Prostate surgery - transurethral resection (TURP)

About TURP

If you have an enlarged prostate gland, you may find it difficult to pass urine because your prostate gland may obstruct the flow of urine from your bladder. Your surgeon may suggest that you have a procedure known as TURP to remove a section of your prostate gland. This can help to reduce the pressure on your bladder if other types of treatment, such as medicines, haven’t helped.

What are the alternatives to TURP?

Conservative management

If your symptoms aren't bothering you too much, your GP may suggest you don’t have treatment straight away. Instead, he or she would monitor your condition with routine check-ups. You may also be offered medicines to help to treat your condition. Your GP may give you some advice on simple lifestyle changes you can make to improve your symptoms. This may include cutting down on caffeine and alcohol, and reducing the amount of fluid you drink in the evening.

Alternative types of treatment

If your enlarged prostate gland symptoms don’t get better, your GP may refer you to a surgeon for advice about your treatment options. TURP is only one type of procedure for an enlarged prostate gland.

Alternative types of procedure include the following.

  • Bipolar TURP. This procedure is similar to TURP. However, the instruments and fluids used in the procedure are different to those used in standard TURP, reducing the risk of a potentially serious complication known as TURP syndrome.
  • Transurethral incision of the prostate. This is a similar procedure to TURP, but involves making one or two small cuts in the neck of your bladder and prostate rather than removing part of your prostate. It’s usually only suitable for men whose prostate is only moderately enlarged.
  • Open prostatectomy. This isn’t a common procedure and is usually only carried out if you have a very large, benign (non-cancerous) prostate. A cut is made in your abdomen (tummy) and the outer portion of your prostate is removed.
  • Minimally invasive treatment (such as electrovaporisation or laser prostatectomy – also called holmium laser enucleation of the prostate). In these types of procedure, laser or electrical energy is used to burn off excess tissue from your prostate. Generally these procedures are the least invasive but don’t remove as much tissue as standard or bipolar TURP.
  • Transurethral needle ablation of the prostate. This procedure uses needles to deliver heat to your prostate to destroy excess tissue. This procedure may have fewer complications than TURP, but the possibility of needing a repeat procedure is higher. This procedure isn’t often used in the UK.

Your surgeon will discuss which procedure is most suitable for you. This will depend on how severe your condition is and what is available at your hospital.

Preparing for your procedure

Your surgeon will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

If you have been prescribed anticoagulant medicines, such as clopidogrel, which can stop your blood from clotting, you may be advised to stop taking these before your procedure. This is because you may bleed more after your procedure if you’re taking these.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

The procedure is usually carried out under general anaesthesia. This means you will be asleep during the procedure. Alternatively, you may have the procedure under spinal or epidural anaesthesia. This completely blocks feeling from your waist down and you will stay awake during the procedure. You may be offered a sedative with a spinal anaesthetic – this relieves anxiety and helps you to relax.

Your surgeon or anaesthetist will advise which type of anaesthesia is most suitable for you.

If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s or surgeon’s advice.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What happens during TURP

The procedure will take up to an hour.

Your surgeon will insert a narrow, rigid, metallic, tube-like telescopic camera called an endoscope into your urethra (the tube that carries urine from your bladder and out through your penis). He or she will then insert a specially adapted surgical instrument called a resectoscope. This is an electrically heated wire loop that is used to cut out and remove the middle of your enlarged prostate. Your surgeon will insert a catheter (a thin flexible tube) into your urethra to drain urine from your bladder into a bag. This is because you may not be able to urinate normally immediately after the procedure as you may have some swelling.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will have a catheter to drain urine from your bladder into a bag. The catheter will also be used to wash out your bladder with a sterile solution, which helps to flush out any blood clots in your bladder. The catheter will be removed when your urine begins to run clear. This is usually within 24 to 48 hours. Occasionally, you may need to keep the catheter in for a short period after you go home. If so, your nurse will show you how to look after it.

You may have a drip in your arm to prevent you getting dehydrated. This will be removed once you’re drinking enough fluids. You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots developing in your legs.

You will usually be able to go home after about two days. You will need to arrange for someone to drive you home. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon’s advice.

Recovering from TURP

If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You may be advised to increase your fluid intake to flush out your bladder and help you to recover. You may find that you have some blood clots in your urine around 10 to 14 days after your procedure. These are scabs from your prostate healing and coming away. If increasing your fluid intake doesn’t clear this up, see your GP.

A small number of men get a urinary infection after the TURP procedure. If you have any stinging when you urinate, see your GP so that your urine can be tested for an infection. Your GP will prescribe you antibiotics if you need them.

It can take up to four weeks to recover fully from TURP. After two to three weeks you can resume your normal activities. To help your recovery, your surgeon may recommend that you do pelvic floor exercises. Your doctor or nurse at the hospital will explain how to do these and how often. Please see our frequently asked questions for more information about pelvic floor exercises.

Don’t do any strenuous activity for about four weeks after your procedure. You can have sex as soon as you’re comfortable – this will probably be at least three to four weeks after your procedure.

What are the risks?

As with every procedure, there are some risks associated with TURP. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure, for example, feeling sick from the effects of the anaesthetic.

Some specific side-effects of TURP include the following.

  • Blood in your urine. This is usually an expected side-effect of the procedure and isn’t normally a cause for concern. If it continues for longer than two weeks, see your GP.
  • An urgent need to pass urine. This is sometimes accompanied by a burning sensation when you pass urine.
  • Incontinence (urine leakage). Talk to your GP if this happens, but it usually improves with time.
  • Erectile dysfunction (impotence). This doesn’t usually happen and you’re unlikely to be affected if you had normal erections before your procedure.

Complications

Complications are when problems occur during or after your procedure. The possible complications of any procedure includes an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT). Specific complications of TURP include the following.

  • Retrograde ejaculation. This is where semen passes into your bladder during an orgasm instead of out of your penis. You will then pass the semen mixed with urine the next time you urinate. Retrograde ejaculation is permanent and can affect your fertility, so talk to your doctor if you’re concerned.
  • Infection. You may be given antibiotics before your procedure to prevent infection.
  • TURP syndrome. This is a condition that can develop if the fluid used to flush your bladder during your procedure is absorbed into your body. This can cause changes in your blood pressure and you may feel sick or vomit. However, this is becoming less common as a different type of fluid is often used to flush your bladder, which is less likely to cause TURP syndrome. Please see our frequently asked questions for more information about TURP syndrome. 
  • Urethral stricture. This is scarring of the inside of your urethra, which causes it to become narrower. Symptoms include problems when urinating, such as urinary retention (being unable to pass urine at all) or incontinence (urine leakage). You may be advised to have a further procedure to widen the inside of your urethra again.
  • Your prostate may grow again. If this happens, you may need to have another procedure if too little was removed during the first procedure.

Read more about the Pros and cons of this procedure.

Why do I need to do pelvic floor exercises after TURP?

Answer

Pelvic floor exercises can help to improve control of your bladder when you get home after your procedure.

Explanation

Your pelvic floor is a layer of muscle that supports your bladder and bowel, It plays an important part in bladder and bowel control. Pelvic floor exercises after transurethral resection of the prostate (TURP) can improve the results of your procedure and help you to recover faster. Pelvic floor exercises can help you maintain good urinary control and prevent erectile dysfunction (impotence) after TURP. If your doctor thinks it would be beneficial for you, he or she will explain how to do these and how often,

You can exercise your pelvic floor muscles by tightening the ring of muscle around your back passage, as if you're trying to control wind. At the same time, imagine you're passing urine and try to stop the flow mid-stream – then restart it. You may see your penis dip down slightly and feel your scrotum lift when you tighten your pelvic floor muscle. It can take time to get the technique right. Your doctor may advise that you build up the number of exercises you do until you are doing several sets a day.

I have heard about laser treatment for an enlarged prostate - what is this?

Answer

Laser treatment uses energy to destroy your prostate tissue. Types of laser treatment include laser resection and photoselective vaporisation of the prostate.

Explanation

Laser resection (also known as holmium laser enucleation of the prostate – HoLEP) uses beams of laser light to cut out the prostate tissue. If you have this procedure, your doctor will insert a small telescope into your urethra and use a laser to target your prostate. The pieces of prostate tissue will then be sucked out of your bladder.

Photoselective vaporisation of the prostate uses a different type of laser that produces green light. This type of laser light is absorbed by tissue that has a good blood supply, which means there is very little bleeding. The green laser light vaporises your prostate tissue without affecting the surrounding tissue so there is less scarring. Photoselective vaporisation procedures don’t remove as much tissue as HoLEP or TURP, so you may need more than one procedure.

Both of these procedures offer advantages over the usual TURP procedure, including:

  • reduced bleeding
  • a shorter hospital stay
  • a shorter time needing a catheter
  • reduced risk of TURP syndrome

However, it's important to note that these procedures are more technically demanding than TURP and not as much is known about their long-term effects.

Your surgeon will advise whether laser treatment is suitable for you.

What is TURP syndrome?

Answer

TURP syndrome is a complication that you can get as a result of having a TURP procedure. During TURP, fluid is used to wash out your bladder. This fluid can be absorbed into your body and may cause side-effects, such as low blood pressure (hypotension), feeling sick or vomiting.

Explanation

TURP syndrome occurs if the fluid used to wash debris and blood from your bladder is absorbed into your body. Different types of fluid that are now available make it less likely that you will develop TURP syndrome. There is some evidence to suggest that newer surgical techniques, for example, those using lasers, have a lower risk of TURP syndrome.

TURP syndrome is very rare because your doctor and anaesthetist will take every precaution to prevent it developing, and monitor you closely to ensure that you’re well.

Symptoms of TURP syndrome include:

  • numbness, 'pins and needles' or a burning sensation on your face and neck
  • your abdomen (tummy) appearing swollen because of absorption of the fluid
  • changes in your blood pressure
  • feeling sick or vomiting
  • blurred vision
  • headache
  • confusion
  • seizures
  • losing consciousness
  • potentially going into a coma

Some of these symptoms don't need treatment (such as blurred vision) and will clear up on their own, but you may be given medicines through a drip to treat others.

Ask your surgeon for more information about TURP and TURP syndrome.

Read more about the Pros and cons of this procedure.