Transurethral Resection of the Prostate (TURP) for Benign Prostatic Hyperplasia
Surgery Overview
During transurethral resection of the prostate (TURP), an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow.
TURP usually requires a stay in the hospital. It is done using a general or spinal anesthetic.
What To Expect
The hospital stay after TURP is commonly 1 to 2 days.
Following surgery, a catheter is used to remove urine and blood or blood clots in the bladder that may result from the procedure. When the urine is free of significant bleeding or blood clots, the catheter can be removed and you can go home.
Strenuous activity, constipation, and sexual activity should be avoided for about 4 to 6 weeks. Symptoms such as frequent urination will continue for a while because of irritation and inflammation caused by the surgery. But they should ease during the first 6 weeks.
Why It Is Done
Your doctor may recommend TURP if symptoms caused by benign prostatic hyperplasia (BPH) have not improved in response to home treatment and medicines.
How Well It Works
For men who have moderate to severe symptoms of prostate enlargement, TURP is more effective than watchful waiting in relieving urinary symptoms. Studies have found that:
- Men who had TURP had a lower symptom score compared with those who used watchful waiting.footnote 1
- Symptoms get better for 7 to 10 out of 10 men who have the surgery.footnote 2
Men experience about an 85% improvement in their American Urological Association (AUA) symptom index scores.footnote 2 For example, if you had a score of 25, after this surgery it might be at about 4. Men who are very bothered by their symptoms are most likely to notice great improvement in their symptoms after TURP. Men who are not very bothered by their symptoms are less likely to notice a big change.
Risks
The risks of transurethral resection of the prostate (TURP) include problems with sexual performance, incontinence, and problems from surgery.
Problems with sexual performance
- Ejaculation into the bladder (retrograde ejaculation) is very common. It occurs in about 25 to 99 men out of 100.footnote 2 This does not affect sexual function.
- Some men report erection problems after this surgery. But it's not clear if the surgery caused these problems. For men who do have trouble getting an erection, medicine can help.
Loss of ability to control urine flow (incontinence)
- A small number of men (about 1 out of 100) say they are completely unable to hold back their urine after the surgery.footnote 2 But some experts say that men who have TURP appear to have no greater risk for incontinence than men who do not have surgery.footnote 3
- Some men find that they can still hold in their urine after the surgery, but they tend to leak or dribble.
Problems related to having surgery
- About 5 out of 100 men have severe bleeding and need a blood transfusion.footnote 4
- Transurethral resection (TUR) syndrome occurs in about 2 out of 100 men who have TURP.footnote 2 This syndrome occurs when the body absorbs too much of the fluid used to wash the area around the prostate while prostate tissue is being removed. The symptoms of TUR syndrome include mental confusion, nausea, vomiting, high blood pressure, slowed heartbeat, and visual disturbances. TUR syndrome is temporary (usually lasting only the first 6 hours after surgery) and is treated with medicine that removes excess water from the body (diuretic).
- About 2 men out of 100 need to have another operation after 3 years. And about 8 men out of 100 need to have another operation after 5 years.footnote 2
- Repeat surgery because of a complication of the surgery is needed less than 10% of the time.footnote 2
What To Think About
TUR syndrome doesn't happen when TURP is done using a bipolar tool (resectoscope) compared to a monopolar resectoscope. You may want to ask your doctor which kind of tool he or she uses.
Surgery usually is not required to treat BPH, although some men may choose it because their symptoms bother them so much. Choosing surgery depends mostly on your preferences and comfort with the idea of having surgery. Things to think about include your expectation of the results of the surgery, the severity of your symptoms, and the possibility of having complications from the surgery.
Men who have severe symptoms often have great improvement in quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life. Men with only mild symptoms may want to think carefully before deciding to have surgery to treat BPH.
References
Citations
- McNicholas T, Kirby R (2011). Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1801/overview.html. Accessed April 12, 2016.
- Fitzpatrick JM (2012). Minimally invasive and endoscopic management of benign prostatic hyperplasia. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2655-2694. Philadelphia: Saunders.
- AUA Practice Guidelines Committee (2010). AUA guideline on management of benign prostatic hyperplasia. Chapter 1: Guideline on the management of benign prostatic hyperplasia (BPH). Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph.
- Wilt TJ, N'Dow J (2008). Benign prostatic hyperplasia. Part 2-Management. BMJ, 336(7637): 206-210.
Current as of: December 3, 2017
