Transurethral Resection of Prostate (TURP)

Transurethral Resection of Prostate (TURP)

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Transurethral resection of the prostate (TURP) is the endoscopic removal of obstructive benign prostate enlargement (BPH). A resectoscope is passed through the urethra to scrape away the enlarged prostate gland piece by piece to re-establish a channel.

The operation takes up to 1 hour and is done under general or spinal anaesthesia. A Foley catheter is inserted into the bladder after the surgery for continuous irrigation to prevent blood clots from forming in the bladder. The catheter can be removed only when the urine is less bloody. As TURP 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.

Complications include:

  • urine infection (UTI). This is common because BPH causes residual urine in the bladder which then becomes infected. The prostate itself can harbor bacteria which is subsequently released during the surgery. Hence, it is important to ensure that the urine is sterile before surgery and antibiotics continued even after the operation.
  • bloody urine. This can last up to 3 weeks. Up to ⅔ of men may also experience frequent urination, urgency and incontinence which can take up to 3 months to subside.
  • dry ejaculation. This is due to the backward passage of sperm during sexual intercourse. It is inevitable because the bladder neck is cut open during TURP and the semen preferentially goes into the bladder. The semen mixed with urine will pass out during urination and is not harmful at all whilst it is in the bladder.
  • re-bleeding (secondary bleeding). This occurs in 3% of cases and tends to occur between the 7th to 10th day after surgery. It is due to urine infection or re-opening of a blood vessel. If the bleeding is heavy, clot retention can occur. Re-hospitalisation is then needed because a catheter needs to be re-inserted to evacuate the blood clots. Rarely, one may be brought back to the operating theatre to stop the bleeding points.

Desired outcomes:

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