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Transurethral resection of the prostate (TURP)


Expert reviewer, Dr Raj Persad, Consultant Urological Surgeon
Next review due March 2023

Transurethral resection of the prostate (TURP) is a surgical procedure for men that involves removing part of the prostate gland. It’s used to treat a common condition where the prostate becomes enlarged, causing difficulty with passing urine. This is known as benign prostatic hyperplasia (BPH).

An image showing the position of the prostate gland and surrounding structures

Why would I need a TURP?

Transurethral resection of the prostate (TURP) is one treatment option for an enlarged prostate (benign prostate hyperplasia or BPH). This is a type of prostate problem in which your prostate gland gets bigger and obstructs the flow of urine from your bladder. It can lead to difficulties with passing urine.

In a TURP, part of your prostate gland is removed (‘resected’) to try and improve the flow of urine. 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).

Your GP will suggest other measures for controlling your symptoms first, such as lifestyle changes, bladder and pelvic muscle training, and medicines. If you’ve tried these and your symptoms aren’t getting any better, your GP may refer you to a specialist in urinary tract problems. They can assess whether TURP or other treatments might be suitable for you.

Deciding on TURP

Like any medical procedure, there are advantages and disadvantages of having a transurethral resection of the prostate (TURP) that you’ll need to consider.

For many men, TURP is very effective at improving the flow of urine and reducing symptoms. These effects are usually long-lasting and may improve your quality of life. However, some men find their symptoms don’t completely go away after TURP. It’s also possible that you may need a repeat procedure if your prostate grows back.

You should also be aware of the risk of complications, such as retrograde ejaculation – see the complications section below for more information. If you go ahead with the procedure, you’ll need to prepare yourself for a short hospital stay and a recovery period of a few weeks.

When you meet the specialist, they’ll go through exactly what will happen during a TURP procedure, what to expect afterwards and the potential risks and benefits. Do ask if you have any questions, or need any more explanation about the procedure. You’ll be asked to sign a consent form before the procedure so it’s important to make sure you feel properly informed.

Alternatives to TURP

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 of the prostate (HoLEP). This uses a high-powered laser to remove part of your prostate.
  • Transurethral vaporisation of the prostate (TUVP). This involves use of an electrical current to burn away parts of your prostate.
  • Photoselective vaporisation (PVP). This technique uses a particular type of laser, which destroys prostate tissue without leaving any fragments behind. It’s sometimes called ‘Greenlight’ laser surgery.
  • Transurethral incision of the prostate (TUIP). This involves your surgeon making small cuts in the neck of your bladder and prostate to widen the bladder opening. It may be an option if your prostate is only slightly enlarged.
  • Open prostatectomy. This is surgery to remove part of your prostate through a cut in your abdomen (tummy), instead of going through the urethra. As a more invasive surgery, it’s usually only suggested for a very large prostate.
  • Urethral lift implant. This is a less invasive option that may be offered for a smaller prostate. It involves a surgeon inserting a small implant to pull the tissue of the prostate away from the urethra, opening it up. One device approved for this procedure is called UroLift.
  • Prostate artery embolisation. This is a procedure to block the blood supply to your prostate gland, causing some of the tissue to die and shrinking your prostate. It’s a less invasive option that might be suitable for some men.
  • Rezum steam treatment. This involves using stream treatment to destroy part of your prostate. The steam is delivered to your prostate using an instrument inserted through your urethra.

Your surgeon will talk to you about which treatment is most suitable for you. This will depend on several factors, including how severe your symptoms are, how big your prostate is, whether you have any other health problems and what’s available at your local hospital.

Preparing for TURP

Your surgeon or nurse will assess you before your operation to check whether you’re fit for surgery. This may be at a preoperative assessment clinic. They’ll also explain how to prepare for your operation. For example, if you smoke, you’ll be asked to stop, as smoking increases your risk of infections and other complications after surgery. They’ll ask you for details of any medicines you take, and advise you if you need to stop any of these before the operation.

TURP is usually carried out under a general anaesthetic, which means you’ll be asleep during the procedure. Sometimes, you may have a spinal anaesthetic instead. This means you’ll be awake, but will be unable to feel anything from your waist down. 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 given clear instructions about when to stop eating and drinking. It’s important that you follow these instructions.

On the day of your operation, your surgeon will meet with you to check you’re well and still happy to go ahead. You may be asked to wear compression stockings, and given an injection of an anticlotting medicine called heparin. This helps to prevent blood clots forming in the veins in your legs. You may also have an injection of antibiotics to help prevent infections after surgery.

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What happens during TURP?

Transurethral resection of the prostate (TURP) usually takes around 45 minutes to an hour.

Once the anaesthetic has taken effect, your surgeon will feed a thin telescopic tube up through your urethra (the tube in your penis that carries urine out of your body), into your bladder. This gives your surgeon a good view of your prostate. They then insert an electrically heated wire loop, and use it to cut out small pieces from the middle of your prostate. Your surgeon uses suction to remove the pieces of prostate from your bladder. These can be sent to a laboratory for testing if needed.

At the end of the procedure, your surgeon will put a tube (catheter) into your bladder and use a salt water fluid (saline) to flush through any clots, blood and loose tissue.

What to expect afterwards

You might need to stay in hospital for up to three nights after you’ve had a transurethral resection of the prostate (TURP). You’ll need to rest until the effects of the anaesthetic have worn off. You might have some discomfort as the anaesthetic wears off, but you'll be offered pain relief if you need it.

Your catheter will need to stay in place for up to four days. It will drain urine from your bladder into a bag. For the first day or so, you’ll have sterile fluid running through the catheter to wash out your bladder and help flush out blood clots. When your catheter is removed, your nurse will check whether you’re able to pass urine normally. Not all men can straightaway. If you have any problems, you’ll have a new catheter put in for a couple more days.

After your catheter is taken out, you may find you have blood in your urine for a while and it might hurt or burn when you pee. You might need to pee more often too. These symptoms can come and go while you recover, but it will usually get better in a few days and is normally nothing to worry about.

When you’re ready to leave hospital, you’ll need to arrange for someone to drive you home. Before you leave, your doctor or nurse will give you some advice about your recovery and information about follow-up appointments.

Recovering from TURP

It can take several weeks to fully recover from TURP. Normally, any side-effects will settle down by around six weeks. You should be prescribed any medication you need – including painkillers from the hospital to take home with you. You can also take over-the-counter painkillers, such as paracetamol or ibuprofen if you need them.

You may be given instructions to drink more than normal for a day or two. This will help to flush out your bladder and reduce the risk of infection. 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’ll usually be advised to do pelvic floor exercises when you get home, to improve your bladder control. Your doctor or nurse at the hospital will explain how to do them and how often. For more information, see our FAQ: Why should I do pelvic floor exercises after 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. It’s best to wait at least two weeks before having sex.

Complications

Complications are problems that can happen 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. This means you have little, or no semen when you ejaculate, as it passes into your bladder instead of out of your penis. It happens in up to seven out of 10 men who have a TURP. For more information, see our FAQ: Will having a TURP affect my sex life?
  • Urine infections. It’s common to have some pain when you pee at first after a TURP. But if this becomes severe, you have a high temperature or your pee is cloudy and smelly, contact your GP surgery. It could be a sign of an infection, and you may need antibiotics to clear it up.
  • 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.
  • Regrowth of the prostate. 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.
  • Incontinence (leaking urine). This usually improves with time but sometimes can be a long-term problem. If you’re having trouble with this, contact your GP and they can talk through the options available to manage it.
  • Erectile dysfunction. This can happen in up to one in 10 men who had normal erections before their TURP. It’s more likely that you had problems with erections related to your symptoms before your operation, and this may continue after TURP.

Frequently asked questions

  • Using laser is another way of cutting away or destroying excess prostate tissue. Like 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.

    Types of laser treatment for enlarged prostate include:

    • photoselective vaporisation (PVP) – this uses a type of ‘greenlight’ laser that vaporises your prostate tissue without going too deeply into the surrounding tissue
    • holmium laser enucleation (HoLEP) – this uses a high-powered laser to cut away excess prostate tissue

    Both of these procedures may offer advantages over the usual TURP procedure, including:

    • reduced bleeding
    • a shorter hospital stay
    • shorter time needing a catheter

    However, they can still be associated with certain complications, such as retrograde ejaculation (although this tends to be less common after PVP). You’re also more likely to need a repeat procedure with PVP, compared to TURP. 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.

  • Pelvic floor exercises may help to improve control of your bladder when you get home after your TURP. It’s thought that they may help if you have problems getting and maintaining an erection too.

    Your pelvic floor is a layer of muscle that supports your bladder and bowel. You can contract 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 helpful, they’ll explain how to do these and how often. Don’t give up even if you think they aren’t working – it can take a few months to see any changes.

  • Having a TURP doesn’t usually affect your sex drive (libido) or your ability to enjoy sex. But it does often cause something called retrograde ejaculation – or ‘dry orgasm’. This means that you don’t ejaculate when you orgasm. Instead, the semen goes backwards, into your bladder and comes out when you pee. This is harmless, but it may make your urine a little cloudy the next time you go. It may also mean that you’ll be unable to father a child. You should still use contraception if you don’t want a baby though, just in case.

    There’s also a possibility that you might find it more difficult to get an erection after a TURP. Up to one in 10 men who have normal erections before their operation may experience difficulties afterwards. However, this might be down to age, or the psychological impact of having the operation, rather than the surgery itself. More often than not, any problems you may have getting an erection are likely to have started before the procedure, and are linked to the symptoms you had. In some men, erections can actually improve after TURP. If you do have trouble getting an erection, 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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Related information

    • Transurethral resection of the prostate. Medscape. emedicine.medscape.com, updated 27 November 2016
    • Transurethral prostatectomy (TURP) for benign disease. British Association or Urological Surgeons, April 2017. www.baus.org.uk
    • Benign prostatic hyperplasia (BPH). MSD Manual. www.msdmanuals.com, last full review/revision October 2019
    • LUTS in men. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2019
    • Lower urinary tract symptoms in men: management. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated June 2015
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    • Personal communication, Raj Persad, Consultant Urological Surgeon, 10 March 2020
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    • Pelvic floor exercises in men. British Association of Urological Surgeons, June 2017. www.baus.org.uk
    • Lavoisier P, Roy P, Dantony E, et al. Pelvic-floor muscle rehabilitation in erectile dysfunction and premature ejaculation. Phys Ther 2014; 94(12):1731–43. doi: 10.2522/ptj.20130354
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  • Reviewed by Pippa Coulter, Freelance Health Editor, March 2020
    Expert reviewer, Dr Raj Persad, Consultant Urological Surgeon
    Next review due March 2023

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