Transurethral Resection of the Prostate (TURP)

This card explains what transurethral resection of the prostate, or TURP, is, why it is generally done, and what the main health bodies say about recovery and risks. It is written for patients, families and students. Individual plans differ, and the treating urologist makes the final recommendation.

What it is

TURP is an operation to reduce the size of the prostate gland, which sits below the bladder and surrounds the urethra (the tube that carries urine out of the body). The NHS says the surgeon passes a long, thin tube with a camera and tools through the penis and up to the prostate, then removes small pieces of prostate tissue. Mayo Clinic names the instrument a resectoscope and says an electrical loop cuts away the extra tissue, without any cut in the skin.

It is one of several approaches to benign prostatic hyperplasia (BPH), a condition in which the prostate grows larger than normal for reasons other than cancer. The glossary explains related terms.

Why it is done

As the prostate enlarges it squeezes the urethra, and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists a weak or interrupted stream, trouble starting urination, urgency, frequency, getting up at night and incomplete emptying among the symptoms. The NHS says TURP can help people who need to urinate often, feel they have not finished, take a long time, or leak urine.

NIDDK says BPH can be managed by watchful waiting, medicines or surgery, and that surgery may be considered if medicines do not help, symptoms are severe or bothersome, or complications such as infections, bladder stones or blood in the urine develop. Mayo Clinic describes TURP as generally considered effective for moderate to serious urinary problems that have not improved with medicine, and adds that other procedures may cause fewer side effects and allow quicker recovery. One such option is HoLEP, and the bladder and prostate procedures page compares the options in this drawer.

How it is done, in outline

The NHS says TURP is done in hospital under either a general anesthetic or a spinal anesthetic, where the lower body is numb. The NHS gives around an hour, depending on how much tissue is removed. The resectoscope is passed through the urethra and trims tissue from inside the prostate one small piece at a time. Fluid carries the pieces into the bladder, and they are removed at the end of the operation.

A catheter is placed afterward to drain urine. The NHS says a small sample of tissue may be sent to a laboratory to check for things such as cancer.

Recovery

The NHS says most people leave hospital 1 to 4 days after TURP, while Mayo Clinic gives 1 to 2 days, so practice varies between centers. Mayo Clinic says the catheter often stays in at least 24 to 48 hours until swelling lessens and urine flows. Blood mixed with urine is common at first, and the NHS says blood may appear again 10 to 14 days later as part of healing. More on drains and removal is in urinary catheters after surgery.

The NHS says usual activities may resume after about 2 to 4 weeks, and that full healing can take up to 6 weeks. The NHS advises avoiding very heavy lifting and intense exercise for around 6 weeks, and Mayo Clinic gives 4 to 6 weeks for strenuous activity. Mayo Clinic also suggests drinking plenty of water and holding off on sex for 4 to 6 weeks. The NHS recommends starting pelvic floor exercises as soon as possible to help regain bladder control, and the pelvic floor muscle training card describes them. General healing guidance is in recovery and rehabilitation.

Risks

The NHS lists ongoing difficulty urinating, heavy bleeding, erectile difficulties, permanent loss of bladder control, the need for repeat TURP if the prostate regrows, and a lack of semen on ejaculation. Mayo Clinic describes this dry orgasm as a common, long-term and harmless effect of prostate surgery that can reduce fertility. It also lists urinary tract infection and a rare condition called TURP syndrome, caused by absorbing too much of the washing fluid.

NIDDK notes that scar tissue can narrow the urethra or the bladder opening, and that surgery relieves symptoms but may not cure BPH. It says about 10% of people who had surgery may need more surgery within 20 years.

The NHS advises an urgent GP appointment or NHS 111 if, after TURP, you have a high temperature or feel hot, cold or shivery, suddenly cannot urinate, bleed from the penis, pass blood that looks like small jelly-like blobs, or have a swollen or red penis. Mayo Clinic advises getting medical care right away for fever, chills or lightheadedness.

Questions to ask your clinician

• What are the alternatives to TURP for my symptoms, including medicines and other procedures?
• Is TURP suited to the size and shape of my prostate, and why or why not?
• Which type of anesthesia will be used, and how long should I expect to stay in hospital?
• How long will the catheter stay in, and who will remove it?
• How might the operation affect bladder control and sexual function in my case?
• Will tissue be sent for testing, and how will I hear the results?
• Which symptoms after discharge mean I should call right away?