Transurethral resection of the prostate (TURP) for benign prostatic hyperplasia
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.
What To Expect After Surgery
The hospital stay after TURP is commonly 1 to 2 days.
Following surgery, a catheter is used to remove 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 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.
TURP is now the most common surgery used to remove part of an enlarged prostate. Open prostatectomies (in which an incision is made into the abdomen) generally are needed only when the prostate is very large.
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.1
- Symptoms get better for 7 to 10 out of 10 men who have the surgery.2
On the average, men experience an 85% improvement in their American Urological Association (AUA) symptom index scores.2 For example, if you had a score of 25, after this surgery it might be reduced to 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 significant change.
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, occurring in about 25 to 99 men out of 100.2 This does not affect sexual function.
may develop in men
who did not have problems before the procedure. The risk of this may depend on
how sexual performance is defined and measured, how sexually active the man was
before the surgery, and how old he is. Many men in the age group who are likely
to have BPH also have some problems with getting an erection. Subsequent
erection problems are reported by about 3 to 35 men out of 100.2 Viagra (sildenafil) is effective in helping some men achieve
an erection after they have had TURP.
- Some older studies that reported high rates of erection problems in men after TURP may have failed to assess the sexual function of the men before surgery and may have had differing definitions of what an erection problem is, so they may have overestimated the numbers of men who had an erection problem as a side effect of TURP.3
- A study comparing TURP with watchful waiting and laser surgery indicated that men who had TURP were no more likely to have erection problems, pain on ejaculation, or a perception of an inferior sex life than men who either had laser therapy or practiced watchful waiting.3
Loss of ability to control urine flow (incontinence)
- A small number of men (about 1%) say they are completely unable to hold back their urine after the surgery.2
- 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 4 out of 100 men require a blood transfusion during or after surgery.4
- TURP syndrome occurs in about 2 out of 100 men who have TURP.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 TURP syndrome include mental confusion, nausea, vomiting, high blood pressure, slowed heartbeat, and visual disturbances. TURP 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 or 3 men out of 100 need to have another operation after 3 years.2
- Repeat surgery because of a complication of the surgery is needed less than 10% of the time.2
What To Think About
Surgery usually is not required to treat BPH, although some men may choose it because their symptoms bother them so much. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to consider include your expectation of the results of the surgery, the severity of your symptoms, and the possibility of developing 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.
For men who have clear indications for surgery, TURP may be less effective than open prostatectomy in relieving the symptoms of BPH. (See the Surgery section of the topic Benign Prostatic Hyperplasia [BPH].)
- Webber R (2006). Benign prostatic hyperplasia, search date May 2005. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
- Fitzpatrick JM (2007). Minimally invasive and endoscopic management of benign prostatic hyperplasia. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 3. pp. 2803–2844. Philadelphia: Saunders Elsevier.
- Brookes ST, et al. (2002). Sexual dysfunction in men after treatment for lower urinary tract symptoms: Evidence from randomised controlled study. BMJ, 324(7345): 1059–1061.
- Paterson R, Goldenberg L (2001). Benign prostatic hyperplasia. In J Teichman, ed., 20 Common Problems in Urology, part 2, pp. 185–198. New York: McGraw-Hill.
Last Updated: March 24, 2008