Trans Urethral Resection of Prostate (TURP): Indications and Risks

Prostate is a glad present below the base of the urinary bladder in all males. With aging some men experience an enlargement of prostate that can lead to urinary symptoms like

• Difficulty in beginning urination
• Weak stream of urine
• Dribbling at the end of urination
• Increased frequency of urination, especially at night
• Difficulty in completely emptying the bladder
• Urinary tract infection

Trans urethral resection of prostate (TURP) is a technique that helps in providing relief from these symptoms.

Procedure

Your urologist will be performing this procedure on an out patient basis. You will be given general anesthesia, to help you stay relaxed and numb the pain during the procedure; and antibiotics to prevent infection prophylactic ally. After the effects of anesthesia have kicked in the urologist will insert a thin tube like instrument, containing a light source, a camera and a wire loop; called a resectoscope into your urethra until it reaches the narrowing caused by the prostate. This instrument contains a wire loop, which has been charged with an electric current to remove the prostate tissue. Small pieces of tissue are progressively removed until the urethra is adequately patent. The pieces of tissue are directed to the bladder with the help of irrigation fluid. They are removed at the end of the procedure.

Indications for TURP

A TURP is suggested for individuals with non cancerous enlargement of prostate with moderate to severe symptoms like:

• Difficulty in beginning urination
• Weak stream of urine
• Dribbling at the end of urination
• Increased frequency of urination, especially at night
• Difficulty in completely emptying the bladder
• Urinary tract infection

Preparation

In preparation for the surgery your doctor might want to know about all the medicines that you’ve been taking and might ask you to stop taking some of them like blood thinners and over the counter pain relief medication to reduce the risk of excessive bleeding. Your doctor would like to know if you have any clotting disorder or have a family history of the same. You are requested to inform your doctor about allergies to anesthetic agents that you might have. It is advisable to arrange for someone to drive you home because you won’t be able to drive home with a catheter in place in your bladder.

Risks of TURP

The complications associated with TURP are:

• Loss of bladder control (incontinence) is a long term complication of TURP
• Retrograde ejaculation: a long term effect of most surgeries on prostate, it leads to release of semen into the bladder during ejaculation leading to a dry orgasm. This doesn’t interfere with the pleasure of the act.
• Erectile dysfunction: rare complication
• Temporary difficulty in urination after the surgery
• Urinary tract infection: it is a complication following any form of surgery on the prostate; the risk increases as the length of time for which the catheter has been in place increases.
• Bleeding during the procedure which might require blood transfusion

Recovery

You may be allowed to go home a day or two after the surgery. A catheter is placed inside your bladder through your urethra to allow you to urinate, as the urethra is swollen after the surgery and may block urination. The catheter is generally kept in place for 24-48 hours. Your doctor will advise you to:

• Drink plenty of water
• Eat food rich in fibres to prevent constipation to avoid straining
• Avoid sex for four to six weeks
• Avoid driving until the catheter is in place

You may also see a pinkish discoloration of your urine after the surgery; this will resolve itself in about a day or two. This can also be accompanied by painful urination which resolves in four to six weeks.

If you experience any of the following symptoms you are requested to contact your doctor immediately:

• Thick, red coloured blood in urine
• Inability to urinate
• Fever

Resources:

• https://www.nhs.uk
• National Institute of Diabetes and Digestive and Kidney Diseases
• American Urological Association
• Premature Ejaculation Treatment Options