TURP

A surgical method in which the inner part of the prostate is removed piece by piece using an electrical loop or similar instrument introduced through the urethra, in patients whose urinary flow is obstructed due to benign prostatic enlargement.

Indication

• Symptoms of benign prostatic hyperplasia (BPH) that do not respond to medication and impair quality of life
• Recurrent urinary tract infections or recurrent urinary retention
• Bladder stones formed due to prostate enlargement
• Recurrent and significant microscopic/visible hematuria of prostatic origin
• Obstruction affecting the upper urinary tract (hydronephrosis, deterioration in kidney function)
• Bladder dysfunction together with large residual urine (post-void residual)

Preparation

• Exclusion of active infection by urinalysis and urine culture before the procedure
• Blood tests (complete blood count, coagulation, kidney function) and ECG
• Blood thinners such as aspirin, clopidogrel, and warfarin are usually discontinued 5-7 days in advance with physician approval
• Fasting for 6-8 hours before the procedure
• Anesthesia (general or spinal) consultation and suitability evaluation

How it's performed

1. The patient is placed in the supine and legs-apart (lithotomy) position
2. General or spinal (lower back) anesthesia is administered
3. The bladder is reached through the urethra with an optical instrument called a resectoscope
4. The inner tissue of the prostate is shaved piece by piece (chips) with an electrical loop or bipolar/laser energy
5. Bleeding vessels are cauterized; the removed pieces are washed out from the bladder
6. At the end of the procedure, a three-way catheter is placed in the bladder; the bladder is kept clean with continuous irrigation
7. Total procedure time is 45-90 minutes depending on the prostate size

Post-procedure

• Generally 1-3 days of hospital stay; the catheter is removed 24-72 hours after bladder irrigation stops
• Fluid intake of 2-2.5 liters per day is recommended for 2-4 weeks after discharge
• Heavy lifting, cycling, and sexual intercourse are not recommended for the first 4-6 weeks
• Urination may initially be frequent and accompanied by urgency; this improves within a few weeks
• First check-up at 1 week, second check-up at 4-6 weeks; uroflowmetry and residual urine assessment are performed

Risks

• Temporary urinary incontinence or urgency sensation (usually in the first weeks)
• Retrograde ejaculation — semen flowing back into the bladder; seen in most patients and does not prevent sexual intercourse but can affect fertility
• Bleeding in the urine and clot passage in the early period (1-2 weeks)
• Urinary tract infection, rarely epididymitis
• Urethral stricture or bladder neck contracture (in late period, 5-10%)
• Very rare TUR syndrome (due to absorption of irrigation fluid), erectile dysfunction, bleeding

FAQ

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