Transurethral Resection of the Prostate (TURP) is a common surgical procedure for benign prostatic hyperplasia (BPH), a condition where the prostate gland enlarges and can obstruct urine flow. While effective for alleviating urinary symptoms, TURP, like any surgery, carries potential risks and complications. Understanding these outcomes is important for preparation and recovery.
Immediate Complications
Bleeding is common during and after TURP. While some blood in the urine is expected, significant or prolonged bleeding, such as bright red blood or clots, can occur. Continuous bladder irrigation often flushes the bladder to prevent clot formation. Rarely, excessive blood loss may require a transfusion.
A rare but serious complication is TURP syndrome, resulting from excessive absorption of irrigation fluid into the bloodstream. This dilutes blood components, including sodium, causing hyponatremia. Symptoms include nausea, vomiting, confusion, headache, dizziness, and a slow heartbeat. Early recognition and intervention are important for managing this condition.
Urinary tract infections (UTIs) can develop after TURP. Risk factors include age (65+), pre-surgical catheter use, diabetes, and prolonged post-operative catheterization. Symptoms often include fever, chills, and painful urination.
Bladder spasms are involuntary contractions of the bladder muscle after TURP. They often cause a frequent, urgent need to urinate, sometimes with pain. A catheter or blood clots can aggravate them. Medication can help control them.
Retrograde ejaculation is a common side effect of TURP. Semen flows backward into the bladder during orgasm instead of exiting through the penis. This results from damage to bladder neck nerves or muscles, which normally prevent backward flow. While generally not harmful and sexual pleasure is maintained, it can affect fertility.
Delayed and Long-Term Complications
Urinary incontinence can occur after TURP. While severe, permanent incontinence is rare, temporary or mild stress incontinence (urine leakage with activities like coughing or sneezing) is common early on. This often improves over weeks to months, though persistent incontinence can occur in a small percentage of patients.
Urethral stricture, a narrowing of the urethra due to scar tissue, can develop weeks or months after TURP. This scarring can make urination difficult, leading to symptoms such as straining to urinate, a weak or split urine stream, or post-void dribbling. The risk of urethral stricture or bladder neck contracture after TURP is low. Factors include urethral trauma from the resectoscope, catheter type, and duration of catheterization.
Bladder neck contracture is similar to a urethral stricture but occurs specifically at the bladder opening where it connects to the urethra. This scarring can also cause obstructive urinary symptoms, such as difficulty emptying the bladder, a slow stream, or urinary retention. The incidence of bladder neck contracture after TURP is low. This complication typically appears within two years of surgery.
Erectile dysfunction is a concern for some patients after TURP. While less common than retrograde ejaculation, some men may experience difficulty getting or maintaining an erection post-surgery. TURP generally does not significantly impact erectile function, and some with pre-existing dysfunction may even improve. However, a small percentage of patients with normal function before surgery might experience worsening.
The need for repeat surgery can arise if prostate tissue regrows over time, leading to a recurrence of urinary symptoms. The reoperation rate for residual or regrowing prostate tissue after TURP is low but increases over time. This may necessitate another procedure to relieve the obstruction.
When to Seek Medical Attention
After TURP, monitor for signs and symptoms that may indicate a complication requiring prompt medical attention. Severe or persistent bleeding, especially bright red blood or large blood clots in the urine that do not improve, warrants immediate contact with a healthcare provider. While some pink urine is normal for a few days, worsening bleeding is concerning.
An inability to urinate (acute urinary retention) requires urgent medical evaluation. This indicates a blockage of urine flow, potentially caused by swelling or blood clots. Similarly, signs of infection, such as persistent fever, chills, severe pain, or foul-smelling urine, should be reported immediately.
Symptoms of TURP syndrome, including confusion, severe headache, significant nausea or vomiting, or unusual weakness, require immediate medical attention. These suggest an imbalance in body fluids and electrolytes. Any persistent or worsening pain not relieved by prescribed medication should also be discussed with a healthcare provider.
Any sudden onset of new or concerning symptoms should prompt communication with the surgical team. Attending all scheduled follow-up appointments is also important, as these visits allow monitoring recovery and addressing any emerging concerns.