The Transurethral Resection of the Prostate (TURP) is a surgical procedure used to treat an enlarged prostate gland, a condition known as Benign Prostatic Hyperplasia (BPH). BPH is a common, non-cancerous growth that affects many men as they age. The prostate surrounds the urethra, which carries urine from the bladder. As the gland grows, it squeezes the urethra, causing bothersome urinary symptoms. TURP mechanically clears this obstruction.
When TURP Becomes Necessary
TURP is typically considered after less-invasive medical therapies have failed to manage BPH symptoms. Patients often experience a weak urine stream, difficulty starting urination, frequent urination, or waking up multiple times at night to urinate. When these symptoms severely diminish quality of life, surgery becomes the next step.
The procedure is also indicated when BPH causes acute complications requiring immediate relief. These complications include acute urinary retention, which is the complete inability to urinate and requires catheterization. Other indications include recurrent urinary tract infections, bladder stones, or kidney damage resulting from prolonged urine blockage. In these serious situations, medications cannot resolve the mechanical obstruction.
How the Procedure is Performed
The TURP procedure is unique because the surgeon accesses the prostate entirely through the urethra, meaning no external incisions are necessary. The patient is first given either a general anesthetic, which induces temporary sleep, or a spinal anesthetic, which numbs the body from the waist down. This choice of anesthesia is made based on the patient’s overall health and the surgeon’s preference.
Once anesthesia is administered, a specialized instrument called a resectoscope is inserted through the urethra to the prostate. This thin, telescope-like instrument contains a light source, a camera for visualization, and a working electrical wire loop. The surgeon uses the wire loop to precisely shave away the excess prostate tissue blocking the central channel of the urethra.
The electrical current applied to the wire loop cuts the tissue and helps to cauterize small blood vessels to control bleeding. As the tissue is removed, sterile irrigation fluid is delivered through the resectoscope to wash the resected fragments into the bladder. These tissue chips and the fluid are flushed out, leaving a wider channel for urine. The entire process typically takes about 60 to 90 minutes.
Immediate Post-Operative Care
Following the procedure, patients are moved to a recovery area and then to a hospital ward, with the hospital stay usually lasting between one to three days. A urinary catheter is immediately placed into the bladder to drain urine, as the urethra will be temporarily swollen. This catheter is connected to a Continuous Bladder Irrigation (CBI) system, which constantly flushes the bladder with fluid.
The CBI system is crucial in the initial post-operative period to prevent blood clots from forming and blocking the catheter or the urethra. It is normal for the draining fluid to appear pink or red with blood during this time, and the irrigation continues until the urine begins to clear. Once the draining fluid is largely free of blood, typically within 24 to 48 hours, the catheter is removed.
After the catheter is taken out, patients are monitored to ensure they can urinate effectively on their own, known as a trial of void. It is common to experience a burning sensation while urinating, increased urinary frequency, and a strong sense of urgency for several weeks as the surgical site heals. Some patients may also temporarily experience a slight loss of bladder control, but this usually resolves within a few weeks as the muscles recover.
Expected Outcomes and Potential Complications
The goal of the TURP procedure is to alleviate the symptoms of BPH, and the outcomes are generally successful, with patients reporting significant improvements in urinary flow and a reduction in bothersome symptoms. The relief of the obstruction is often immediate, though full healing of the urinary tract can take several weeks. Most men maintain these improved urinary function results for many years.
While effective, the procedure is associated with potential side effects. The most common long-term change is retrograde ejaculation, which occurs in up to 90% of cases. This happens because the surgical removal of prostate tissue widens the bladder neck, allowing semen to travel backward into the bladder during orgasm, resulting in a “dry orgasm.”
The risk of permanent urinary incontinence is low, affecting less than 1% of patients, though temporary incontinence is more common immediately after catheter removal. Erectile dysfunction is also a possible complication, with studies suggesting a low risk that may range from 5% to 10%, particularly in men without pre-existing issues. Small risks also include bleeding, infection, and the need for a repeat procedure years later if the prostate tissue grows back.