Causes of enlarged prostate
We don’t completely understand the cause of enlarged prostate (benign prostate hyperplasia or BPH). It happens because of an increase in the number of cells in your prostate gland. This is thought to be caused by hormonal changes as you get older. Benign means it is not cancer.
BPH is unusual in men under 45, but it becomes more common as you get older. By the age of 60, four in 10 men are affected and by 90, nine out of 10 men have an enlarged prostate.
When you have an enlarged prostate, you may have difficulties with holding in urine. So, you may find you have to urinate more often, and/or have a sudden urge to go. You may need to get out of bed several times to pass urine in the night.
You may also have problems with passing urine. This is because the enlarged prostate gland can obstruct the flow of urine from your bladder. Some men have trouble starting to pass urine, and then only have a weak stream. You may also have problems with dribbling after you’ve finished emptying your bladder. Sometimes the bladder doesn’t completely empty and you may feel that you have to strain to pass urine.
About enlarged prostate treatment
There are medicines and other treatments for enlarged prostate. But if these don’t work, stop working so well, or you don’t get on with them, your doctor may suggest that you have TURP treatment.
In a TURP, part of your prostate gland is removed (‘resected’). The term ‘transurethral’ describes the way your surgeon reaches your prostate. Instead of cutting through your skin they pass instruments through your urethra (the tube that carries urine from your bladder and out through your penis).
There may be options other than TURP that your doctor might recommend. See our information on Alternatives to TURP.
Deciding on TURP
Like any medical procedure, there are advantages and disadvantages of having a transurethral resection of the prostate (TURP). Think about how important each is to you. Your surgeon can help you to weigh up the pros and cons to decide what’s right for you.
- TURP can improve your flow of urine and reduce your symptoms. This may improve the quality of your life.
- The effects of the TURP procedure are long-lasting.
- Unlike some other treatments, the prostate tissue that’s removed can be sent to a laboratory to test for cancer cells.
- You’ll need to spend up to three nights in hospital after your TURP, and be off work for a few weeks while you recover.
- At some point you may need another procedure. One in every eight men who have a TURP need another procedure within eight years because the prostate grows back.
- There’s a chance that you could develop a complication after your TURP. See our section on What are the risks of TURP for more information.
- It’s possible that your symptoms won’t improve after your TURP.
Preparing for TURP
You’re likely to be invited to a pre-admission assessment appointment before the day of your transurethral resection of prostate (TURP) operation. Your surgeon or specialist nurse will explain how to prepare for your operation and assess your fitness for surgery. If you smoke, you’ll be asked to stop, as smoking increases your risk of getting a chest or bladder infection, which can slow your recovery.
Your surgeon or anaesthetist will ask you about all the medicines you take, including herbal medicines. If you take clopidogrel, warfarin or aspirin to prevent blood clots, you should discuss this with your surgeon before your operation. You may bleed more after your operation if you’re taking these, but you may be at risk of getting a blood clot if you stop. Ask your surgeon about the risks and benefits of either option.
Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. This is your chance to ask questions so that you understand what will happen. You don’t have to go ahead with the operation if you decide you don’t want it. Once you understand the operation and if you agree to have it, you’ll be asked to sign a consent form.
The operation may be carried out under a general anaesthetic. This means you’ll be asleep while it goes on. Alternatively, you may have a spinal anaesthetic. This completely blocks feeling from your waist down and you’ll be awake during the operation. Your surgeon or anaesthetist will discuss with you which type of anaesthesia is most suitable for you.
If you’re having a general anaesthetic, you’ll be asked not to eat or drink for up to six hours beforehand. This is for your own safety during surgery so 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 also have an injection of antibiotics to help prevent infections after surgery.
Alternatives to TURP
If your symptoms aren't bothering you too much, you may not need to have treatment straightaway. Instead, your GP will probably want to monitor your condition with routine check-ups. This is sometimes called ‘watchful waiting’. Your GP may give you some advice on simple lifestyle changes you can make to improve your symptoms. This may include cutting down on caffeine and alcohol, and reducing the amount of fluid you drink in the evening. Your GP may also check other medicines you are taking as some may make your symptoms worse. You may also be offered medicines to help to treat your condition.
Other types of treatment
If your symptoms don’t get any better, your GP may refer you to a surgeon to discuss your treatment options. Transurethral resection of the prostate (TURP) is only one type of procedure for an enlarged prostate gland. Other options include the following.
- Holmium laser enucleation (HoLEP) uses a high-powered laser to remove part of your prostate. It may be suggested if you have a very enlarged prostate. It’s thought to work as well as TURP. It’s only available at certain hospitals, but becoming increasingly common.
- Transurethral vaporisation of the prostate (TUVP) uses an electrical current to burn away parts of your prostate. It’s thought to be as good as TURP at improving symptoms.
- Photoselective vaporisation (PVP) uses a high-energy laser to destroy prostate tissue. It’s sometimes called ‘Greenlight’ laser surgery.
- Transurethral incision of the prostate (TUIP) may be suggested for a slightly enlarged prostate that is still causing symptoms. The surgeon makes small cuts in the neck of your bladder and prostate to widen the bladder opening.
- Open prostatectomy is usually only suggested for a very large prostate. Your surgeon removes part of the prostate through a cut in your abdomen (tummy), instead of going through the urethra.
- Urethral lift implant is a less invasive option that may be offered for a smaller prostate. This involves a surgeon inserting a small implant that pulls the tissue of the prostate away from the urethra, so that it’s not blocked. One device approved for this procedure is called UroLift.
Your surgeon will discuss with you which treatment is most suitable. This will depend on how troublesome your symptoms are, how healthy you are generally, and what is available at your hospital.
What happens during TURP?
Transurethral resection of the prostate (TURP) usually takes 45 minutes to an hour.
Your surgeon will reach your prostate gland through your urethra (the tube that carries urine from your bladder and out through your penis). They put in a thin tube with a telescopic camera on the end, called an endoscope. This gives your surgeon a good view of your prostate. They then cut out and remove the middle of the prostate using an electrically heated wire loop. The bits of your prostate gland that are removed will be checked for cancer cells, just in case.
Your surgeon will put a tube into your bladder (a catheter) to drain urine, blood and any loose tissue into a bag. For the first 12–18 hours, the catheter will also be used to flush a salt water fluid (saline) through your urethra and bladder. You usually have the catheter removed after a couple of days.
What to expect afterwards
You should expect to be in hospital for up to three nights when you have a transurethral resection of the prostate (TURP). After your procedure, you’ll need to rest until the effects of the anaesthetic have worn off. You may not be able to feel or move your legs for several hours after a spinal anaesthetic.
You might have some discomfort as the anaesthetic wears off, but you'll be offered pain relief if you need it. You will have a catheter in place to drain urine from your bladder into a bag. This may be a little uncomfortable at first. Until you are eating and drinking normally, you may have a drip in your arm to stop you getting dehydrated. You need to drink plenty to lower the risk of any blood clots blocking your catheter. Your nurses will encourage you to get out of bed and move around as soon as possible.
For the first day or so, you will have sterile fluid running through the catheter to wash out your bladder. This helps to flush out blood clots.
The fluid draining into your catheter bag will be pink or red at first as there’s usually some bleeding. The catheter will be removed when this begins to clear, usually within two to four days.
After your catheter is taken out, you may find your urine becomes bloodstained again for a while and passing urine can be a little painful. This will usually get better in a few days and is normally nothing to worry about.
Some men find that they can’t pass urine after their catheter is removed. If this happens, you’ll have a new catheter put in for around 48 hours. You may need to keep this catheter in for a while when you go home. If so, your nurse will show you how to look after it.
When you’re ready to leave hospital, you’ll need to arrange for someone to drive you home.
Recovering from TURP
If you need pain relief after your transurethral resection of the prostate (TURP), 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.
Your surgeon may ask you to drink more to flush out your bladder and help you to recover. You may find that you have some blood clots in your urine around 10 to 14 days after your procedure. These are scabs from your prostate healing and coming away. If drinking more doesn’t clear this up, contact your GP. You may be prescribed a course of antibiotics.
Some men get a urinary infection after a TURP procedure. If you have any stinging when you urinate, a high temperature or your urine goes cloudy and smelly, contact your GP surgery. Your GP or a nurse practitioner can test your urine for an infection and prescribe you antibiotics if you need them.
It can take between four and eight weeks to recover fully from TURP. Most people wait two or three weeks before going back to work, but always follow your surgeon’s advice. If your job is strenuous or involves heavy lifting, you may need to stay off work for longer.
To help your recovery, your surgeon may recommend that you do pelvic floor exercises. These may help you to control your urine flow and stop any leaking. Your doctor or nurse at the hospital will explain how to do them and how often.
Don’t do any strenuous activity for about four weeks after your procedure. You can have sex as soon as you’re comfortable, but should wait at least two weeks after your procedure. Ask your doctor when it’s OK to start driving again. 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. You should wait at least two weeks after your procedure.
Please see our FAQs below for more information about pelvic floor exercises and having sex after TURP.
What are the risks of TURP?
As with every procedure, there are some risks associated with transurethral resection of the prostate (TURP). But how these risks apply to you will be different to how they apply to others. Be sure to ask for more information if you have any concerns.
Side-effects are the unwanted but mostly temporary effects that you may have after the operation. Some specific side-effects of TURP include the following.
- Blood in your urine for up to two weeks is an expected side-effect of the procedure and isn’t normally something to worry about. If it continues for longer, or suddenly gets a lot worse, contact the hospital ward or your GP.
- An urgent need to pass urine, or going more often. Sometimes you also get a burning sensation when you pass urine.
- Incontinence (leaking urine). This usually improves with time but sometimes can be a long-term problem. Contact your GP if you are having trouble with this, and they’ll talk through the options available to manage incontinence.
Don’t be discouraged if you have problems with passing urine often or leaking after your TURP. This should gradually improve in the weeks following your operation. If you find you are leaking urine when coughing, laughing or sneezing, pelvic floor exercises may help.
Complications are when problems occur during or after your procedure. The possible complications of any surgery include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis or DVT). Specific complications of TURP include the following.
- Retrograde ejaculation happens in up to seven out of 10 men who have a TURP. This means semen passes into your bladder during an orgasm instead of out of your penis. It is permanent and can affect your ability to have children. Talk to your surgeon before your operation if you’re concerned about this.
- Urine infections. Your surgeon may give you antibiotics before your procedure to prevent infection.
- Narrowing of the tube from the bladder (urethral stricture) caused by scarring. This can happen in up to one in 10 men and can slow the flow of urine. You may need a small operation to remove the scar tissue.
- In up to one in eight men the prostate regrows and blocks urine flow again years later. If this happens, you may need to have a repeat procedure.
- Not being able to get an erection (impotence) happens in up to one in 10 men who had normal erections before their TURP. However, this is more likely to be connected to symptoms you had before the surgery, rather than actually caused by the TURP procedure.
- TURP syndrome is a rare but serious condition. It develops if the fluid used to flush your bladder during your procedure gets into your bloodstream. It can cause breathlessness, confusion or sickness. This can happen in up to two in 100 men, but it’s becoming much rarer as a different type of fluid is now normally used to flush your bladder.
FAQ: What is laser treatment for an enlarged prostate?
Using a laser is just another way of operating. In a conventional transurethral resection of the prostate (TURP), the surgeon cuts away the excess prostate tissue. With these treatments, the prostate tissue is either cut away with the laser or destroyed with heat. Types of laser treatment include:
- photoselective vaporisation (PVP)
- holmium laser enucleation (HoLEP)
Transurethral vaporisation of the prostate (TUVP) is similar but uses an electric current instead of a laser.
Like the TURP, these treatments use instruments that your surgeon passes along your urethra – the tube that carries urine from your bladder and out through your penis.
HoLEP uses a laser to cut away the prostate tissue that was obstructing your flow of urine. The pieces of removed tissue are then sucked out of your bladder.
PVP uses a different type of laser that produces green light. This type of laser is very good at sealing blood vessels quickly, so there is very little bleeding. The green laser light vaporises your prostate tissue without going too deeply into the surrounding tissue so causes fewer side-effects. It’s more likely that you’ll need to have treatment again some years later after PVP than after TURP.
Both of these procedures may offer advantages over the usual TURP procedure, including:
- reduced bleeding
- a shorter hospital stay
- shorter time needing a catheter
Laser treatment isn’t available at all hospitals. Your surgeon will advise whether it is available at your hospital and if it’s suitable for you.
There might also be other alternatives available, depending on your situation and where you’re treated. This could include a urethral lift implant. For this procedure, a device (the surgeon may use one called a UroLift) is used to insert a small implant into your body. This pulls the prostate away from blocking the urethra. This can have some of the same advantages as laser treatment mentioned above.
FAQ: Why should I do pelvic floor exercises after TURP?
Pelvic floor exercises may help to improve control of your bladder when you get home after your TURP.
Your pelvic floor is a layer of muscle that supports your bladder and bowel. It plays an important part in bladder and bowel control. Your surgeon may recommend that you do pelvic floor exercises after your TURP. They may even suggest you start these to strengthen the muscles before going into hospital for your procedure. Pelvic floor exercises may help with problems getting and maintaining an erection. They may also help to prevent or reduce incontinence after TURP.
You can exercise your pelvic floor muscles by tightening the ring of muscle around your back passage (anus) as if you're trying to control wind. At the same time, imagine you're passing urine and try to stop the flow mid-stream – then restart it. You may see your penis dip down slightly and feel your scrotum lift when you tighten your pelvic floor muscle. It can take time to get the technique right, so don’t be discouraged if you find it difficult at first.
If your doctor thinks pelvic floor exercises would be beneficial for you, they will explain how to do these and how often. You need to do the exercises at least four or five times a day, every day. Don’t give up even if you think they aren’t working – it can take a few months to see any changes.
At the same time as recommending these exercises, your doctor may also suggest other steps you could take. This might include cutting down on caffeine or taking certain tablets to stop your bladder from being over-active.
FAQ: Will having a TURP affect my sex life?
There are two ways in which a TURP can affect your sex life. The first is called ‘retograde ejaculation’. This means that semen goes backwards, into the bladder when you orgasm, instead of coming out of your penis. The semen then comes out when you pass urine. This is harmless, but it may make your urine a little cloudy the next time you go.
Retrograde ejaculation happens because the neck of the bladder has become wider during your TURP procedure. It affects as many as three out of every four men who have a TURP. If it does happen to you, it will be permanent.
If you have retrograde ejaculation, it may feel different when you orgasm because there is little or nothing coming out of your penis. Because the semen is going into the bladder, you may not be able to father a child through sex after TURP. But you should still use contraception if you don’t want to have a baby because there is still a possibility that your partner could become pregnant.
Some men find it more difficult to get an erection afterwards. However, this is most likely to be a result of the symptoms you experienced before having TURP, rather than the procedure. This can happen in around one in 10 men who had normal erections before their operation. Try not to dwell on this too much before your TURP. If it happens to one in 10 men, then it doesn’t happen to nine out of 10. In some men, erections can actually improve after TURP. If you do have trouble getting an erection afterwards, do talk to your surgeon or GP. There are medicines and other treatments that may help.
Generally, the advice is to wait for about two weeks after a TURP before having sex, but do follow your own surgeon’s advice.
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Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, November 2017 Expert reviewer, Dr Raj Persad, Consultant Urological Surgeon Next review due, November 2020
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