The cause of enlarged prostate (benign prostate hyperplasia) isn’t completely understood, but 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 not cancerous.
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 most men in their seventies and eighties have some symptoms. If you have an enlarged prostate gland, it may obstruct the flow of urine from your bladder. You may find you have to urinate more often, or have a sudden urge to go. You may need to get out of bed several times to pass urine in the night. Some men have problems starting to pass urine, and then only have a poor stream. You may also have problems with dribbling after you’ve finished emptying your bladder.
There are medicines and other treatments for enlarged prostate. But if these don’t work, 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 are advantages and disadvantages of having a transurethral resection of the prostate (TURP). Think about how important each particular issue is to you. Your surgeon can help you to weigh up the pros and cons to make a decision that'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.
- The prostate tissue that’s removed can be sent to a laboratory to test for cancer cells.
- You’ll need to stay in hospital for a few days 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 10 men who have a TURP need another procedure within ten years.
- There’s a chance that you could develop a complication, such as incontinence, impotence or fertility problems after your TURP. See our section on risks for more information.
- It’s possible that your symptoms won’t improve after your TURP.
You’re likely to be invited to a pre-admission assessment appointment before the day of your transurethral resection of prostate (TURP) procedure. Your surgeon or specialist nurse will explain how to prepare for your procedure and assess your fitness for surgery. If you smoke, you’ll be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
If you take medicines such as clopidogrel or aspirin to prevent blood clots, you should discuss this with your surgeon before your procedure. You may bleed more after your procedure if you’re taking these, but you may be at risk of getting a blood clot if you stop. Ask your GP or your surgeon about the risks and benefits of either option.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your chance to ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to have it, you’ll be asked to sign a consent form.
The procedure may be carried out under general anaesthesia. This means you’ll be asleep while it goes on. Alternatively, you may have spinal anaesthesia. This completely blocks feeling from your waist down and you’ll stay awake during the procedure. You may be offered a sedative with a spinal anaesthetic if you’re feeling very anxious. This will help you to feel calmer and more relaxed. 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 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.
If your symptoms aren't bothering you too much, you may not need to have treatment straight away. Instead, your GP will probably want to monitor your condition with routine check-ups. This is sometimes called ‘watchful waiting’. You may also be offered medicines to help to treat your condition. 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.
Alternative types of treatment
If your symptoms don’t get any better, your GP may refer you to a surgeon to talk to you about your treatment options. Transurethral resection of the prostate (TURP) is only one type of procedure for an enlarged prostate gland. Alternative types of procedure include the following.
- Holmium laser enucleation (HoLEP). This uses a high-powered laser to remove part of your prostate. It’s suitable for men who have a very large prostate. It may not improve your symptoms as much as a TURP would, but you normally need less time in hospital. This procedure is only available at certain centres.
- Transurethral vaporisation of the prostate (TUVP). In this procedure, your doctor uses an electrical current to burn away parts of your prostate. It’s thought to be just as effective as TURP at improving your symptoms.
- Photoselective vaporisation (KTP). In this procedure, your doctor uses a high-energy laser to heat up parts of your prostate tissue. It’s sometimes called ‘Greenlight’ laser surgery.
- Transurethral incision of the prostate (TUIP). Instead of removing parts of your prostate, your surgeon will make small cuts inside the neck of your bladder and prostate to widen your urethra. It’s usually only suitable for men with only a moderately enlarged prostate.
- Open prostatectomy. This is usually only offered if you have a very large prostate. Your surgeon will make a cut in your abdomen (tummy) and remove the outer portion of your prostate.
Your transurethral resection of the prostate (TURP) procedure will probably take up 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’ll insert a thin tube with a telescopic camera on the end, called an endoscope, into your urethra. This gives your surgeon a good view of your prostate. They will then cut out and remove the middle of your enlarged prostate using an electrically heated wire loop. The bits of your prostate gland that are removed will be sent to the laboratory to check there are no cancer cells, just in case.
Your surgeon will insert a catheter (a thin flexible tube) into your urethra to allow urine, blood and any loose tissue to pass out of your bladder into a bag. For the first 12–24 hours, the catheter will also be used to flush a salt water fluid (saline) through your urethra and bladder. You’ll usually have the catheter removed after a couple of days.
Most people stay in hospital for two days after a transurethral resection of the prostate (TURP). After your procedure, you’ll 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 anaesthetic.
You might have some discomfort as the anaesthetic wears off, but you'll be offered pain relief as you need it. You may have a drip in your arm to stop you getting dehydrated. This will be removed once you’re drinking enough. You’ll be encouraged to get out of bed and move around as soon as possible.
You’ll 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, which helps to flush out any blood clots. The fluid draining into your catheter bag will be quite red at first as there’s usually some bleeding. The catheter will be removed when your urine begins to run clear. This is usually within two to four days. Some men find that they can’t pass urine after the catheter is removed. If so, you’ll have a new catheter put in. 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.
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 suggest you 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 increasing your fluid intake doesn’t clear this up, contact your GP.
Some men get a urinary infection after the 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. To help your recovery, your surgeon may recommend that you do pelvic floor exercises. Your doctor or nurse at the hospital will explain how to do these and how often. Please see our frequently asked questions for more information.
Don’t do any strenuous activity for about four weeks after your procedure. You can have sex as soon as you’re comfortable – this will probably be at least three to four 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.
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 you may get after having the procedure. Some specific side-effects of TURP include the following.
- Blood in your urine. This is an expected side-effect of the procedure and isn’t normally something to worry about. If it continues for longer than two weeks though, or suddenly gets a lot worse, contact 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. Talk to your GP if you are having trouble with this, and they’ll discuss with you the options available to manage incontinence.
Complications are when problems occur during or after your procedure. The possible complications of any procedure include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your 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’ll then pass the semen mixed with urine the next time you urinate. Retrograde ejaculation is permanent and can affect your future ability to have children. Talk to your surgeon before your operation if you’re concerned about this.
- Infection of the bladder, testicles or kidneys. Your surgeon may offer you antibiotics before your procedure to prevent infection.
- Not being able to get an erection (impotence). You may be less likely to be affected if you had normal erections before your procedure.
- TURP syndrome. This is a serious condition that can develop if the fluid used to flush your bladder during your procedure gets into your bloodstream. It can cause temporary changes in your blood pressure and you may feel confused or sick, and vomit. TURP syndrome is becoming less common as many centres now use a slightly different technique that’s less likely to cause TURP syndrome. See our frequently asked questions for more information about TURP syndrome.
- Urethral stricture. This is scarring of the inside of your urethra, making it narrower. This might slow down the flow of urine. You may be advised to have a further procedure to remove the scar tissue.
- Your prostate may obstruct your flow of urine again years later. If this happens, you may need to have a repeat procedure.
I've heard about laser treatment for an enlarged prostate – what is this?
Laser treatment can be used to break down and remove tissue from your prostate gland. Types of laser treatment include laser resection and photoselective vaporisation of the prostate.
These laser treatments, like the transurethral resection of the prostate (TURP) procedure, are performed through instruments that your surgeon passes along your urethra. This is the tube that carries urine from your bladder and out through your penis.
Laser resection includes a procedure called holmium laser enucleation of the prostate (HoLEP). Your surgeon uses a laser to cut away large pieces of the prostate tissue which was obstructing your flow of urine. The pieces of prostate tissue will then be sucked out of your bladder.
Photoselective vaporisation of the prostate (also known as KTP) uses a different type of laser that produces green light. This type of laser light is absorbed by tissue that has a good blood supply, which means 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 a further procedure after photoselective vaporisation of the prostate 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
What is TURP syndrome?
TURP syndrome is a serious complication that you can get as a result of having a TURP procedure. It can give you breathing problems, and make you feel sick and confused.
During TURP, special fluid is used to wash out your bladder. TURP syndrome occurs if some of this fluid is absorbed into your bloodstream. The fluid dilutes your blood and makes your heart work harder than it should for a while. This may give you difficulties breathing and make you feel confused and sick.
About two in 100 men who have the standard TURP procedure get TURP syndrome. Your surgeon and anaesthetist will take every precaution to prevent it developing, and monitor you closely to ensure that you’re well.
TURP syndrome is becoming less common, as various procedures to remove prostate tissue are now available that make it less likely that you’ll develop it. This is because they don’t use the same type of fluid as standard TURP.
Ask your surgeon for more information about TURP and TURP syndrome.
Why do I need to do pelvic floor exercises after TURP?
Pelvic floor exercises can help to improve control of your bladder when you get home after your procedure.
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 prevent you having problems getting and maintaining an erection after TURP. 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 anus (back passage) 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 – you need to practice short squeezes and long squeezes.
If your doctor thinks pelvic floor exercises would be beneficial for you, they will explain how to do these and how often. You’ll probably need to do the exercises at least three 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.
- The British Association of Urological Surgeons
020 7869 6950
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- The British Association of Urological Surgeons
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