Transurethral Resection of Prostate (TURP)

TURP instrument
TURP instrument

Transurethral resection of the prostate (TURP) is for men with obstructive benign prostate enlargement (BPH). Under general or spinal anaesthesia, a resectoscope is inserted to cut away the enlarged prostate to re-create a channel.

TURP process

The prostate chips are sent for histology to check if there is any incidental cancer. A catheter is inserted into the bladder after the surgery with continuous irrigation fluid to prevent blood clots from blocking the bladder. The operation takes an 1 hour.

Prostate chips removed at TURP

As this can be a very bloody operation, any blood-thinning medication, such as Aspirin or Plavix must be stopped 1 week beforehand. Hospital stay is 3 to 4 days depending on the bleeding. For the laser method, the hospitalization period is shorter and just an overnight stay.

Complications include:

  • bloody urine. This can last 2 to 3 weeks. Many patients may also experience frequent urination, urgency and incontinence but this usually subsides by 1 to 3 months.
  • dry ejaculation. This is inevitable because the bladder neck is cut open during TURP and the semen goes into the bladder during ejaculation. The semen will be pass out together with the urine and is not harmful whilst it is in the bladder.
  • re-bleeding (secondary haemorrhage). This happens in 3% of patients and occurs between the 7th to 10th day after TURP. It is due to urine infection or re-opening of a blood vessel. If the bleeding is heavy, clot retention can occur. A catheter needs to be re-inserted to help evacuate the blood clots. Rarely, one may be brought back to the operating theatre to seal the bleeding vessels.
  • infection. This can still occur despite antibiotics because the prostate may harbor bacteria which subsequently gets released during the surgery. The bacteria can infect the bladder or even travel down to the testis to cause a painful scrotal swelling.

Desired outcomes:

  • no blood transfusion ( < 1% rate )
  • low UTI rate ( < 5% occurrence )
  • no re-admission for secondary bleeding< 3% rate )