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Transuretheral resection of the prostate (TURP) This information tells you about an operation on the prostate
called a transurethral resection of the prostate (TURP). It
explains how the operation is done, how it can help, what the
risks are and what to expect afterwards.
The benefits and risks described here are based on research
studies and may be different in your hospital. You may want
to talk about this with the doctors and nurses treating you.
clinical evidence for patients, from the What is a TURP?
If you have a TURP, a surgeon cuts away part of your prostate
Transurethral resection of the
to stop it pinching the tube that carries urine from your
bladder out through your penis. This tube is called the urethra.
prostate (TURP)
An operation to cut away part of your enlarged
prostate
under your bladder and is partly wrapped around your It makes the milky fluid (semen) that comes out of your penis when you have an orgasm.
The operation is called a transurethral resection because your surgeon will pass a tube through your urethra (transurethral) and cut away your prostate (resect it).
This information is based on Clinical Evidence, the British Medical Journal‘s worldwide survey of the best, most up-to-date medical research, used by doctors everywhere.
You can find out more about your condition and your treatment choices at NHS Direct Online (www.nhsdirect.nhs.uk).
Transuretheral resection of the prostate (TURP) An operation to cut away part of your enlarged prostate Why do I need a TURP?
• Your symptoms are causing you a lot of trouble, and drug It’s common for men’s prostates to get bigger as they get
older. Doctors call this benign prostatic hyperplasia, or BPH.
• You have large bladder stones. These can form if your Benign means it isn’t cancer. Hyperplasia means extra growth of normal cells. Nobody knows exactly why it happens, but it’s probably linked to changes in the amount of some hormones TURP is the most common type of operation for an enlarged prostate, although it’s not as common as it used to be. About 40,000 of these operations are done each year in the UK.5 BPH isn’t usually serious but if your prostate is enlarged it can press on your bladder and your urethra. This can cause problems when you urinate. You may:3 What happens during the operation?
• Make lots of trips to the toilet, and need to get up in the A TURP usually takes between half an hour and an hour, depending on how much of the prostate needs to be removed.
You’ll be given either a general anaesthetic (a drug that makes
you sleep) or an epidural (an injection into your spine). If you
have an epidural, the lower part of your body will be numb.
• Have a weak urine flow or one that stops and starts You won’t be able to see the operation, but you’ll be able to hear what’s going on. Usually a nurse or the anaesthetist will • Leak or dribble urine (some men wear pads to keep dry). Not everyone who has BPH will need an operation. It’s usually A surgeon will put a thin tube into the opening of your penis and up your urethra to your prostate. The tube has a light and a tiny camera on the end. The tube also has a tiny looped wire • Your urethra is so blocked that your bladder often doesn’t attached to it. This is heated with an electric current and used empty completely. The urine that’s left can keep causing to cut away the bit of your prostate that’s blocking your urine. The pieces of prostate are flushed down the tube with water.
• You suddenly can’t urinate at all. This is called acute
You won’t be able to urinate properly straight after the urinary retention and can damage your kidneys
operation because your urethra will be sore and swollen.
Transuretheral resection of the prostate (TURP) An operation to cut away part of your enlarged prostate How can this operation help me?
There’s good research to show that surgery helps with the symptoms of an enlarged prostate. In one study, 9 in 0 men said that their symptoms were still better three years after their operation. This compares with 4 in 0 men who waited to see what would happen rather than having treatment.6 • After the operation, you should have a stronger stream of urine, and you shouldn’t have to strain or push to get your urine flowing.6 7 • You may also have more control over when you urinate and need to go less often and less urgently.6 7 • Your symptoms are less likely to interfere with your normal activities. So you may not need to rush to the bathroom or get up in the night as often as you did before. Many men say they can get back to doing things they enjoy, like outdoor sports and going to the cinema, without having to worry about being close to the toilet. What are the risks?
A thin, flexible tube called a catheter is put into your urethra to drain your urine (and any bits of prostate that still haven’t All operations carry risks, and your surgeon should tell you come out) into a jar or bag by your bed. The doctor may flush fluid through the catheter into your bladder to help clear any blood clots. The fluid then drains away with your urine. Men Anaesthetics can have side effects. You may feel sick after say this flushing feels as though their bladder is constantly full.
the operation. And you may have an allergic reaction to the
anaesthetic. If you have any allergies, you must tell your
You won’t need stitches or dressings after the operation.
doctor. Some people get breathing or heart problems. This is Transuretheral resection of the prostate (TURP) An operation to cut away part of your enlarged prostate serious but very rare. Your blood pressure, heartbeat, body Urine infection: There’s a small chance that you’ll get an
temperature and breathing will be closely monitored.
You may bleed heavily during or after surgery. And you may TURP syndrome: This happens to about  in 50 men.4 It’s most
get an infection. It’s also possible to get a blood clot (known as common in men whose operations last more than an hour. a deep vein thrombosis or DVT) in a vein in your leg. This clot
TURP syndrome can make you slightly unsteady, confused can break off and travel to your lungs where it may cause a or queasy, or make you vomit. It can also raise your blood blockage. You may need to wear tight elastic stockings during pressure or cause problems with your sight. These problems the operation to help prevent clots.
are triggered by your body absorbing the fluid that’s used to wash away the bits of prostate removed during surgery. This These extra problems are called complications. You may need
upsets the balance of salts in your blood and is particularly further treatment for complications, such as surgery to stop harmful for men who have a heart problem or a kidney bleeding or antibiotics to deal with an infection.
problem. TURP syndrome is easily treated.
It’s hard to say exactly how often problems happen because the research isn’t very good. You can use the statistics we give below as a guide, but it’s important to discuss with your doctor Problems that can happen later
how often problems happen in your hospital.
Dry climax: About 7 in 0 men get a problem called retrograde
Men over 80 have a higher risk of complications, especially if ejaculation (or ‘dry climax’) after a TURP.4 5 6  This means that, when they orgasm, no semen (or much less semen than usual) comes out of their penis.
If you have dry climax, you’ll still be able to get erections and Problems that can happen straight after the
you’ll still feel as though you climax during sex. So you should operation
be able to enjoy sex as you did before the operation. However, you may not be able to father children through sexual Bleeding: You may have heavy bleeding into your urine, but
this should stop after a few days. In most studies, about  in 50 men need to be given extra blood (a blood transfusion) or Erection problems: The nerves that control erections are next
need to go back into the operating theatre for the bleeding to to the prostate and can be damaged during surgery. But be stopped.4 5 7 But some studies have found that the problem some studies show that TURP doesn’t seem to cause erection happens around twice as often as this. You may be less likely to bleed with newer operations than with TURP.9 Transuretheral resection of the prostate (TURP) An operation to cut away part of your enlarged prostate In one study, men who had the surgery didn’t get any more What will happen if I choose not to have the
erection problems than men who didn’t have a TURP.6 In operation?
another trial, many men who had this operation said that the quality of their erections actually improved.3 Some men feel that the risks of TURP are too great. If your Losing control over your urine flow (incontinence): About 
symptoms are mild and don’t bother you much, you don’t have in 50 men can’t hold on to their urine after they have a TURP.4 much to gain from this operation. Even if your symptoms are 6 This is called incontinence. You may become incontinent if severe, you can choose to put off the operation and wait to the ring of muscle (sphincter) at the neck of your bladder is see what happens.4 Your doctor will keep monitoring your symptoms and give you advice on how to manage them. This is called ‘watchful waiting’ or ‘active monitoring’. Your However, a study comparing men who had TURP with men symptoms probably won’t improve, but they may not get any who weren’t treated didn’t find that incontinence was more common in men who had surgery.6  So there’s mixed evidence on whether you are at risk of becoming incontinent Having a large prostate is unlikely to make you seriously ill and there’s no evidence that it causes prostate cancer.6 7 8 The
main problem is suddenly being unable to urinate at all (acute
Problems passing urine again: About  in 5 men get scarring
urinary retention). This can cause an infection or damage your around the opening of their bladder or in their urethra. This kidneys. One study found that the average 60 year old man makes it difficult and painful to pass urine. You may need with a large prostate has a  in 5 chance of getting urinary Needing another operation: About  in 00 men who have a
How your condition develops often depends on how severe TURP need another one in the future because their prostate your symptoms are to start with. In one study of men who didn’t have any treatment, those with mild symptoms usually didn’t get severe symptoms or need surgery. Over the next Dying from surgery: There’s an extremely small chance that
four years, this is what happened to the men whose symptoms • Half still had the same level of symptoms Transuretheral resection of the prostate (TURP) An operation to cut away part of your enlarged prostate •  in 8 improved and had only mild symptoms. Both alpha-blockers and 5-alpha-reductase inhibitors can cause dry climax. Some men who take finasteride lose interest in sex Your doctor will talk to you about the risk of not having and have problems getting or keeping an erection.8 3 3 surgery. Older men, and men with very large prostates and high levels of PSA, are most likely to get worse.9  PSA is a Drugs may not help your symptoms as much as surgery, and substance that helps your semen stay liquid, so your sperm the effects may not last as long. But drugs have fewer risks can swim. When something goes wrong with your prostate, than surgery. And after surgery you need several weeks to large amounts of PSA enter your bloodstream. PSA stands for prostate-specific antigen.
Newer types of surgery
What other treatments are there?
There are several operations that are simpler and less
serious than TURP. These use heat from an electric current,
microwaves or laser beams to burn away part of your prostate.
Another type of operation is called a transurethral incision of
Medicines
the prostate (TUIP). In this operation, a surgeon makes small
Doctors advise most men to try drugs before surgery. There cuts where your bladder meets your prostate. This relieves the are two types available: alpha-blockers and 5-alpha-reductase
inhibitors.
These operations may help with symptoms and make it easier Alpha-blockers improve the flow of urine by relaxing the for you to urinate.7 33 They have fewer side effects and cause muscles in your prostate and your bladder. They can reduce less bleeding than TURP.0 33 34 35 36 Your stay in hospital will your symptoms by about 30 to 50 percent. 3 usually be shorter, and you may have to use a catheter for less time afterwards.7 37 38 But there’s no research on whether the There are two 5-alpha-reductase inhibitors available. They’re benefits of these newer operations last as long as the benefits called finasteride and dutasteride. They both shrink your prostate, which should make it easier for you to urinate.4 5 6 They may not be as good at helping symptoms as alpha-blockers.7 8 9 30 But taking finasteride for four years can halve Herbal remedies
your chances of suddenly being unable to pass urine (acute urinary retention) and needing prostate surgery.4 Saw palmetto extract is one of several herbal remedies that some men find helpful. There’s some evidence that saw palmetto extract can help men who have BPH.39 Transuretheral resection of the prostate (TURP) An operation to cut away part of your enlarged prostate What can I expect after the operation?
heavy lifting, for about six weeks until you’ve healed properly. Try to drink plenty of water. This helps prevent constipation After your operation, you’ll feel a bit sore and tired. You can take painkillers for any pain you have. If these don’t work it’s important to tell the nurse, as being in pain may slow your It may be a couple of months before you heal completely. recovery. You may need a higher dose or a different type of Generally, the longer you had the problem before you were treated, the longer your recovery time will be.
The good news is that most men think their operation was a success.40 4 In one study, men were asked how they felt a year after their operation. Three-quarters of the men said that they felt much better and less anxious than they did before their notice that your urine flows faster straight away. But it may take a while before you can urinate normally again. Some men need to come back to hospital and have the References
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This information does not replace medical advice.
If you have a medical problem please see your doctor or phone NHS Direct on 0845 46 47.

Source: http://urology.me.uk/app/download/5785146754/TURP.pdf