Transurethral Resection of the Prostate (TURP) is a procedure designed to alleviate bothersome urinary symptoms due to an enlarged prostate. While the entire prostate gland does not regenerate, symptoms can indeed recur over time. This article will delve into the specifics of the TURP procedure and explain why a return of symptoms can occur.
Understanding TURP and Prostate Tissue
Transurethral Resection of the Prostate (TURP) is a surgical procedure aimed at relieving urinary obstruction caused by an enlarged prostate, a condition known as Benign Prostatic Hyperplasia (BPH). During a TURP, a surgeon inserts a slender instrument called a resectoscope through the urethra, the tube that carries urine out of the body, to reach the prostate gland. This instrument uses an electrical loop or laser to remove excess prostate tissue that is blocking the flow of urine.
The primary goal is to create a wider channel for urine to pass through, improving urinary symptoms. A TURP removes only the enlarged inner portion of the prostate gland, specifically the tissue surrounding the urethra. The outer capsule and some normal prostate cells are intentionally left intact. The remaining prostatic tissue, even after the procedure, remains susceptible to the hormonal influences that contribute to prostate growth.
The Nature of Post-TURP Recurrence
The entire prostate gland does not regenerate after a TURP. Instead, the remaining prostate cells, particularly those in the outer capsule or any residual inner tissue, can gradually continue to grow over time. This leads to a re-enlargement of the prostate, which can eventually cause a recurrence of BPH symptoms. This new growth is a benign process and does not signify the return or development of prostate cancer.
This phenomenon is often referred to as “re-enlargement” or “new benign growth” to accurately reflect that it is not a complete regrowth of the original gland. Some studies indicate that patients may experience significant re-enlargement within five to ten years following the initial surgery. While the procedure generally provides long-lasting relief, with effects often lasting 10 to 15 years or longer, the duration of symptom relief can vary for each individual. Approximately 20% of patients may require re-treatment within 10 years due to this new tissue growth.
Factors Influencing Symptom Return
Several factors can influence the likelihood and timeline of BPH symptom recurrence after a TURP. The original size of the prostate before surgery plays a role, as does the amount of tissue removed during the initial procedure. A less complete removal of obstructive tissue may increase the chances of earlier symptom return.
Individual hormonal responses also contribute, as the remaining prostate cells are still influenced by hormones that promote growth. Patient age is another significant factor, as BPH is an age-related condition, and prostate tissue naturally continues to grow as men get older. Inflammation within the prostate tissue, even after surgery, has been identified as a contributing factor to prostate volume progression. Studies suggest that a younger age at the time of surgery and a larger prostate size can be associated with a higher risk of recurrence.
Monitoring and Managing Future Symptoms
Following a TURP, regular monitoring involves routine check-ups and ongoing assessment of urinary symptoms. Individuals should be aware of signs that might indicate a recurrence of BPH-related issues. These can include an increased frequency of urination, particularly at night, a weak or interrupted urinary stream, or the persistent feeling that the bladder has not been completely emptied.
If symptoms do return, various management and treatment options are available. Initially, lifestyle modifications, such as dietary adjustments and fluid management, may be recommended. Medications, including alpha-blockers that relax bladder neck muscles or 5-alpha-reductase inhibitors that can shrink the prostate, may be prescribed. In some instances, if symptoms are severe or do not respond to medication, a repeat procedure might be considered. This could involve another TURP or other minimally invasive therapies designed to remove or reduce the new prostate tissue, ensuring that recurrent symptoms are effectively addressed.