Transurethral Resection of the Prostate (TURP)

Also known as: Prostatectomy

Surgery overview
Transurethral resection of the prostate (TURP) is an operation used to relieve moderate to severe symptoms caused by an enlarged prostate gland. An instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow.

Your doctor may recommend TURP if symptoms caused by an enlarged prostate, also known as benign prostatic hyperplasia (BPH), have not improved in response to home treatment and medicines.

TURP is now the most common surgery used to remove part of an enlarged prostate. Open prostatectomies (in which an incision is made into the abdomen) generally are needed only when the prostate is very large.

What to expect
The hospital stay after TURP is commonly 1 to 2 days.

Following surgery, a catheter is used to remove blood or blood clots in the bladder that may result from the procedure. When the urine is free of significant bleeding or blood clots, the catheter can be removed and you can go home.

Strenuous activity, constipation, and sexual activity should be avoided for about 6 weeks. Symptoms such as frequent urination will continue for a while because of irritation and inflammation caused by the surgery. But they should ease during the first 6 weeks.

How well it works
For men who have moderate to severe symptoms of prostate enlargement, TURP is more effective than watchful waiting in relieving urinary symptoms.

Studies have found that:

  • Men who had TURP had a lower symptom score compared with those who used watchful waiting.
  • Symptoms get better for 7 to 10 out of 10 men who have the surgery.

On the average, men experience an 85% improvement in their American Urological Association (AUA) symptom index scores. For example, if you had a score of 25, after this surgery it might be reduced to about 4. Men who are very bothered by their symptoms are most likely to notice great improvement in their symptoms after TURP. Men who are not very bothered by their symptoms are less likely to notice a significant change.

Risks
The risks of transurethral resection of the prostate (TURP) include problems with sexual performance, incontinence, and problems from surgery.

Problems with sexual performance: 

  • Ejaculation into the bladder (retrograde ejaculation) is very common, occurring in about 25 to 99 men out of 100. This does not affect sexual function.
  • Erection problems may develop in men who did not have problems before the procedure. The risk of this may depend on how sexual performance is defined and measured, how sexually active the man was before the surgery, and how old he is. Many men in the age group who are likely to have BPH also have some problems with getting an erection. Subsequent erection problems are reported by about 3 to 35 men out of 100. Medicine can help some men achieve an erection after they have had TURP. 

Loss of ability to control urine flow (incontinence):  A small number of men (about 1%) say they are completely unable to hold back their urine after the surgery. Some men find that they can still hold in their urine after the surgery, but they tend to leak or dribble.

Problems related to having surgery

  • Need for additional surgery:  Occasionally, as the prostate heals it can cause the bladder neck to narrow again. The prostate will also continue to grow over time, which may cause re-narrowing of the urethra. About 2 or 3 men out of 100 need to have another operation after 3 years to relieve symptoms.
  • Bleeding during surgery:  About 5 out of 100 men have severe bleeding and need a blood transfusion.
  • TURP syndrome occurs in about 2 out of 100 men who have TURP. This syndrome occurs when the body absorbs too much of the fluid used to wash the area around the prostate during surgery. Advances in the TURP method have reduced the need. TURP syndrome is temporary (usually lasting only the first 6 hours after surgery) and is treated with medicine that removes excess water from the body (diuretic).
  • Repeat surgery because of a complication of the surgery is needed less than 10% of the time.

What to think about
Surgery usually is not required to treat BPH, although some men may choose it because their symptoms bother them so much. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to consider include your expectation of the results of the surgery, the severity of your symptoms, and the possibility of having complications from the surgery.

Men who have severe symptoms often have great improvement in quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life. Men with only mild symptoms may want to think carefully before deciding to have surgery to treat BPH.

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