TURP stands for transurethral resection of the prostate, a surgery that removes excess prostate tissue blocking the flow of urine. It’s the most established surgical treatment for benign prostatic hyperplasia (BPH), the noncancerous prostate enlargement that affects most men as they age. The procedure is done entirely through the urethra, so there are no external incisions.
How the Procedure Works
A surgeon inserts a thin instrument called a resectoscope through the tip of the penis and into the urethra, the tube that carries urine from the bladder. The resectoscope has a built-in camera and a small electrical wire loop. That loop shaves away strips of prostate tissue that have grown inward and narrowed the urinary channel. As tissue is cut, the instrument releases fluid that flushes the pieces into the bladder, where they’re collected and removed at the end of the operation.
The whole procedure typically takes under 90 minutes. It works best on prostates that weigh roughly 75 to 80 grams or less. Larger glands, especially those over 100 grams, usually call for a different approach because the surgery becomes harder to complete safely within that time window.
Why It’s Done
TURP isn’t the first step in treating an enlarged prostate. Most men start with medications that relax the prostate or shrink it over time. Surgery enters the picture when those medications stop working well enough, or when the blockage is causing real harm.
Specific reasons a urologist may recommend TURP include:
- Urinary symptoms that remain bothersome despite medication
- Repeated episodes of being completely unable to urinate (urinary retention)
- Bladder stones forming because the bladder can’t empty fully
- Kidney damage caused by chronic back-pressure from a blocked bladder
- Recurring bloody urine linked to the enlarged prostate
Prostate size alone doesn’t determine whether you need surgery. The deciding factors are how much the blockage is affecting your quality of life and whether it’s causing, or could cause, lasting damage to the bladder or kidneys.
Tests Before Surgery
Before scheduling a TURP, your urologist will run several tests to confirm that the blockage is real and measure how severe it is. A uroflow test has you urinate into a device that measures the speed of your stream. A peak flow rate below 10 milliliters per second strongly suggests significant obstruction. You’ll also have a post-void residual measurement, which uses ultrasound to check how much urine stays in your bladder after you’ve finished urinating. In some cases, a more detailed urodynamic study maps out bladder pressure and contraction strength to help predict how well surgery will work for you.
You’ll typically need to stop blood-thinning medications in the days before the procedure, since even minor bleeding inside the prostate can be difficult to control during surgery.
What Recovery Looks Like
After surgery, you’ll have a catheter draining your bladder. In many cases, it comes out on the first day after the operation, and the median hospital stay is about three days. Around 13% of patients need the catheter reinserted if bleeding or swelling prevents normal urination right away. For those patients, the catheter typically stays in for another four to seven days, and the hospital stay stretches to five or six days.
Expect to see blood in your urine for the first week or two. Urinary urgency and some burning during urination are common during early recovery as the surgical site heals. Most men notice a dramatically stronger urine stream within a few weeks.
How Much Symptoms Improve
The symptom relief from TURP is substantial. Urologists track prostate symptoms on a standardized 35-point scale. In one study, patients started with an average score of about 22 (moderate to severe symptoms) and dropped to roughly 6 (mild symptoms) by six months after surgery. That’s a 17-point improvement on average. Urine flow rate increased by about 10 milliliters per second, and the amount of urine left in the bladder after voiding dropped by nearly 100 milliliters.
These results hold up well over time, though the prostate can gradually regrow. About 8% of men need a repeat TURP within eight years of the original procedure, and the overall rate of needing any follow-up procedure is around 13% at the eight-year mark.
Sexual Side Effects
The most common side effect of TURP is retrograde ejaculation, sometimes called “dry orgasm.” This happens when semen flows backward into the bladder during climax instead of out through the penis. It occurs in roughly 48% of men who remain sexually active after the procedure. Orgasm sensation is preserved, but little or no fluid comes out. The semen passes harmlessly in your next urination. If you’re hoping to father children, this is an important factor to discuss before surgery.
Erectile function is less affected than many men fear. In a study of 264 patients, only about 6% of men who had good erections before surgery reported worsening afterward. Some men with pre-existing mild erectile problems actually saw improvement, possibly because the relief from urinary symptoms reduced stress and improved sleep. Complete erectile dysfunction after TURP occurred in fewer than 4% of cases overall.
Other Risks
TURP is a well-established operation, but it carries some procedure-specific risks. The surgery uses irrigation fluid to flush tissue out of the bladder, and if too much of that fluid gets absorbed into the bloodstream, it can cause a condition called TUR syndrome. This involves a dangerous drop in blood sodium levels, leading to confusion, nausea, and in severe cases, seizures. Modern surgical techniques and newer irrigation fluids have made this complication uncommon, but it remains a recognized risk, particularly in longer procedures.
Bleeding that requires a blood transfusion is possible but infrequent. Temporary urinary incontinence can occur while the muscles around the bladder recover, and urinary tract infections are a possibility in the early postoperative period.
How TURP Compares to Laser Surgery
The main alternative to TURP for larger prostates is HoLEP (holmium laser enucleation of the prostate), which uses a laser to core out prostate tissue in larger pieces rather than shaving it away in strips. In a head-to-head trial of prostates over 60 grams, HoLEP removed more tissue (about 48 grams vs. 45 grams), required shorter catheterization (roughly 31 hours vs. 48 hours), and led to shorter hospital stays (about 42 hours vs. 55 hours). Blood loss was similar, though three patients in the TURP group needed transfusions compared to none in the HoLEP group.
The tradeoff is operating time. TURP averaged about 73 minutes while HoLEP took closer to 90 minutes. HoLEP also requires specialized training that not all urologists have, so availability varies by hospital. For prostates in the typical range, both procedures produce comparable long-term symptom relief.