Transurethral Resection of the Prostate (TURP)

A transurethral resection of the prostate (TURP) is a surgical procedure that involves cutting away a section of the prostate.

A transurethral resection of the prostate (TURP) is a surgical procedure that involves cutting away a section of the prostate.

The prostate is a small gland in the pelvis only found in men. It’s located between the penis and bladder, and surrounds the urethra (the tube that carries urine from the bladder to the penis).

If the prostate becomes enlarged, it can place pressure on the bladder and urethra. This can cause symptoms such as having difficulty peeing.

Why TURP is carried out

TURP is often recommended when prostate enlargement causes troublesome symptoms and fails to respond to treatment with medication.

Symptoms that may improve after TURP include:

  • Problems with starting to pee.
  • A weak flow of pee, or stopping and starting.
  • Having to strain to pee.
  • A frequent need to pee.
  • Waking up frequently during the night to pee.
  • A sudden urge to pee.
  • Being unable to empty your bladder fully.

How TURP is Performed

TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire. This is passed along your urethra until it reaches your prostate, which means no cuts (incisions) need to be made in your skin.

The loop of wire is then heated with an electric current and used to cut away the section of your prostate causing your symptoms. A thin tube called a catheter is then inserted into your urethra to pump fluid into the bladder and flush away pieces of prostate that have been removed.

General or spinal anaesthesia is used during the procedure so you don’t feel any pain while it’s carried out.

Recovering from TURP

You’ll usually need to stay in hospital for 1 to 3 days after your operation, although at some hospitals you can go home on the same day.

The catheter used during the operation will usually be taken out between 1 day and 1 week afterwards.

It’s common to feel tired and under the weather for a week or two after going home. Most men are up and about after this time, but you’ll need to take things easy for 3 to 4 weeks. You’ll usually be advised to stay off work and avoid lifting heavy objects, doing strenuous exercise, driving and having sex for at least a few weeks.

It’s normal to have some difficulties peeing and some blood in your pee for a few weeks.

These problems should get better as you recover, but you should contact the hospital clinic or your GP if you’re concerned.

What are the Risks?

In most cases, TURP is a safe procedure and the risk of serious complications is very small.

However, many men who have a TURP lose the ability to ejaculate semen during sex or masturbation, although they still have physical pleasure from ejaculation (orgasm). This is known as retrograde ejaculation.

Some men also 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 erectile dysfunction, difficulties passing urine and urinary tract infections (UTIs).

Alternatives to TURP

There are a number of alternatives to TURP that can be just as effective with a lower risk of complications.

They include:

  • PLASMA system – electrodes are put into the prostrate through the urethra and are used to cut out prostate tissue.
  • Holmium laser enucleation of the prostate (HoLEP) – a laser attached to a resectoscope is used to cut away excess prostate tissue.
  • Transurethral laser resection or vaporisation of the prostate – a thin tube called a cystoscope is inserted into the urethra and a laser attached to the cystoscope fires pulses of energy to burn away prostate tissue.
  • Prostatic urethral lift (PUL) implants – a surgeon inserts implants that hold the enlarged prostate away from the urethra so that the urethra is not blocked; this helps to relieve symptoms like pain or difficulty when peeing.

These procedures aren’t suitable for all men with prostate enlargement. Your doctor will discuss your options with you.

A transurethral resection of the prostate (TURP) is carried out in hospital under anaesthetic. You’ll usually need to stay in hospital for 1 to 3 days.

Preparing for Surgery

You’ll usually be asked to attend a pre-admission appointment a few weeks before your operation so a doctor or nurse can make sure the operation is suitable for you and that you’re well enough to have an anaesthetic.

This may involve tests such as blood tests and an electrocardiogram (ECG) to check your general health. An ECG is a simple test to check the electrical activity of your heart.

You can also use this appointment as an opportunity to ask any questions about the procedure and discuss any concerns you have.

Make sure you tell your doctor or nurse if you’re currently taking medication to prevent blood clots, such as warfarin, rivaroxaban, aspirin or clopidogrel. These medications could cause heavy bleeding during surgery, so you may be advised to stop taking them in the lead-up to your operation.

If you smoke, you should try to cut down or give up completely before your operation, as this can help reduce your risk of potentially serious complications such as chest infections and blood clots.

Before the Procedure

You’ll usually be asked to come into hospital on the day of the operation or the day before.

You’ll be asked to stop eating and drinking around 6 hours before surgery. Depending on the results of your pre-admission assessment, you may be given compression stockings to help prevent blood clots.

Just before the operation is carried out, you’ll be given an anaesthetic to stop you feeling any pain during the procedure. The type of anaesthetic used may be either:

  • General – this means you’ll be unconscious throughout the procedure.
  • Spinal or epidural anaesthetic – this means you’ll be awake during the procedure but won’t be able to feel anything below your waist.

Waiting Times

TURP isn’t normally regarded as an urgent operation, which means, in Ireland, you may have to wait several months for it to be carried out.

However with Healthcare Abroad we use the Cross Border Directive (CBD) where we help our patients travel to any European country, get their Surgery Now and get the reimbursement by the HSE.

Following a transurethral resection of the prostate (TURP), you may need to recover in hospital for 1 to 3 days before you can go home.

While in hospital, you may be given fluids directly into a vein (intravenously) until you’ve recovered from the anaesthetic and are able to eat and drink.

You shouldn’t experience any severe pain, but there may be some discomfort and bladder spasms (contractions) from the catheter, which is left in place because your urethra (the tube that carries urine out of the body) will be swollen and sore.

Peeing after TURP

You won’t be able to pee normally at first because your urethra will be swollen.

The catheter used to flush out your bladder during the operation will be left in place for a while to allow you to pee until the swelling goes down.

During the day after the operation, water may be pumped through the catheter to clean your bladder and get rid of any blood clots and other debris.

This usually is not painful, but may make your bladder feel uncomfortably full. The catheter may be removed to check if you can pee before going home.

It’s normal to find peeing uncomfortable and difficult to control for at least a few days after the catheter is removed. If you still cannot pee, a catheter may need to be put back in.

You’ll be able to go home with the catheter still in place, and an appointment will be made to remove it a few days or weeks later.

Recovering at Home

It’s common to feel tired and under the weather for a week or two after having a TURP. Most men are up and about after 3 to 4 weeks recovery.

For the first 3 to 4 weeks, you shouldn’t lift or move any heavy objects (including shopping) or do any strenuous exercise. If possible, ask friends or family members if they can help around the house.

Once you feel able, gentle exercise such as walking will help keep your blood circulating and lower your risk of getting a blood clot in your legs.

Drinking plenty of water while you’re recovering may help reduce the risk of getting a UTI and can help clear any blood from your pee.

You may also be advised to do some pelvic floor exercises to help improve your bladder control.

Any pain can usually be treated by taking over-the-counter painkillers, such as paracetamol or ibuprofen.

Returning to your normal activities

It usually takes between 3 and 4 weeks to fully recover from a TURP. Your surgeon or GP will advise you about when it’s safe to return to your normal activities.

Returning to Work

When you can return to work will largely depend on your job. For example, someone who works in an office may be able to return to work sooner than someone who does heavy manual work.

In most cases, you’ll be advised to take around 3 or 4 weeks off work.

Driving

Ask your surgeon or GP for advice on when it’s safe for you to drive again.

You should also speak to your insurer before driving again after having surgery.

Having Sex

It will probably be around 3 or 4 weeks after your operation before you feel comfortable enough to have sex.

Blood in your Pee

After having a TURP, it’s normal to occasionally notice some blood in your urine. Around a week or two after the operation, the amount of blood may increase as the scab on your prostate falls off.

Drinking plenty of fluids will help flush any blood or small blood clots out of your bladder.

When to seek Medical Advice

While you’re recovering, you should contact a GP immediately or call 112 if:

  • You have a high temperature.
  • You have severe pain when peeing.
  • You cannot pee.
  • There’s a lot of blood in your pee or this gets worse.
  • There are blood clots in your pee.

These symptoms can be a sign of a problem, such as internal bleeding or a urinary infection, that needs to be treated.

Transurethral resection of the prostate (TURP) is generally a safe procedure. However, as with all types of surgery, there are potential risks.

Urinary Incontinence

Some degree of urinary incontinence, where you pee without meaning to, is quite common after TURP.

It usually gets better in the weeks following surgery, but can very occasionally be a long-term problem. It usually takes the form of urge incontinence, where you have a sudden urge to pee and lose control of your bladder if you do not find a toilet quickly enough.

A number of treatments are available for incontinence, including lifestyle changes, medication and surgery.

Erectile Dysfunction

Up to 10% of men who have a TURP have difficulty getting and maintaining an erection (erectile dysfunction) afterwards. This can be either temporary or permanent.

Medication can be prescribed to help reduce the problem if necessary, but you should speak to your surgeon if this is a concern. Your surgeon may be able to provide more information on your individual risk.

Urethral Strictures

Narrowing of the urethra (urethral strictures) can happen if the urethra is damaged during surgery and becomes scarred.

Symptoms of a urethra stricture may include:

  • Straining to pee.
  • Spraying pee or a “split-stream”.
  • Dribbling drops of pee once you have finished going to the toilet.
  • Mild pain when peeing.
  • If the narrowing of the urethra is mild, it can usually be treated by inserting a rod to widen the urethra. More extensive narrowing may require surgery.

Other Risks

Some of the other risks of a transurethral resection of the prostate include:

  • Bleeding – there may be persistent bleeding during or after the operation that means a blood transfusion is required
  • Urinary Tract Infection (UTI)– UTIs can usually be successfully treated with antibiotics.
  • Urinary Retention – the muscles that control the bladder may be temporarily damaged, which can lead to problems fully emptying the bladder; in some cases, the bladder muscles regain their normal function within a few weeks.
  • The prostate becoming enlarged again – some men need to have a TURP again within 10 years.

TURP Syndrome

A rare but potentially serious risk associated with a TURP is known as TURP syndrome.

This occurs when too much of the fluid used to wash the area around the prostate during the procedure is absorbed into the bloodstream.

Initial symptoms of TURP syndrome include:

  • Feeling or being sick.
  • Confusion.
  • Dizziness.
  • Headache.
  • Swelling of your stomach.
  • Slow heartbeat.

Left untreated, life-threatening problems can develop, such as seizures or fits, shortness of breath, blue skin (cyanosis), and coma.

If you experience the symptoms of TURP syndrome during your procedure, the surgeon will stop the surgery and inject you with a diuretic, which is a type of medication used to remove fluid from the body. Tell hospital staff immediately if you develop any symptoms after returning to the ward.

The risk of TURP syndrome is estimated to be less than 1% and is likely to reduce even further as new techniques that avoid pumping water into the bladder are increasingly used.

Risk of Death

TURP carries a very small risk of causing death. The risk of dying as a result of the procedure is now estimated to be less than 1 in 1,000. The risk usually arises from complications involving the heart or a serious postoperative infection.