Prostate Surgery: Transurethral Resection (TURP)

What is a transurethral resection of the prostate?

Transurethral resection of the prostate (TURP) is surgery done to relieve blockage and incomplete emptying of the bladder caused by 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, your healthcare provider uses a scope and a heated wire loop to remove part of the prostate gland. A specialist called a urologist will do the procedure. Urologists specialize in problems of the kidneys and bladder.

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. You will have less discomfort and will be able to urinate more easily.

Instead of this procedure, other treatments may include:

• 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)
• using heat to destroy part of the prostate
• 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)

You may choose not to have treatment. Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• Tell your provider if you have any food or medicine allergies.
• You may go home with a catheter for a few days after the procedure/surgery. It's best to learn about the catheter and urine collection bag before your procedure/surgery. Follow any instructions your healthcare provider may give you.
• Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Tell your healthcare provider about all medicines and supplements that you take.
• Your healthcare provider may prescribe antibiotics for you to take a few days before and after surgery to help prevent infection.
• Your healthcare provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for tests or procedures.

What happens during the procedure?

The procedure is usually done the hospital.

You will be given regional or general anesthesia to keep you from feeling pain during the procedure. Regional anesthesia numbs part of your body while you stay awake. You will probably be given medicine with the regional anesthetic to help you relax. General anesthesia relaxes your muscles and you will be asleep.

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.

The procedure usually take about 1.5 to 2 hours.

What happens after the procedure?

After the procedure you may stay in a recovery area for at least a few hours You may be able to leave the hospital or clinic the day you have the procedure or you may stay in the hospital overnight.

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, usually in 2 to 3 days.

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.

Ask your healthcare provider:

• how long it will take to recover
• what activities you should avoid, including lifting, and when you can return to your normal activities
• how to take care of yourself at home
• what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

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.”

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• In rare cases you may have an allergic reaction to medicines used during the procedure.
• 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.
• Rarely, 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).

Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.