Transurethral Resection of the Prostate (TURP)

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Definition

Transurethral resection of the prostate, or TURP, is the surgical removal of part of the prostate gland.

The prostate gland is part of a man's reproductive system. It makes and stores seminal fluid, a milky fluid that nourishes sperm and forms part of semen. The prostate is about the size of a walnut. It is located below the bladder and in front of the rectum.

Parts of the Body Involved

  • Prostate gland
  • Urethra
  • Penis
  • Bladder

Reasons for Procedure

TURP is done when a man has an enlarged, benign (non-cancerous) prostate, called benign prostatic hyperplasia (BPH) . In BPH, the prostate grows larger and presses against the urethra and bladder, interfering with the normal flow of urine.

TURP may also be performed when a man has a cancerous prostate, but the decision has been made that a complete prostate removal surgery is too risky. In this case, TURP is done to remove part of the prostate in order to relieve obstruction and improve some of the patient's symptoms.

Other reasons include:

Repeated urinary tract infections due to an enlarged prostate Recurrent bloody urineBladder stonesWeakened or damaged bladderInability to empty the bladder, leading to kidney damage Risk Factors for Complications During the ProcedureObesitySmokingMalnutritionRecent or chronic illnessAlcoholismDiabetesUse of some prescription and nonprescription drugs What to Expect Prior to Procedure Your doctor will likely do the following: Physical examReview of medications and supplements Blood tests including complete blood count, renal function, PSA (prostate-specific antigen)Urine tests including urine cultureUltrasound of kidney, bladder, prostate Urodynamics to assess degree of obstructionX-rays of kidneys and chest In the days leading up to your procedure: The night before, eat a light dinner, and do not eat or drink anything after midnight. During Procedure: You will receive IV fluids, anesthesia, and medications.A bladder catheter (tube) will be inserted to drain urine. Anesthesia TURP requires general or spinal anesthesia . Description of the ProcedureA specialized cystoscope (a thin, lighted tube used to examine the bladder) is inserted into the urethra via the penis and up into the bladder. The bladder is filled with a solution, so that the surgeon can better see its interior. The prostate gland is examined through the scope. The surgeon inserts a surgical loop through the cystoscope to remove the portion of the prostate that has become enlarged. A catheter is left in the bladder to allow for urine flow after the procedure, and may also be used to flush the bladder to remove accumulated blood clots.
Several new techniques are currently being used, including laser vaporization, transurethral needle ablation, and bipolar resection. These techniques may result in fewer complications in certain patients. Transurethral Resection of the Prostate (TURP) 2008 Nucleus Medical Art, Inc. After ProcedureRemoved tissue is sent to a lab and analyzed. How Long Will It Take?The procedure should take about one hour. Will It Hurt?For several days after the surgery, you may feel some pain. The catheter may also cause some discomfort. Possible ComplicationsTURP syndrome (occurs in about 2 percent of patients, usually within the first 24 hours); symptoms includeIncrease or decrease in blood pressureBradycardia (slow heart action) or abnormal heart rhythmTachypnea (increased rate of respiration)Nausea or vomitingBlurred visionConfusionAgitationComa and shock in serious case Other complications include:Urinary tract infection (most common)IncontinenceRetrograde ejaculation (expected after surgery and almost always occurs)Erectile dysfunctionThrombophlebitis (blood clots in the superficial veins) Excessive bleeding, which may require blood transfusion (2nd most common) Complications of anesthesiaNeed for recatheterizationNeed for reoperation Average Hospital StayAn overnight stay is typically planned for a TURP but in some cases, the stay can be as much as 2 to 5 days.
Postoperative CareThere will be a catheter in your bladder to drain urine which is typically left just overnight. The urine may be bloody, but do not be alarmed. This is normal. Water may be flushed through the catheter into your bladder to wash out blood and clots.Always keep the catheter drainage bag below the level of your bladder.Do breathing and coughing exercises regularly.Rest in bed until the next morning and perhaps longer. The nurse can assist you the first time you get out of bed.Clean the area where the catheter enters the urethra several times a day with soap, water, and a washcloth.Drink lots of fluids, especially during the day, to help flush your bladder.Avoid heavy lifting or exertion for three to four weeks.Avoid sexual activity for four to six weeks after surgery.Avoid consumption of alcohol, caffeine, and spicy foods that may over-stimulate the bladder. OutcomeRecovery from surgery should take about three weeks. Symptoms such as frequent or painful urination may continue for a while but should lessen during the first six weeks. If there is blood in your urine, lie down, relax, and drink a glass or two of fluid. The next time you urinate the bleeding should have stopped. If it doesn't, call your doctor.Although sexual activity should be avoided for four to six weeks after surgery, the TURP procedure should not affect your sex drive or ability to have sex. Retrograde ejaculation in which most of your sperm will flow into your bladder and be expelled when you urinate, is likely to occur. This should not, however, be considered a method of birth control. Some sperm may make it into ejaculation. If you are hoping to conceive children in the future, talk to your doctor about the possibility of developing retrograde ejaculation after the TURP.
Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the surgery siteCough, shortness of breath, chest pain, or severe nausea or vomitingPain, burning, urgency or frequency of urination, or persistent bleeding in the urineDifficulty or inability to urinateImpotence for longer than three months after surgery RESOURCES: American Cancer Societyhttp://www.cancer.org National Cancer Institutehttp://www.cancer.gov CANADIAN RESOURCE: The Prostate Centrehttp://www.prostatecentre.ca/ Men's Health Centrehttp://www.menshealthcentre.net References: Complete Guide to Symptoms, Illness & Surgery . Putnam Publishing Group; 2000. Leocdio DE, Frenkl TL, Stein BS. Office based transurethral needle ablation of the prostate with analgesia and local anesthesia. J Urol . 2007 Nov;178(5):2052-4; discussion 2054. Leslie SW. Transurethral resection of the prostate (October 3, 2006). Available at: http://www.emedicine.com . Lynch M, Anson K. Time to rebrand transurethral resection of the prostate? Curr Opin Urol . 2006;16:20-4.
Michielsen DP, Debacker T, De Boe V, Van Lersberghe C, Kaufman L, Braeckman JG, Amy JJ, Keuppens FI.. Bipolar transurethral resection in salinean alternative surgical treatment for bladder outlet obstruction? J Urol . 2007 Nov;178(5):2035-9; discussion 2039. Nakagawa T, Toguri AG. Early catheter removal following transurethral prostatectomy: a study of 431 patients. Med Princ Pract . 2006;15(2):126-30. National Cancer Institute website. Available at: http://www.cancer.gov . Tan A, Liao C, Mo Z, Cao Y. Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg . 2007 Oct;94(10):1201-8. Wendt-Nordahl G, Bucher B, Hacker A, Knoll T, Alken P, Michel MS. Improvement in mortality and morbidity in transurethral resection of the prostate over 17 years in a single center. J Endourol. 2007 Sep;21(9):1081-7. Last reviewed November 2007 by A. Carmack, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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