Transurethral Resection of the Prostate (TURP)

What is a transurethral resection of the prostate (TURP)?

Transurethral resection of the prostate (TURP) is surgery done to relieve the symptoms of an enlarged prostate gland.

The prostate gland is part of a man's reproductive system. It is normally a little bigger than a walnut. It is located between the base of the bladder and the beginning of the penis. It surrounds the upper part of the urethra. (The urethra carries urine from the bladder out through the penis.) The prostate makes the fluid that nourishes and carries sperm.

To relieve the symptoms caused by the enlarged prostate, the urologist (a surgeon who specializes in problems of the kidneys and bladder) uses a scope and a heated wire loop to remove part of the prostate gland. Another term for this surgery is transurethral prostatectomy.

When is it used?

When the prostate gland is enlarged it is called benign prostate hyperplasia, or BPH. When the prostate gets bigger than normal, it may put pressure on the urethra and cause problems with urination. You may have trouble passing urine and you may feel the need to urinate urine often, sometimes even at night. The need to urinate can come on suddenly, which can make travel, work, and some social situations difficult or awkward. In severe cases BPH can completely block your ability to pass urine. This can cause kidney damage if not treated promptly.

Surgery is done to make the prostate smaller by removing some pieces of it, which relieves the blockage. This reduces pressure on the urethra and generally gives relief from urinary symptoms.

Examples of alternatives to this procedure are:

• taking medicine to shrink the prostate or stop it from getting bigger or to relax prostate muscles
• destroying some of the prostate tissue with a laser (a procedure called laser prostatectomy, or laser TURP)
• using high-frequency radio waves to destroy the part of the prostate gland (a procedure called transurethral needle ablation, or TUNA)
• making small cuts in the prostate and part of the urethra to relieve pressure (a procedure called transurethral incision of the prostate, or TUIP)
• removing the enlarged part of the prostate gland through a cut in the lower abdomen (a procedure called suprapubic prostatectomy).

If your symptoms do not bother you too much, you may choose not to have treatment other than regular checkups with your healthcare provider. You should ask your provider about your choices for treatment.

How do I prepare for TURP?

Plan for your care and recovery after the operation, especially if you are going to have general anesthesia. Find someone to give you a ride home from the hospital. Allow for time to rest and try to find people to help you with your day-to-day duties.

Ask for the instructions for using and caring for a catheter and urine collection bag after the surgery. It’s best to learn about this before your surgery, when you are most alert and able to understand and remember the directions.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you take some medicines daily, ask your healthcare provider if you should take any of your medicines before surgery. If you take blood thinners, daily aspirin, or anti-inflammatories such as ibuprofen (for example, Motrin or Advil) or naproxen (Aleve), ask your provider if you need to stop them before surgery. If you do need to stop taking your medicines, ask your provider when you can start taking them again. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.

Antibiotics may be prescribed for a few days before and after surgery to help prevent infection.

Follow any other instructions your healthcare provider may give you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given either a general or spinal anesthetic. The general anesthetic will relax your muscles, put you to sleep, and keep you from feeling pain. The spinal anesthetic will make you feel numb from the chest down. You will probably be given medicine with the spinal anesthetic to make you sleepy.

Once you are numb, your healthcare provider will pass a scope through the urethra and into the bladder. The scope is a thin, lighted tube with lenses like a microscope. Fluid will be passed into the bladder to stretch the bladder and help your provider see the area to be removed. A scope with a heated wire loop will be used to remove pieces of prostate tissue. The pieces of tissue will be flushed out of the bladder.

What happens after the procedure?

You may be able to leave the hospital the day you have the procedure or you may stay in the hospital overnight, depending on your condition.

You will likely have some pain or discomfort in the area over the bladder, as well as at the base of the penis.

You may have a catheter (tube) in your bladder to help it drain and flush out any blood clots that have formed. Your healthcare provider will remove the catheter after the bleeding stops.

While recovering from surgery, you may have trouble controlling your bladder. You may notice blood in your urine or have trouble urinating. These symptoms usually go away as you heal. If they do not get better, call your healthcare provider.

Drink a lot of water and for 4 to 6 weeks avoid activities that put strain on your abdomen, such as straining to have a bowel movement or heavy lifting.

Ask your provider how to care for yourself, when you can go back to work, and when you should come back for a checkup.

What are the benefits of this procedure?

TURP relieves blockage and incomplete emptying of the bladder caused by the enlarged prostate. You will have less discomfort and will be able to urinate more easily.

Many men notice that their bladder symptoms are better within 2 to 3 weeks after the surgery: They do not feel the need to urinate as often and they have few or no urination “emergencies.”

The improvement in symptoms tends to last a long time. Sometimes the symptoms come back. If they do, you may need to have the procedure again after several years.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. In older adults, mild to severe confusion can occur. Discuss these risks with your healthcare provider.
• Spinal anesthesia may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Spinal anesthesia is considered safer than general anesthesia.
• You may have infection or bleeding.
• Any problem you may have with heart failure could become worse right after the procedure because of the fluid passed into the bladder during the procedure.
• The extra prostate tissue may grow back.
• Your bladder could be damaged or become infected. If this causes a lot of discomfort, you may not be able to pass urine.
• The muscle around your urethra may be permanently damaged. This could make it hard to control your urine.
• A scar may form around the urethra and make it narrow. In the future, you may need to have your urethra stretched to widen the passageway.
• Your ability to have an erection may be affected. Also, when you have an orgasm, semen may not come out of your penis. Instead it may flow backward into your bladder (retrograde ejaculation). This is a problem only in that it may lessen the sensation of orgasm and lessen the chance of pregnancy, if that is desired.
• You may become sterile (unable to father a child).

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

After surgery, follow your provider’s instructions for taking care of yourself. If you have not been given specific instructions about when to call your provider, here are some guidelines:

Call your provider right away if:

• You are bleeding a lot or passing blood clots.
• You have a fever of 100°F (37.8°C) or higher.
• You cannot use the catheter you were given.
• You are having more pink or red urine in your catheter bag than expected.
• You cannot pass urine.

Call during office hours if:

• You have a question about your follow-up appointment or care.