Transurethral resection of the prostate (TURP)

Published by Bupa’s Health Information Team, March 2011.

This factsheet is for men who are having a type of prostate surgery called transurethral resection of the prostate (TURP), or who would like information about it.

TURP is a common operation for men who have an enlarged prostate gland (benign prostatic hyperplasia).

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About TURP

If you have an enlarged prostate gland, you may find it difficult to pass urine, as your prostate gland can obstruct the flow of urine from your bladder. Your surgeon may suggest that you have a procedure known as TURP to remove a section of your prostate gland and reduce the pressure on your bladder.

What are the alternatives to TURP?

You will usually only be advised to have surgery if your symptoms haven’t improved after taking medicines. There are alternative types of surgery to TURP, including the following. The type you are advised to have will depend on the severity of your condition.

• Transurethral incision of the prostate – this is a similar operation to TURP, but involves making one or two small cuts in the neck of your bladder and prostate rather than removing part of the prostate. It is usually only suitable for men whose prostate is only moderately enlarged.
• Open prostatectomy – a cut will be made in your abdomen (tummy) and the outer portion of your prostate will be removed. This is usually only carried out in men who have a very large, benign (non-cancerous) prostate and is rarely done.
• Minimally invasive surgery (such as electrovaporisation and laser prostatectomy) – in these types of operation, laser or electrical energy will be used to burn off excess tissue.

Your surgeon will discuss which procedure is most suitable for you.
 

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the operation to go ahead, which you may be asked to do by signing a consent form.

The operation is usually done under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may have the surgery under spinal or epidural anaesthesia. This completely blocks feeling from the waist down and you will stay awake during the operation. You may be offered a sedative with a spinal anaesthetic – this relieves anxiety and helps you to relax.

Your surgeon or anaesthetist will advise which type of anaesthesia is most suitable for you.

If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s or surgeon’s advice.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What happens during TURP

The operation will take about an hour.

Your surgeon will insert a narrow, rigid, metallic, tube-like telescopic camera called an endoscope into your urethra. He or she will then cut out and remove the middle of your enlarged prostate using specially adapted surgical instruments that use heat energy to remove tissue.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will have a catheter to drain urine from your bladder into a bag. The catheter will also be used to wash out your bladder with a sterile solution. This will help to flush out any blood clots in your bladder. The catheter will be removed when your urine begins to run clear. This is usually within 24 to 48 hours. Occasionally, you may need to keep the catheter in for a while after you go home – if so, your nurse will show you how to look after it.

You may have a drip in your arm to prevent you getting dehydrated – this will be removed once you’re drinking enough fluids. You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs.

You may be able to go home after about one to three days. You will need to arrange for someone to drive you home. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon’s advice.

Recovering from TURP

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You may be advised to increase your fluid intake. This is to flush out your bladder and help you to recover.

It can take up to four weeks to recover fully from TURP. After two to three weeks you can resume your normal activities. Don’t do any strenuous activity for about four weeks after the operation. You can have sex as soon as you are comfortable – this will probably be at least three to four weeks after your operation.

What are the risks?

As with every procedure, there are some risks associated with TURP. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the operation.

Some specific side-effects of TURP include the following.

• Blood in your urine – this should clear up fully within about two weeks. If it continues for longer than this, see your GP.
• An urgent need to pass urine sometimes accompanied by a burning sensation when you do pass urine – this usually clears up after a few weeks.
• Incontinence (urine leakage) – talk to your GP if this happens, but it nearly always clears up with time.
• Impotence – this isn’t usually a problem and most men aren’t affected if they had normal erections before surgery.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Specific complications of TURP include the following.

• Retrograde ejaculation – this is where semen passes into your bladder during an orgasm instead of out of your penis. You will then pass the semen mixed with urine the next time you urinate. Although retrograde ejaculation is permanent and can affect your fertility, it isn’t usually a problem for most men.
• Infection. You may be given antibiotics before the operation to prevent infection.
• TURP syndrome. This is where the fluid used to flush your bladder during the operation is absorbed into your body. This can cause changes in your blood pressure and you may feel sick or vomit. However, this is becoming less common nowadays as surgeons can use a different type of fluid to flush your bladder, which is less likely to cause TURP syndrome.
• Your prostate may grow again and you may need to have another operation – you may also need another operation if too little was removed during the first operation. 
   

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.