Transurethral Resection Of The Prostate (TURP)

Transurethral resection of the prostate is a surgery used to remove parts of the prostate gland. It is used to treat an enlarged prostate and relieve the urinary problems associated with it. 

The surgery is also known as TURP (medical abbreviation). TURP, a medical term, may sound very complicated, but it is not. If you had to define TURP, it can be divided into two aspects. The term “transurethral” means that the procedure is performed through the urethra. The phrase “resection of the prostate gland” means cutting out tissue or part of the gland.

TURP is a highly recommended treatment and is extensively carried out with great outcomes. It may also be referred to as “transurethral prostatectomy”.

The prostate is a small gland found in the pelvis of men. It is situated between the penis and the bladder and surrounds the urethra (the tube carrying urine from the urinary bladder to the penis). If the prostate gland becomes enlarged, it can pressurize the bladder as well as the urethra, and thus cause urinary problems/symptoms.

During this procedure, a flexible instrument called a resectoscope is inserted through the tip of the penis into the urethra. The excess prostate tissue is cut off or trimmed away by electricity supplied through the resectoscope. 

TURP, the medical abbreviation for “transurethral resection of the prostate”, is most effective in treating an enlarged prostate.

As discussed, TURP, or “transurethral resection of the prostate” is performed to reduce the urinary symptoms caused by an enlarged prostate (a condition known as Benign Prostatic Hyperplasia or BPH). 

The procedure is recommended in men suffering from moderate to severe urinary problems which did not get relieved even after taking medications.

Benign prostatic hyperplasia (BPH) is a non-cancerous condition in which the prostate gland grows in size. It is fairly common in men with aging. When it causes the prostate to grow, it can cause blockage in the urethra and result in symptoms including:

• Difficulty starting urination
• Urgent need to urinate
• Increased frequency of urination at night (nocturia)
• Slow and prolonged urination
• Stopping and then starting again during urination
• Feeling that your bladder is not completely empty (urinary retention)
• Urinary tract infections (UTIs)

These symptoms can improve after the transurethral resection of the prostate or TURP surgery. 

Furthermore, TURP is also carried out to prevent or treat the following complications caused due to blocked urine flow:

• Inability to control urination
• Inability to urinate
• Bladder stones
• Bladder or kidney damage
• Recurring urinary tract infections (UTIs)
• Blood in urine

• To start off the process, discuss the surgery at length with a doctor. Find out its benefits and risks, and clarify your expectations and doubts about it. 
• The doctor would need to know your complete medical and surgical history, as well as your current symptoms.
• The doctor may conduct a thorough physical examination and tests for evaluating your fitness for undergoing this surgery. This involves tests such as electrocardiogram (ECG) and blood tests. You will also be checked for any pre-existing health conditions such as hypertension, diabetes, etc.
• Make sure you discuss your current medications and supplements with your doctor. The doctor may ask you to modify the dose of certain medicines or avoid them completely. 
• Antibiotics to reduce the risk of UTIs may be prescribed by the doctor before the surgery.
• You’ll need to give up smoking before the transurethral resection of the prostate gland. 
• You’ll be asked not to eat or drink anything for at least 6 to 8 hours before the procedure. 
• Moreover, you’ll need to arrange for someone to take you back home after surgery. You will not be able to drive yourself, especially with a catheter in your bladder. 
• In case you are unable to perform your bowel movements on the day prior to the surgery, you’ll be given an enema to help you relieve your bowels completely before the surgery. 
• Make sure you bring only loose-fitting garments to the hospital that are easy to wear and take off.

TURP procedure steps are as follows:

• You will be asked to empty your bladder, wear a hospital gown and position yourself on your back on the operating table.
• An IV line will be placed in your arm or hand.
• The TURP procedure requires about 60 to 90 minutes. It is performed under general or spinal anesthesia. While general anesthesia will put you to sleep, you’ll remain conscious under spinal anesthesia with your lower body numb. Anesthesia will ensure that you feel no pain during the procedure.
• Once you are under the effect of anesthesia, a breathing tube may be put through the throat into your lungs and you are connected to a ventilator to help you breathe during the surgery. 
• Your legs are placed in stirrups and an instrument called a resectoscope is used during the surgery. 
• A resectoscope is a thin metal tube with a light, a camera, and an electric loop of wire to cut tissue and seal blood vessels. The resectoscope is about 12 inches long and 0.5 inches in diameter. It also contains valves that control irrigating fluid. 
• The surgeon inserts the resectoscope from the tip of the penis, passing it through the urethra, into the prostate area. There won’t be any incisions (cuts) required on the outside of the body.
• The urethra and bladder are inspected, the extra prostate tissue is identified and electric current through the resectoscope is used to cut or trim the excess tissue within the prostate gland, piece by piece. A laser may also be used instead of an electric current. 
• As the small pieces of tissue are cut out, they are temporarily carried along with the irrigating fluid released by the resectoscope into the bladder. 
• The pieces are removed at the end from the urethra and the resectoscope is removed from the body.
• A thin tube called a catheter is also inserted into the bladder to drain urine during initial recovery.

• At the end of the surgery, you are moved to a recovery room and your vitals are monitored while you wake up from the effects of the anesthesia. 
• You will be required to stay in the hospital for 1 to 2 days after the surgery. In some cases, the patient can leave on the same day as well.
• While in the hospital, you may be given fluids intravenously until you recover from anesthesia and are able to eat and drink.
• The urinary catheter stays in your body because urethral swelling may block the urine flow. It is removed after 24 to 48 hours, as by that time, the swelling decreases and allows the patient to urinate on their own.
• Post-surgery, you may notice blood in the urine, which is fairly common. 
• There may also be some urinary symptoms. You can feel pain during urination or an urge for frequent urination after TURP. Painful urination usually takes six to eight weeks to improve.
• It is common to feel lethargic (tired) and under the weather for the first 1 to 2 weeks after the surgery. After that, you’ll be up and about, but you should still take things easy for 4 to 8 weeks.

• Drink lots of water. This will help flush out the bladder, clear blood from urine, and reduce the risk of UTIs.
• Eat a healthy and balanced diet, rich in fiber, to prevent constipation and promote normal bowel movements. The doctor may also suggest a stool softener for this purpose.
• Resume taking blood-thinning medicines only after consulting with your doctor.
• Avoid strenuous activity like heavy lifting for 4 to 6 weeks or as your doctor says.
• Once you feel able, resume gentle exercise like walking. This will prevent your risk of forming blood clots in the legs.
• You can also do some pelvic floor exercises to improve bladder control. Make sure you consult your doctor before starting any exercise. 
• Hold off on sexual activity for 4 to 6 weeks. 
• Also, avoid driving until you’re on prescribed pain medications. Do not drive till your catheter is removed. Take further advice from your doctor as to when you can start full-fledged driving.
• You may be able to return to work in 2 to 3 weeks if your job does not require physical exertion. Ask the doctor about the recovery time you may require in particular.
• After TURP surgery, you should experience better and stronger urine flow within a few days.

Transurethral resection of the prostate or TURP is a medical procedure with several benefits, including:

• It’s a minimally invasive procedure and recovery is not prolonged.
• There are no cuts, bandages, or sutures.
• There is a low risk of complications.
• TURP causes only minimal bleeding and carries reduced chances of infection.
• The chances of recurrence of prostate enlargement are very little post-TURP.
• Results are quick as the surgery helps improve symptoms within a few days.
• TURP is helpful when medications have failed to give relief from the urinary issues created because of BPH (benign prostate hyperplasia – a condition referring to an enlarged prostate). 
• It also helps treat severe conditions such as bladder stones, kidney stones, and kidney damage from BPH.

There can be a risk of developing some urination problems after TURP surgery. The possible risks and complications can be summed up below:

• Temporary difficulty peeing after the procedure for a few days: A catheter can assist in addressing this issue. This tube is inserted into the penis to carry urine out of the bladder until you can urinate on your own.
• Urinary tract infection (UTI): A UTI is likely to occur the longer you have a catheter in place. Some men who’ve had TURP have recurring UTIs. 
• Dry orgasm (also called retrograde ejaculation): Dry orgasm refers to the release of semen into the bladder during ejaculation rather than out of the penis. This effect is not harmful. It does not affect sexual pleasure but can impact your ability to father a child. Note that retrograde ejaculation is the most common of all TURP complications (long-term). It can occur in about 90% of cases.
• Erectile dysfunction: The risk of erectile dysfunction after TURP is very small, but does exist. 
• Excessive bleeding:  In extremely rare cases, enough blood is lost in TURP surgery to even require a blood transfusion. It is more common in men with larger prostates.  
• Loss of bladder control (incontinence): Difficulty in holding urine can be a long-term complication of TURP. Usually, it passes in a few weeks.
• Low sodium in the blood: TURP can sometimes lead to a condition known as TURP syndrome or transurethral resection (TUR) syndrome. It occurs if the body absorbs too much of the fluid that was used to wash the surgery region. It is life-threatening if left untreated. Bipolar TURP surgery, where a low-frequency bipolar electrical current is used, eliminates the risk of developing this condition and thus helps manage TUR syndrome. 
• Need for re-treatment: There can be two scenarios where a re-treatment may be required. One is, when symptoms fail to improve even after the surgery, or they return after some time. And second is, when TURP causes the urethra or the bladder neck to become narrow (urethral strictures). 
• Injury to the bladder or urethra: As with any surgery, there is a possibility of injury to the surrounding organs and tissues, such as the bladder and urethra during the TURP procedure. 
• Blood in the urine: This condition is known as hematuria and can be a possible complication associated with TURP.

You must immediately contact your doctor upon noticing the following symptoms after transurethral resection of the prostate (TURP):

• Inability to pee
• Bright red blood, pus, or clots in the urine
• Urine that is not clear even after 24 hours of drinking fluids and resting.
• High fever (above 38° C/100.4° F) 
• Severe pain during urination
• Urinary symptoms such as a weak stream or frequent urge to pee

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