Introduction
Transurethral resection of the prostate (TURP) is a procedure primarily used to treat bladder outlet obstruction secondary to benign prostatic hyperplasia. In this procedure, the obstructing part of the prostate called the transition zone is resected to enlarge the channel through which urine can flow, making it easier for the patient to urinate.
Indications
A TURP is indicated in the following conditions:
- Bladder outlet obstruction secondary to benign prostatic hyperplasia that has failed medical therapy.
- Acute urinary retention.
- Failed trial of void.
- Haematuria likely to be coming from the prostate that is refractory to medical therapy.
- Recurrent urinary tract infections associated with chronic retention of urine.
Preoperative Instructions
A urine test will be performed to ensure the patient does not have an active urinary tract infection, as this will require treatment prior to the procedure. An ultrasound may be performed so that the urologist can gain an understanding of the size of the prostate which can impact upon the operative time and risks associated with the procedure. Certain medications that promote bleeding such as warfarin, clopidogrel, rivaroxaban and apixaban will need to be stopped for certain period prior to the procedure to reduce the risk of significant bleeding. This procedure can still be performed if the patient is taking aspirin.
Procedure
Initially a cystoscopy is performed to assess the lower urinary tract and to understand the configuration of the prostate. A resectoscope is then placed which is the instrument that is used to resect the prostate tissue. Once the tissue has been resected and removed, any bleeding is controlled and a catheter is placed in the bladder. This catheter allows for irrigating fluid to run into the bladder to wash out any clots and further reduce the risk of bleeding.
Postoperative Instructions
The patient will awaken with a catheter in and irrigating solution running into the bladder. Irrigation of the bladder usually stops in the first 24 hours and the catheter is removed in 48 hours. At this point the patient undergoes a trial of void where they are observed to ensure they can empty their bladder appropriately. The patient is then discharged home with a review in approximately 8 weeks. During this time the patient may notice urinary frequency, urgency, dysuria and may also notice some blood in the urine. These symptoms all gradually settle down in the first few months, but some of these symptoms can persist for up to a year. Medications can be used to manage these symptoms whilst the patient waits for them to resolve.
Risks
Some of the risks associated with a TURP are:
- Bleeding.
- Infection.
- Retrograde ejaculation.
- Urethral stricture.
- Bladder injury.
- TUR syndrome – an abnormality of salt level in the blood.
Treatment Alternatives
TURP is usually employed after a patient does not achieve the desired results with medications. Alternative surgical treatment alternatives may include UroLift and GreenLight Laser PVP of the Prostate.
Related Information
Benign Prostatic Hyperplasia
UroLift
GreenLight Laser PVP of the Prostate