TURP - Trans Urethral Resection for Benign Prostatic Hypertrophy
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Really, the surgical treatments for benign prostatic enlargement can be divided into treatments that channel through the prostate, and treatments that lead to some sort of cell death in the prostate, usually by heat, and subsequently the cells die, and the prostate pulls back, and you have a clear channel to pass urine.
The classic treatment is the standard Trans Urethral Resection of the Prostate (TURP).
What happens with that is we put a telescope through the eye of the penis; we cut away little chips of the prostate until you have a clear channel.1
You can think of it like an apple, and us taking the apple core a little bit more out.
During this procedure we use glycine, a particular type of fluid.
We can’t use saline, the same thing we put in our drip, because it conducts electricity, and we use electrical energy to cut the prostate.
Some of this glycine can absorb into the system, and very rarely can cause a serious problem called TUR syndrome2, where fluid is absorbed, and it’s like having water intoxication.
Generally with the TURP we make little chips and cut the prostate and get bleeding, and then we cauterise the vessels.
So there is a risk of transfusion, and some risk of bleeding.
Patients are usually in hospital for two to three days, they have a catheter put in afterwards, and after the procedure they have some burning and stinging which normally settles over a few weeks.3
It’s really important to do this operation very carefully to prevent any tears in the capsule, the lining of the prostate, and these days we operate through a big TV screen in the theatre, so everything’s really magnified, so the side effects of this operation is decreased4.
Patients do still suffer from side effects such as retrograde ejaculation, when they ejaculate the semen may go back into the bladder5.
There’s a five or ten percent chance of regrowth with time6, or you can get an infection or scarring of the neck of the bladder or stretching into the urethra.
One percent of cases can develop some degree of incontinence5, although this is very, very rare these days with the improved techniques.
So that’s the standard Trans Urethral Resection of the Prostate - TURP.
TURP – Trans Urethral Resection for Benign Prostatic Hypertrophy
How TURP works
Trans Urethral Resection of the Prostate (TURP) is the classic surgical treatment for an enlarged prostate. A telescope is passed through the urethra (the channel inside the penis) and small chips of prostate tissue are cut away until a clear channel is created for urine to flow.1 The principle is similar to coring out an apple - the outer prostate stays in place, and a wider channel is opened through the middle.
Electrical energy is used to cut the tissue, so a non-conductive fluid called glycine is used to irrigate during the operation rather than ordinary saline.
Risks and things to be aware of
Because the cuts bleed and are then cauterised, there is some risk of bleeding and, rarely, a transfusion. Very rarely, some glycine can be absorbed into the body and cause TUR syndrome - a fluid-overload state similar to water intoxication.2
Longer-term side effects include retrograde ejaculation (semen passing back into the bladder rather than out),5 a five to ten percent chance of regrowth with time,6 and occasional scarring at the bladder neck or urethra. Around one percent of patients develop some degree of incontinence,5 although this is now very rare with modern techniques.
Great care is taken not to tear the capsule (the outer lining of the prostate). Operating on a large, magnified screen in theatre has reduced the rate of side effects from this operation.4
What to expect
Patients are usually in hospital for two to three days and have a catheter in after the procedure. Some burning and stinging when passing urine is normal afterwards and usually settles over a few weeks.3
TURP Patient Information Brochures
References
- Transurethral resection of the prostate (TURP) - for benign prostate disease - Department of Health, State Government of Victoria, Australia - https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/transurethral-resection-of-the-prostate-turp-for-benign-prostate-disease
- Vinay Kumar, Kumar Vineet, and Adiveeth Deb - TUR syndrome - A report - Urol Case Rep. 2019 Sep; 26: 100982. doi: 10.1016/j.eucr.2019.100982
- What is a transurethral resection of the prostate (TURP)? - John Hopkins Medicine - https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/transurethral-resection-of-the-prostate-turp
- James S. Magera, Brant A. Inman, Jeffrey M. Slezak - Increased Optical Magnification From 2.5× to 4.3× With Technical Modification Lowers the Positive Margin Rate in Open Radical Retropubic Prostatectomy - Journal of Urology - https://doi.org/10.1016/j.juro.2007.08.128
- Risks - NHS - https://www.nhs.uk/conditions/transurethral-resection-of-the-prostate-turp/risks/
- Prostate Enlargement (Benign Prostatic Hyperplasia) - NIH - https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia