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TURP – Transurethral Resection of the Prostate

TURP (Transurethral Resection of the Prostate) is a minimally invasive surgical procedure used to treat benign prostatic hyperplasia. Excess prostate tissue is removed through the urethra to improve urinary flow.

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Things worth knowing about "TURP"

TURP (Transurethral Resection of the Prostate) is a minimally invasive surgical procedure used to treat benign prostatic hyperplasia. Excess prostate tissue is removed through the urethra to improve urinary flow.

What is TURP?

TURP (Transurethral Resection of the Prostate) is a well-established urological surgical procedure used to treat benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland. During the procedure, excess prostate tissue that narrows the urethra and restricts urine flow is removed through the urethra -- without any external incision. TURP has been considered the gold standard surgical treatment for BPH for several decades.

When is TURP Recommended?

TURP is typically recommended when conservative measures or medications have not provided sufficient relief from BPH symptoms. Common indications include:

Significant urinary obstruction (restricted urine flow)
Recurrent urinary tract infections caused by incomplete bladder emptying
Bladder stones resulting from urinary retention
Kidney damage due to chronic urinary backflow
Haematuria (blood in the urine) caused by an enlarged prostate
Failure of medical therapies such as alpha-blockers or 5-alpha reductase inhibitors

How is TURP Performed?

The procedure is carried out under general or spinal anaesthesia. The urologist inserts a specialised instrument called a resectoscope through the urethra to reach the prostate. Using an electrically heated wire loop (electrocautery) or modern laser technology, excess prostate tissue is systematically cut away and removed. The procedure typically takes between 60 and 90 minutes.

Classic and Modern Variants

Monopolar TURP: The traditional technique using an electric loop; requires a non-saline irrigation fluid.
Bipolar TURP: A more modern approach using physiological saline solution; significantly reduces the risk of TUR syndrome.
Laser TURP (HoLEP/ThuLEP): Uses laser energy for precise tissue removal; associated with less bleeding and suitable for larger prostate volumes.

Preparation and Hospital Stay

Before the procedure, patients undergo blood tests, urinalysis, and often an ultrasound of the prostate. Blood-thinning medications are usually discontinued several days prior to surgery. After the procedure, a urinary catheter is placed for a few days to ensure proper urine drainage. The typical hospital stay is between 2 and 5 days.

Outcomes and Effectiveness

TURP leads to a significant improvement in urinary flow and quality of life for the majority of patients. Clinical studies show that approximately 85 to 90 percent of patients experience meaningful symptom relief following the procedure. The results are generally long-lasting.

Possible Risks and Side Effects

As with any surgical procedure, TURP carries certain risks that patients should be aware of:

Retrograde ejaculation: The most common side effect; semen flows backward into the bladder during ejaculation rather than out of the body (occurs in up to 90% of cases).
Erectile dysfunction: Less common but can occur in some patients.
Urinary incontinence: Temporary or, rarely, persistent loss of bladder control.
TUR syndrome: Absorption of irrigation fluid into the bloodstream (mainly associated with monopolar technique); largely avoided with bipolar methods.
Bleeding and infection: General surgical risks applicable to any operation.
Urethral stricture: Narrowing of the urethra as a possible long-term complication.

Recovery and Aftercare

After discharge, patients are advised to rest, drink plenty of fluids, and avoid strenuous physical activity for several weeks. Mild blood in the urine or a slight burning sensation when urinating during the first few weeks is normal. Regular follow-up visits with a urologist are strongly recommended.

References

Gravas S et al. -- EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS). European Association of Urology, 2023.
Rassweiler J, Teber D, Kuntz R, Hofmann R. -- Complications of Transurethral Resection of the Prostate (TURP) -- Incidence, Management, and Prevention. European Urology, 2006;50(5):969-980.
McVary KT et al. -- Update on AUA Guideline on the Management of Benign Prostatic Hyperplasia. Journal of Urology, 2011;185(5):1793-1803.

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