A transurethral resection of the prostate (TURP) is a minimally-invasive or endoscopic surgical procedure that involves cutting away a section of the prostate. This improves the flow of urine from the bladder to the outside.
The prostate is a small gland in the pelvis only found in men. It's located between the penis and bladder, and surrounds the urethra (the tube that carries urine from the bladder to the penis).
If the prostate becomes enlarged, it can place pressure on the bladder and urethra. This can cause symptoms that affect urination.
Why TURP is carried out
TURP is often recommended when prostate enlargement (benign prostatic hyperplasia) causes troublesome symptoms and fails to respond to treatment with medication. It can also be indicated following an episode of acute urinary retention.
Symptoms that may improve after TURP include:
- problems starting to urinate (hesitancy)
- a weak urine flow or stopping and starting
- having to strain to pass urine
- a frequent need to urinate
- waking up frequently during the night to urinate (nocturia)
- a sudden urge to urinate
- being unable to empty your bladder fully
Benefits of Bipolar TURP
Bipolar TURP appears to be just as effective as traditional TURP at shrinking the prostate. A few studies have suggested at some advantages of this newer procedure, but there isn’t a lot of long-term evidence to prove that it’s any better than regular TURP.
One advantage of bipolar TURP is that all the energy stays inside the device. In regular (or monopolar) TURP, the electric current can leave the wire and damage tissues around the prostate.
Some studies have also that bipolar TURP reduces complications, such as bleeding during and after surgery. This may also lead to a shortening of the time men have to use a catheter (a tube to remove urine) after surgery. However, other studies have found no difference in complication rates.
One post-TURP problem bipolar TURP does appears to prevent is a rare but very serious condition called TUR syndrome. During regular (monopolar) TURP, the surgeon washes out the surgical area with a fluid to keep the area clean and clear. This fluid is low in sodium and there is a potential for if it to get into the bloodstream, dilute blood levels of sodium leading to low sodium levels in the body. Bipolar TURP uses a saltwater (saline) solution, which effectively reduces the risk of this dreaded complication called the TUR syndrome. The reduced risk of TUR syndrome allows surgeons to spend more time doing the procedure, which ideally means they can work on larger prostates or perform more complex surgeries with bipolar TURP.
Potential Risks and Complications
As with any surgical procedure there are risks and potential complications that are associated with Bipolar TURP. These include:
- Bleeding: Blood loss during Bipolar TURP is generally minimal. The risk of bleeding requiring a blood transfusion is ≤5%
- Infection: Also ≤5%. Broad-spectrum antibiotics are administered at the start of the operation to minimize the risk of a urinary infection.
- Retrograde ejaculation: 80%
- Erectile dysfunction: ≤5%.
Alternatives to Bipolar TURP
- Monopolar or Regular/Standard TURP
- Laser Prostatectomy
- Trans-urethral water vapourisation of the prostate (‘Rezum’) - See separate information
What to Expect After Surgery
During your hospitalisation
Following your surgery, you will be transferred to the recovery room and then to your hospital room once you are fully awake.
Following surgery, pain is typically minimal and controllable with oral analgesics which will be prescribed.
A bladder catheter is placed in the operating theatre while you are asleep and left in place for typically 1-2 days after the surgery. This allows your surgical team to continuously monitor your urine output. It is not uncommon to have blood-tinged urine for a several days after surgery. The catheter is usually removed prior to discharge.
Your diet will be advanced slowly from clear liquids to solid foods as tolerated once fully awake. In addition, intravenous fluids will be administered to keep your body well hydrated following surgery.
Fatigue is not uncommon and should start to subside in a few weeks following surgery.
On the evening of or latest morning after surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. During and after your hospital stay it is advised that you keep walking - The more walking you can tolerate the better.
The average length of hospital stay for most patients is approximately 2 days.