral resection of the prostate or TURP?

A transurethral resection of the prostate (TURP) is a surgical procedure that removes portions of the prostate gland through the penis. A TURP requires no external incision.

The surgeon reaches the prostate by inserting an instrument through the urethra (the narrow channel through which urine passes from the bladder out of the body). This instrument, called a resectoscope, is about 12 inches long and one-half inch in diameter. It contains a light, valves that control irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels. It's inserted through the penis and the wire loop is guided by the surgeon so it can remove the obstructing tissue one piece at a time. The pieces of tissue are carried by fluid into the bladder and flushed out at the end of the procedure.

What is the prostate gland?

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The prostate gland is about the size of a walnut and surrounds the neck of a man's bladder and urethra—the tube that carries urine from the bladder. It's partly muscular and partly glandular, with ducts opening into the prostatic portion of the urethra. It's made up of three lobes, a center lobe with one lobe on each side.

As part of the male reproductive system, the prostate gland's primary function is to secrete a slightly alkaline fluid that forms part of the seminal fluid (semen), a fluid that carries sperm. During male climax (orgasm), the muscular glands of the prostate help to propel the prostate fluid, in addition to sperm that was produced in the testicles, into the urethra. The semen then travels through the tip of the penis during ejaculation.

Researchers don't know all the functions of the prostate gland. However, the prostate gland plays an important role in both sexual and urinary function. It's common for the prostate gland to become enlarged as a man ages, and it's also likely for a man to encounter some type of prostate problem in his lifetime.

Many common problems are associated with the prostate gland. These problems may occur in men of all ages and include:

• Benign prostatic hyperplasia (BPH). An age-related enlargement of the prostate that isn't malignant. BPH is the most common noncancerous prostate problem, occurring in most men by the time they reach their 60s. Symptoms are slow, interrupted, or weak urinary stream; urgency with leaking or dribbling; and frequent urination, especially at night. Although it isn't cancer, BPH symptoms are often similar to those of prostate cancer.

• Prostatism. This involves decreased urinary force due to obstruction of flow through the prostate gland.  The most common cause of prostatism is BPH.

• Prostatitis. Prostatitis is inflammation or infection of the prostate gland characterized by discomfort, pain, frequent or infrequent urination, and sometimes fever.

• Prostatalgia. This involves pain in the prostate gland, also called prostatodynia.  It's frequently a symptom of prostatitis.

Cancer of the prostate is a common and serious health concern. According to the American Cancer Society (ACS), prostate cancer is the most common form of cancer in men older than age 50, and the third leading cause of death from cancer.

There are different ways to achieve the goal of removing the prostate gland. Methods of performing prostatectomy include:

• Surgical removal includes a radical prostatectomy (RP), with either a retropubic or perineal approach. This is used to treat cancer. Radical prostatectomy is the removal of the entire prostate gland. Nerve-sparing surgical removal is important to preserve as much function as possible.

• Transurethral resection of the prostate, or TURP, which also involves removal of part of the prostate gland, is an approach performed through the penis with an endoscope (small, flexible tube with a light and a lens on the end).

• Cryosurgery is a less invasive procedure than surgical removal of the prostate gland. Treatment is administered using probe-like needles that are inserted in the skin between the scrotum and anus. The urologist can also use microwaves.

• Laparoscopic surgery, done manually or by robot, is another method of removal of the prostate gland.

Reasons for the procedure

TURP is generally done to relieve symptoms due to prostate enlargement, often due to benign prostatic hypertrophy (BPH). When the prostate gland is enlarged, the gland can press against the urethra and interfere with or obstruct the passage of urine out of the body. BPH is a condition in which the prostate gland may become quite enlarged and cause problems with urination. Symptoms may include:

• Problems with getting a urine stream started

• Having to urinate more frequently at night

• Having an urgent need to urinate

• Dribbling after you finish urinating

These symptoms can create problems such as retaining urine in the bladder, which can contribute to bladder infections or formation of stones in the bladder.

BPH can also raise prostate-specific antigen (PSA) levels two to three times higher than the normal level. An increased PSA level doesn't always indicate cancer, but the higher the PSA level, the higher the chance for having cancer. A TURP may be done in men who can't tolerate a radical prostatectomy due to their age or overall health status.

Specific treatment for BPH will be determined by your physician based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Eventually, BPH symptoms usually require some kind of treatment. When the gland is just mildly enlarged, treatment may not be needed, as research has shown that some of the symptoms of BPH can clear up without treatment in some mild cases. This decision can only be made by your physician after careful evaluation of your individual condition. Regular checkups are important, however, to watch for developing problems.

Sometimes a TURP is done to treat symptoms only, not to cure the disease. For example, if you're unable to urinate because of cancer, but radical prostatectomy isn't an option for you, you may need a TURP.

There may be other reasons for your physician to recommend a TURP.

Risks of the procedure

As with any surgical procedure, certain complications can occur. Some possible complications may include:

• Blood in the urine after surgery

• Painful or difficult urination

• Possibility of infection

• Retrograde ejaculation (when ejaculation occurs in the bladder and not the penis)

• Bleeding

• Infection

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the procedure

Some things you can expect before the procedure include:

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You'll be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something isn't clear.

• In addition to a complete medical history, your physician may perform a physical examination to ensure you're in good health before you undergo the procedure. You may also undergo blood tests and other diagnostic tests.

• You'll be asked to fast for eight hours before the procedure, generally after midnight.

• Notify your physician if you're sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general.)

• Notify your physician of all medications (prescribed and over the counter) and herbal supplements that you're taking.

• Notify your physician if you have a history of bleeding disorders or if you're taking any anticoagulant (blood-thinning) medications, aspirin, or any other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

• If you smoke, you should stop smoking as soon as possible prior to the procedure, in order to improve your chances for a successful recovery from surgery and to improve your overall health status.

• You may receive a sedative prior to the procedure to help you relax.

Based upon your medical condition, your physician may request other specific preparation.

During the procedure

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Transurethral resection of the prostate requires a stay in the hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, a TURP follows this process:

1. You'll be asked to remove any jewelry or other objects that may interfere with the procedure.

2. You'll be asked to remove your clothing and will be given a gown to wear.

3. You'll be asked to empty your bladder prior to the procedure.

4. An intravenous (IV) line will be started in your arm or hand.

5. You'll be positioned on the operating table, lying on your back.

6. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Once you're sedated, a breathing tube will be inserted through your throat into your windpipe and you'll be connected to a ventilator, which will breathe for you during the surgery.

7. The surgeon will inspect the urethra and bladder with an endoscope. This is done by passing the scope through the tip of the penis, then into the urethra and bladder. This allows the physician to examine these areas for any tumors or stones in the bladder.

8. Next, the resectoscope (electrical loop) is passed into the urethra. It cuts out pieces of tissue from the prostate that are bulging or blocking the urethra. Electricity will be applied through the resectoscope to stop any potential bleeding.

9. The physician will insert a catheter into the bladder to empty urine.

10. You'll be transferred from the operating table to a bed then taken to the recovery room.

After the procedure

After the procedure, you may be taken to the recovery room to be closely monitored. You'll be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level.

Once your blood pressure, pulse, and breathing are stable and you're alert, you'll be taken to your hospital room.

You may receive pain medication as needed, either by a nurse, or by administering it yourself through a device connected to your intravenous line.

Once you're awake and your condition has stabilized, you may start liquids to drink. Your diet may be gradually advanced to more solid foods as you are able to tolerate them.

The urine catheter will stay in place for one to three days to help urine drain while your prostate gland heals. You'll probably have blood in your urine after surgery.

Also, a liquid solution may be attached to the catheter to flush the blood and potential clots out of the catheter. The bleeding will gradually decrease, and then the catheter will be removed.

Arrangements will be made for a follow-up visit with your physician.

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Once you're home, it'll be important to drink lots of fluid. This aids in flushing out any remaining blood or clots from your bladder.

You'll be advised to not do any heavy lifting for several weeks after the TURP. This is to prevent any recurrence of bleeding.

You may be tender or sore for several days after a TURP. Take a pain reliever for soreness as recommended by your physician.

You shouldn't drive until your physician tells you to. Other activity restrictions may apply. Notify your physician to report any of the following:

• Fever and/or chills

• Redness, swelling, or bleeding or other drainage from the incision site

• Increase in pain around the incision site

• Trouble urinating

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.