Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate.
An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The resectoscope helps your doctor see and trim away excess prostate tissue that's blocking urine flow.
TURP is generally considered an option for men who have moderate to severe urinary problems that haven't responded to medication. While TURP has been considered the most effective treatment for an enlarged prostate, a number of other, minimally invasive procedures are becoming more effective. These procedures generally cause fewer complications and have a quicker recovery period than TURP.
TURP helps reduce urinary symptoms caused by benign prostatic hyperplasia (BPH), including:
Frequent, urgent need to urinate
Difficulty starting urination
Slow (prolonged) urination
Increased frequency of urination at night
Stopping and starting again while urinating
The feeling you can't completely empty your bladder
Urinary tract infections
TURP might also be done to treat or prevent complications due to blocked urine flow, such as:
Recurring urinary tract infections
Kidney or bladder damage
Inability to control urination or an inability to urinate at all
Bladder stones
Blood in your urine
5. Introduction
A surgery used to treat urinary problems, caused by an
enlarged prostate such as benign prostatic hyperplasia
(BPH)
Removing the inside part of the prostate gland, using
electricity.
5
By inserting a resectoscope in your
urethra, so you don’t have any
incisions
Takes about 1 to 2 hours
An option for men who have
moderate to severe urinary problems
that haven't responded to
medication
6. TURP May Be Recommended If You
Have
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• Difficulty emptying your
bladder
• Frequent urinary tract
infections
• Bleeding from the prostate
• Bladder stones with
prostate enlargement
• Extremely slow urination
• Damage to the kidneys
due to an inability to
urinate
• Getting up often at night to
urinate
• Bladder control issues due
to a large prostate
7. Equipment
•Antimicrobial prep
•Preoperative antibiotics
•Resectoscope with at least two wire
electrode loops
•Normal saline (bipolar), glycine,
sorbitol-mannitol, or otherwise
appropriate irrigation (monopolar)
•Large bore 3-way foley catheter
(typically 22 or 24 French with a 30cc
balloon
8. Equipment
•Continuous bladder irrigation (CBI)
tubing and connectors
•Sterile lubricant
•Foley bag (large)
•Catheter tipped syringe
•Catheter guide
•Bladder evacuator (Ellik or similar)
9. Personnel
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Urologic surgeon –
performs the TURP
Anesthesia – maintains
anesthesia
Operating room nurse –
supports the surgeon
and anesthesia,
replaces irrigation bags,
obtains supplies as
needed, etc.
Surgical technician –
supports the surgeon,
prepares instruments,
empties the Ellik, etc.
10. Before the Procedure
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The
following
steps are
always
taken
necessarily
before the
surgery
Complete physical exam
Treating and controlling diabetes, high blood pressure,
heart or lung problems, and other conditions
Get to know about the drugs, vitamins, and other
supplements, if patient is taking any.
11. 11
Weeks Before Surgery
Ask the patient, to stop taking
medicines that can thin
blood, such as Aspirin,
Ibuprofen (Advil, Motrin),
Naproxen (Aleve, Naprosyn),
Vitamin E, Clopidogrel
(Plavix), Warfarin
(Coumadin), Apixaban
(Eliquis), and others.
On the day of Surgery
Tell patient NOT to eat or drink
anything after midnight the night
before surgery.
Advice patient to take the drugs
he have been told to take, with a
small sip of water.
Tell the patient when to arrive at
the hospital.
12. During the procedure
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General or spinal anesthesia is used.
Resectoscope (a combined visual and surgical
thin metal tube containing a light, camera and
loop of wire) is inserted into the tip of your
penis
Extended through your urethra and into the
prostate area
Won't need to make any cuts (incisions) on the
outside of your body.
13. During the procedure
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The loop of wire is then heated with an electric
current and used to cut away the section of
your prostate causing your symptoms, one
small piece at a time.
Catheter is then inserted into your urethra to
pump the irrigating fluid into the bladder.
To flush away pieces of prostate that have
been removed.
About 150,000 men and people AMAB in the
U.S. have TURP each year.
14. 14
• Stay in the hospital for 1 to 3 days
• Will have a small tube, called a Foley
catheter, in your bladder to remove urine
(removed within 1 to 3 days)
• Bladder may be flushed with fluids (irrigated)
to keep it clear of clots
• urine will look bloody at first.
• Blood can also seep around the catheter
After the Procedure
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• Help patient change positions in bed.
• Teach patient exercises to keep blood
flowing.
• Teach patient how to perform coughing and
deep breathing techniques. Patient should
do these every 3 to 4 hours.
• May need to wear tight stockings and use a
breathing device to keep your lungs clear
• May need medicine to relieve bladder
spasm.
After the Procedure
16. Risks
• Retrograde ejaculation
• Urinary incontinence
• Erectile dysfunction
• Urethral strictures
• Urinary tract infection (UTI)
• Urinary retention – the muscles that control the
bladder may be temporarily damaged
• Bleeding during or after the operation
17. TURP syndrome
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Fluid used to wash the area around prostate during
procedure is absorbed into bloodstream.
Risk of TURP syndrome is estimated to be less than
1%
Initial symptoms of TURP syndrome include:
• feeling or being sick
• confusion and dizziness
• headache
• swelling of your tummy
• slow heartbeat
18. Alternative procedures
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• PLASMA system – different instruments and
fluids are used to perform the procedure,
which is thought to lead to a lower risk of
TURP syndrome
• holmium laser enucleation of the prostate
(HoLEP) – a laser attached to a resectoscope
is used to cut away excess prostate tissue
• Prostatic urethral lift (UroLift)
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• Transurethral resection or vaporisation of
the prostate (TUVP) – a thin tube called a
cystoscope is inserted into the urethra (the
tube that passes urine out of the body), and a
laser attached to the cystoscope fires pulses
of energy to cut or burn away prostate tissue
• Open prostatectomy is bigger operation
where a cut is made in your tummy to access
and remove the outer part of your prostate.
