Transurethral Resection of Prostate (TURP)

Transurethral Resection of Prostate (TURP)

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Transurethral resection of the prostate (TURP) is the endoscopic removal of benign prostate enlargement (BPH). A resectoscope (a loop instrument) is passed through the urethra to scrape away the enlarged prostate gland piece by piece to re-establish a channel and clear the bladder obstruction.

The operation takes up to 1 hour and done under general or spinal anaesthesia. A catheter is inserted post- surgery for continuous irrigation to prevent blood clots forming in the bladder. As this can potentially be a very bloody operation, any blood-thinning medication, such as aspirin or plavix must be stopped 5 days beforehand. Hospital stay is 3 to 4 days. For the laser method, the hospitalization period is shorter.

Complications include:

  • bloody urine. This can be severe enough to cause clot retention. If so, manual bladder washouts are needed. Blood in the urine can last up to 3 weeks because it can take that long for the prostate bed to heal. In this respect, blood-thinning drugs are not resumed until the urine is clear.
  • frequent urination. The frequent urge to pass urine may persist for up to 3 months. In one-third of patients, this may not resolve and is due to pre-existent bladder instability (overactive bladder). They may then need medication to "stabilise" the bladder.
  • dry ejaculation. This is due to the backward passage of sperm during sexual intercourse. It is inevitable because the bladder neck is cut during the surgery and the semen preferentially goes into the bladder. The semen will be passed out with the urine and poses no harm.
  • re-bleeding. This occurs in 3% of patients and occurs between the 7th to 10th day after surgery. It is due to urine infection or re-opening of a blood vessel. If the bleeding is heavy, clot retention can occur. Re-hospitalisation is then needed for evacuation of these blood clots. One may be also be brought back to the operating theatre to seal the bleeding.