Transurethral Resection Of The Prostate

Alternate Names
TURP

Definition of Transurethral Resection Of The Prostate

A transurethral resection of the prostate, abbreviated as TURP, is surgical procedure that is most often done to treat benign prostatic hyperplasia (BPH). BPH is the enlargement of the prostate gland that often occurs as a man ages. The prostate gland is located in the pelvis just below the bladder. Its main role is to secrete substances into the semen that help sperm fertilize a woman's egg.

Who is a candidate for the procedure?

The enlarged gland in a man with BPH can press against the urethra, the tube that carries urine from the bladder to the outside of the body. This pressure can interfere with a man's ability to urinate. Medications are usually prescribed to relieve these symptoms.

If the man does not want to take the medicines or if symptoms are not relieved, the healthcare provider may recommend a TURP. TURP is sometimes used when there are urinary problems caused by prostate cancer. The goal of the operation in this case is to treat the blockage, not to manage the cancer. Other treatments are needed for the cancer.

How is the procedure performed?

A TURP is done in the hospital by a urologist. A urologist is a surgeon who treats people with diseases of the kidney and urinary tract. The procedure can be performed under general or regional anesthesia. With general anesthesia, the man is given medications to put him completely to sleep, so that he feels no pain and has no awareness of the procedure. With regional anesthesia, the man is given medication to make him numb from the waist down and medication also to make him slightly drowsy.

First, the surgeon inspects the urethra and bladder with an endoscope. An endoscope is a special tube with a camera on the end which allows the surgeon to see the inside of the urinary tract. The scope is passed through the tip of the penis. It is then passed into the urethra and bladder. This is to double check that the planned operation is correct. It is also to look for any unplanned problems such as bladder tumors or stones in the bladder.

Next, an electrical loop is passed into the urethra. The loop is placed near the part of the urethra that is surrounded by the prostate. The loop is used to cut out pieces of tissue from the prostate that bulge into or block the urethra. This process is similar to coring an apple. Electricity is applied through the same loop to stop bleeding.

After the procedure is over, the pieces of the prostate that were trimmed away are removed. The tissue is sent to the lab to make sure that prostate cancer is not present. A urinary catheter is then inserted through the penis and into the bladder.

What happens right after the procedure?

The man usually stays in the hospital for at least a day after the procedure. Urine from the bladder is drained through the urinary catheter. The urine contains quite a bit of blood at first. The catheter can be removed when the amount of blood in the urine is minimal. Sometimes, the catheter is irrigated with water to help keep the urine clear.

The urine usually clears between several hours to 2 days after the procedure. If possible, the catheter is removed before the man leaves the hospital. Men may need to go home with the catheter still in the bladder. It can be removed later in the office when the swelling from the operation has subsided.

What happens later at home?

Once home, the individual should drink plenty of fluids. This helps wash any remaining blood out of the bladder. This is important since clotting of the blood could create a urinary blockage. The man should also avoid heavy lifting for several weeks after this procedure. This activity could result in bleeding. Pain medicine can be used as directed if needed.

What are the potential complications after the procedure?

Surgery can be complicated by bleeding, infection, or reactions to anesthesia. A specific complication of a TURP involves absorbing the irrigation fluid through bleeding vessels, during a deep or prolonged resection of the prostate. This is called transurethral resection syndrome, or TUR syndrome, and involves dangerous levels of diluted sodium in the man's bloodstream.

It is the risk of this syndrome which makes a man with a prostate size greater than 100 grams not an ideal candidate for this procedure. If this syndrome occurs the procedure is immediately terminated and intensive care monitoring is needed to complete resolution of the diluted sodium and its effects on the body.

The main long-term side effect of TURP is retrograde ejaculation. This is a condition in which semen flows back into the bladder during ejaculation. Normally, semen is ejected out through the end of the penis. For the most part, this problem does not affect a man's ability to have an erection or an orgasm. It does, however, make him infertile. Men who wish to father children should understand this side effect before considering the procedure.

Symptoms such as weak urine stream and inability to completely empty the bladder usually go away quickly following a TURP procedure. Other symptoms such as the need to urinate frequently and incontinence may take longer to clear up. Sometimes, medicines such as oxybutynin (i.e., Ditropan) or tolterodine (i.e., Detrol) can be used to "calm" the bladder until these symptoms go away.

Most of the time these medicines are needed only temporarily. Occasionally, they may have to be taken long term. Following TURP, a urinary catheter may need to be put back into the bladder temporarily after the procedure. This probably occurs because of swelling at the site. The catheter is usually needed only for a few days. Other rare complications include urinary incontinence, or the inability to control urine. An abnormal narrowing of the urethra may cause trouble with urination in rare cases. Any new or worsening symptoms should be reported to the healthcare professional.