Transurethral resection of the prostate(TURP)

Why would I need a TURP?

Transurethral resection of the prostate (TURP) is one treatment option for an enlarged prostate (benign prostate hyperplasia or BPH). This is a type of prostate problem in which your prostate gland gets bigger and obstructs the flow of urine from your bladder. It can lead to difficulties with passing urine. 

In a TURP, part of your prostate gland is removed (‘resected’) to try and improve the flow of urine. The term ‘transurethral’ describes the way your surgeon reaches your prostate. Instead of cutting through your skin they pass instruments through your urethra (the tube that carries urine from your bladder and out through your penis).

Your doctor will suggest other measures for controlling your symptoms first, such as lifestyle changes, bladder and pelvic muscle training, and medicines. If you’ve tried these and your symptoms aren’t getting any better, your doctor may refer you to a specialist in urinary tract problems. They can assess whether TURP or other treatments might be suitable for you.

Deciding on TURP

Like any medical procedure, there are advantages and disadvantages of having a transurethral resection of the prostate (TURP) that you’ll need to consider.

For many men, TURP is very effective at improving the flow of urine and reducing symptoms. These effects are usually long-lasting and may improve your quality of life. However, some men find their symptoms don’t completely go away after TURP.

It’s also possible that you may need a repeat procedure if your prostate grows back.

You should also be aware of the risk of complications, such as retrograde ejaculation – see the complications section below for more information. If you go ahead with the procedure, you’ll need to prepare yourself for a short hospital stay and a recovery period of a few weeks.

When you meet the specialist, they’ll go through exactly what will happen during a TURP procedure, what to expect afterwards and the potential risks and benefits. Do ask if you have any questions, or need any more explanation about the procedure. You’ll be asked to sign a consent form before the procedure so it’s important to make sure you feel properly informed. 

Alternatives to TURP

Transurethral resection of the prostate (TURP) is only one type of procedure for an enlarged prostate gland. Other options include the following.

• Holmium laser enucleation of the prostate (HoLEP). This uses a high-powered laser to remove part of your prostate. 
• Transurethral vaporisation of the prostate (TUVP). This involves use of an electrical current to burn away parts of your prostate.
• Photoselective vaporisation (PVP). This technique uses a particular type of laser, which destroys prostate tissue without leaving any fragments behind. It’s sometimes called ‘Greenlight’ laser surgery.
• Transurethral incision of the prostate (TUIP). This involves your surgeon making small cuts in the neck of your bladder and prostate to widen the bladder opening. It may be an option if your prostate is only slightly enlarged.
• Open prostatectomy. This is surgery to remove part of your prostate through a cut in your abdomen (tummy), instead of going through the urethra. As a more invasive surgery, it’s usually only suggested for a very large prostate.
• Urethral lift implant. This is a less invasive option that may be offered for a smaller prostate. It involves a surgeon inserting a small implant to pull the tissue of the prostate away from the urethra, opening it up. One device approved for this procedure is called UroLift.
• Prostate artery embolisation. This is a procedure to block the blood supply to your prostate gland, causing some of the tissue to die and shrinking your prostate. It’s a less invasive option that might be suitable for some men.
• Rezum steam treatment. This involves using stream treatment to destroy part of your prostate. The steam is delivered to your prostate using an instrument inserted through your urethra. 

Your surgeon will talk to you about which treatment is most suitable for you. This will depend on several factors, including how severe your symptoms are, how big your prostate is, whether you have any other health problems and what’s available at your local hospital.

Preparing for TURP

Your surgeon or nurse will assess you before your operation to check whether you’re fit for surgery. This may be at a preoperative assessment clinic. They’ll also explain how to prepare for your operation. For example, if you smoke, you’ll be asked to stop, as smoking increases your risk of infections and other complications after surgery. They’ll ask you for details of any medicines you take, and advise you if you need to stop any of these before the operation. 

TURP is usually carried out under a general anaesthetic, which means you’ll be asleep during the procedure. Sometimes, you may have a spinal anaesthetic instead. This means you’ll be awake, but will be unable to feel anything from your waist down. Your surgeon or anaesthetist will discuss with you which type of anaesthesia is most suitable for you.

If you’re having a general anaesthetic, you’ll be given clear instructions about when to stop eating and drinking. It’s important that you follow these instructions.

On the day of your operation, your surgeon will meet with you to check you’re well and still happy to go ahead. You may be asked to wear compression stockings, and given an injection of an anticlotting medicine called heparin. This helps to prevent blood clots forming in the veins in your legs. You may also have an injection of antibiotics to help prevent infections after surgery.

What happens during TURP?

Transurethral resection of the prostate (TURP) usually takes around 45 minutes to an hour.

Once the anaesthetic has taken effect, your surgeon will feed a thin telescopic tube up through your urethra (the tube in your penis that carries urine out of your body), into your bladder. This gives your surgeon a good view of your prostate. They then insert an electrically heated wire loop, and use it to cut out small pieces from the middle of your prostate.Your surgeon uses suction to remove the pieces of prostate from your bladder. These can be sent to a laboratory for testing if needed.

At the end of the procedure, your surgeon will put a tube (catheter) into your bladder and use a salt water fluid (saline) to flush through any clots, blood and loose tissue. 

What to expect afterwards

You might need to stay in hospital for up to three nights after you’ve had a transurethral resection of the prostate (TURP). You’ll need to rest until the effects of the anaesthetic have worn off. You might have some discomfort as the anaesthetic wears off, but you'll be offered pain relief if you need it.

Your catheter will need to stay in place for up to four days. It will drain urine from your bladder into a bag. For the first day or so, you’ll have sterile fluid running through the catheter to wash out your bladder and help flush out blood clots. When your catheter is removed, your nurse will check whether you’re able to pass urine normally. Not all men can straightaway. If you have any problems, you’ll have a new catheter put in for a couple more days.

After your catheter is taken out, you may find you have blood in your urine for a while and it might hurt or burn when you pee. You might need to pee more often too. These symptoms can come and go while you recover, but it will usually get better in a few days and is normally nothing to worry about.

When you’re ready to leave hospital, you’ll need to arrange for someone to drive you home. Before you leave, your doctor or nurse will give you some advice about your recovery and information about follow-up appointments. 

Recovering from TURP

It can take several weeks to fully recover from TURP. Normally, any side-effects will settle down by around six weeks. You should be prescribed any medication you need – including painkillers from the hospital to take home with you. You can also take over-the-counter painkillers, such as paracetamol or ibuprofen if you need them.

You may be given instructions to drink more than normal for a day or two. This will help to flush out your bladder and reduce the risk of infection. You may find that you have some blood clots in your urine around 10 to 14 days after your procedure. These are scabs from your prostate healing and coming away. If drinking more doesn’t clear this up, contact your doctor. 

You’ll usually be advised to do pelvic floor exercises when you get home, to improve your bladder control. Your doctor or nurse at the hospital will explain how to do them and how often. For more information, see our FAQ: Why should I do pelvic floor exercises after TURP?

Most people wait two or three weeks before going back to work, but always follow your surgeon’s advice. If your job is strenuous or involves heavy lifting, you may need to stay off work for longer. It’s best to wait at least two weeks before having sex.  

Complications

Complications are problems that can happen during or after your procedure. The possible complications of any surgery include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis or DVT). Specific complications of TURP include the following.

• Retrograde ejaculation. This means you have little, or no semen when you ejaculate, as it passes into your bladder instead of out of your penis. It happens in up to seven out of 10 men who have a TURP. For more information, see our FAQ: Will having a TURP affect my sex life?
• Urine infections. It’s common to have some pain when you pee at first after a TURP. But if this becomes severe, you have a high temperature or your pee is cloudy and smelly, contact your doctor surgery. It could be a sign of an infection, and you may need antibiotics to clear it up. 
• Narrowing of the tube from the bladder (urethral stricture) caused by scarring. This can happen in up to one in 10 men and can slow the flow of urine.
• Regrowth of the prostate. In up to one in eight men the prostate regrows and blocks urine flow again years later. If this happens, you may need to have a repeat procedure.
• Incontinence (leaking urine). This usually improves with time but sometimes can be a long-term problem. If you’re having trouble with this, contact your doctor and they can talk through the options available to manage it.
• Erectile dysfunction. This can happen in up to one in 10 men who had normal erections before their TURP. It’s more likely that you had problems with erections related to your symptoms before your operation, and this may continue after TURP.