Treatments

Transurethral Resection of the Prostate (TURP)

A transurethral resection of the prostate (TURP) is a surgical procedure done to relieve moderate to severe urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). It is used to remove portions of the prostate gland through the penis with the help of an endoscope (small, flexible tube with a light and a lens on the end). A TURP requires no external incision.

TURP is one of the most effective options for treating urinary symptoms caused by BPH. To determine whether TURP or another treatment is the right choice for you, your doctor will consider how severe your symptoms are, what other health problems you have, and the size and shape of your prostate.

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.

Hospital Stay: Hospital Stay: 3 days
Duration: Duration: 1 hr
Cost Estimate: Cost Estimate: 1913 USD - 5200 USD These are indicative prices in Indian Hospitals

TURP is generally done to relieve symptoms due to prostate enlargement, often due to 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
  • Difficulty emptying bladder
  • Bleeding from prostate
  • Frequent UTI

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.
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.

You will be given medicine before surgery so you don’t feel pain. You may get one of the following:

  • General anaesthesia: You are asleep and pain-free
  • Spinal anaesthesia: You are awake, but relaxed and pain-free

A TURP is usually carried out using a device called a resectoscope. A resectoscope is a thin metal tube that contains:

  • a light
  • a camera
  • a loop of wire

The surgeon will insert the resectoscope into your urethra (the tube that carries urine from your bladder to your penis) before guiding it to the site of your prostate with the help of the light and the camera.
An electric current is used to heat the loop of wire, and the heated wire is used to cut away the section of your prostate that is causing your symptoms. After the procedure, a catheter (a thin, flexible tube) is used to pump saline water into the bladder and flush away pieces of prostate that have been removed.
A TURP can take up to an hour to perform, depending on how much of your prostate needs to be removed.
Once the procedure has been completed, you will be moved back to your hospital ward so you can recover.

Before the procedure

You will have many visits with your doctor and tests before your surgery. Your visit will include:

  • Complete physical exam
  • Treating and controlling diabetes, high blood pressure, heart or lung problems, and other conditions

If you are a smoker, you should stop several weeks before the surgery. Your doctor or nurse can give you tips on how to do this.
Always tell your doctor or nurse what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.

During the weeks before your surgery:

  • You may be asked to stop taking medicines that can thin your blood, such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and others.
  • Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

  • Do not eat or drink anything after midnight the night before your surgery.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

During the procedure

Transurethral resection of the prostate requires a stay in the hospital. Procedures may vary depending on your condition and your doctor’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 doctor 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 doctor 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

In the hospital

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. 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.
You will stay in the hospital for 3 days.
After surgery, you will have a small tube, called a Foley catheter, in your bladder to remove urine. The urine will look bloody at first. In most cases, the blood goes away within a few days. Blood can also seep around the catheter. A special solution may be used to flush out the catheter and keep it from getting clogged with blood. The catheter will be removed within 1 to 3 days for most people.

Your health care team will:

  • Help you change positions in bed.
  • Teach you exercises to keep blood flowing.
  • Teach you how to perform coughing and deep breathing techniques. You should do these every 3 to 4 hours.
  • Tell you how to care for yourself after your procedure.

You may need to wear tight stockings and use a breathing device to keep your lungs clear.
You may be given medication to relieve bladder spasms.

At Home:

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 doctor.

Notify your doctor 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

TURP is often recommended when prostate enlargement (benign prostatic hyperplasia) causes troublesome symptoms and fails to respond to treatment with medication.

Symptoms that may improve after TURP include:

  • problems starting to urinate
  • a weak urine flow or stopping and starting
  • having to strain to pass urine
  • a frequent need to urinate
  • waking up frequently during the night to urinate (nocturia)
  • a sudden urge to urinate
  • being unable to empty your bladder fully

In most cases, TURP is a safe procedure and the risk of serious complications is very small.
Many men temporarily lose the ability to control their bladder (urinary incontinence), although this usually passes in a few weeks. In rare cases, it may be persistent and need further treatment.
There’s also a small risk of problems such as difficulties in passing urine and urinary tract infections (UTIs).

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