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Vital Insights on TURP, a Surgery for Enlarged Prostate: What to Know

Enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a very common condition in men, especially those over 50. BPH can present with a host of urinary symptoms, from a weak urine stream to not being able to urinate at all. Over time, an enlarged prostate can affect how the bladder functions. A transurethral resection of the prostate (TURP) is a surgery that’s commonly performed to treat urinary problems caused by BPH. Here's everything you need to know about it.

Who is a good candidate for TURP?

TURP is typically recommended when an enlarged prostate causes bothersome symptoms that fail to respond to lifestyle adjustments and medications. Urinary symptoms that may improve after TURP include problems with starting to urinate, a weak stream of urine, a stream that starts and stops, frequent urge to urinate, waking up during the night to urinate, a sudden urge to urinate, or inability to completely empty the bladder.

Patients who do particularly well with a TURP are those who have a certain type of blockage, where a part of the prostate protrudes into the bladder and blocks the flow of urine, according to Neel Parekh, M.D., a urologist with Cleveland Clinic in Cleveland, Ohio.

“Depending on the anatomy of their prostate, they tend to do pretty well after a TURP procedure,” Parekh said, adding that a TURP is also indicated for prostates that are larger than 80 grams. A normal prostate is 30–40 grams.

“A lot of the therapies out now are not approved or indicated for prostates that are larger than 80 grams, but a TURP procedure is effective in patients with larger prostates,” Parekh said.

Preparing for prostate surgery

On the day of your TURP, abstain from eating and drinking six hours prior to the procedure. Take any prescribed medications with a small sip of water.

You’ll likely be asked to check into the hospital the day before or the day of the procedure. Your urologist may ask you to stop taking blood thinners (medications that prevent blood clots), such as aspirin, before the surgery.

Types of prostate surgery

There are a host of minimally invasive surgical options for treating BPH, including:

  • Water vapor thermal therapy
  • Prostatic urethral lift
  • Laser therapy
  • Prostate artery embolization

TURP remains the "gold standard" for surgical management of BPH due to its effectiveness, according to Martin Kathrins, M.D., an assistant professor of surgery at Harvard Medical School and a urologist at Brigham and Women’s Hospital in Boston, Massachusetts. According to him, TURP is effective in 85–90% of patients.

“It’s the bar against which all other newer therapies are measured,” Kathrins said.

TURP makes use of a resectoscope, a thin metal device containing a light, camera, and loop of wire, which is inserted through the urethra. The loop of wire is heated with an electrical current so it can cut away excess tissue in the prostate.

There are two main types of TURP: the monopolar TURP (M-TURP) and the bipolar TURP (B-TURP).

The M-TURP is the conventional method and is not as widely used because of the greater risks associated with it, Parekh said. With the M-TURP, the electric current can leave the wire and damage the tissues surrounding the prostate. With the B-TURP, high-frequency energy is used to disintegrate the tissue in the prostate. An advantage of bipolar TURP is that all the energy stays inside the device.

The surgical procedure: what to expect

Patients are usually given antibiotics before TURP to help prevent urinary tract infections (UTIs). There are no incisions involved with TURP as it’s done transurethrally, meaning through the urethra in the penis. Anesthesia will be administered so you won’t feel anything.

“Essentially, we use a camera to go in through the urethra and snip away prostate tissue, and then that gets removed through the camera apparatus,” Kathrins said.

The surgery typically takes 1–2 hours, depending on how large the prostate is and how much needs to be removed.

Post-surgery recovery

You will typically need a catheter, a thin, flexible tube used to empty the bladder, for at least one day to drain the urine after the TURP.

On average, men will experience urinary symptoms for up to three months following the TURP, according to Kathrins.

“The recovery is mostly in the form of urinary symptoms that can get worse initially,” Kathrins said. “Men may have some pain or discomfort when they’re peeing. They may have some blood in the urine.”

Patients may also experience initial worsening of overactive bladder symptoms, such as leakage and frequent urination.

Medication and post-surgery care

According to Parekh, most patients don’t have too much pain when recovering from the TURP.

“Afterwards, they have some discomfort with the catheter,” he said. “But after the catheter is out the next morning, most guys do fine with Tylenol [acetaminophen] or ibuprofen and typically don’t require any narcotic pain medication.”

Possible complications and risks

The main risk with M-TURP is TURP syndrome, which happens when too much of the fluid used to wash around the prostate is absorbed into the bloodstream. This can cause abnormally low blood sodium (hyponatremia).

“That’s one of the reasons why it’s fallen out of favor, and it’s not commonly used,” Parekh said.

With B-TURP, risks include hypothermia (when the body loses heat faster than it can produce heat) because of the room-temperature fluid used in the procedure and bleeding.

Rare risks are injuring the bladder or the openings of the ureters in the bladder during the procedure.

In the weeks after the procedure, it’s common for patients to experience burning during urination and blood in the urine. Some men may develop urinary incontinence — the leaking of urine that you can’t control. These symptoms are typically temporary.

Life after prostate surgery

Following the TURP, it’s important to drink plenty of water to keep the urine dilute and help prevent blood clots from forming, Parekh said.

In the first few weeks after surgery, avoid any heavy lifting and straining, such as when having a bowel movement.

To illustrate what happens to the prostate after the TURP, Parekh gave the example of getting cut on the skin and forming a scab.

“After the TURP procedure, your body forms a scab on the prostate,” Parekh said. “And if you’re straining or anything like that, it can cause that scab to slough off, and that can cause significant bleeding. Or you might need a catheter replaced.”

Diet and lifestyle adjustments

While you’re healing, drinking lots of water will help flush out any blood in your urine and lower your chance of developing a UTI. In the days following the TURP, it’s best to avoid consuming caffeine or alcohol as these are bladder irritants.

Avoid strenuous activities, including sex, in the first few weeks following the TURP. Talk to your provider about when it is safe to resume such activities.

“You probably don’t want to get on a plane within at least a week of the surgery,” Kathrins said. “But beyond taking it easy, pain is generally well managed with over-the-counter medications and hydration, and the urinary symptoms can take a few months to settle down.”

Sexual function and prostate surgery

Most men who have a TURP will experience retrograde ejaculation, which is when semen goes into the bladder rather than outside of the body during ejaculation.

“It’s important to make this known to the man, and different men have different degrees of concern for that side effect,” Kathrins said.

A far less common sexual effect of TURP is erectile dysfunction, or the inability to achieve and maintain an erection firm enough for sexual activity.

For decades, TURP has been used safely and effectively to treat symptoms of an enlarged prostate. While several minimally invasive therapies for BPH have been developed in recent years, TURP remains a viable surgical option for many men. However, as with all surgeries, TURP is not without its risks and side effects. Talk to your doctor if you’re experiencing bothersome urinary symptoms due to BPH and think you may benefit from a TURP.

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