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Trans-Urethral Resection of the Prostate

Trans-Urethral Resection of the Prostate Gland (TURP))

Trans-urethral resection of the prostate is an endoscopic surgical procedure to treat patients with an enlarged, benign prostate, called Benign Prostate Hyperplasia (BPH).

The prostate is a walnut-sized gland located in front of the rectum, at the outlet of the bladder. It contains gland cells that produce seminal fluid, which protects and nourishes sperm cells in semen.

TURP is usually reserved to surgically treat men with significant symptoms. This procedure is performed under a general or spinal anaesthetic. Antibiotics prophylactic dose is given during the operation to reduce the risk of infection.

TURP is usually reserved to surgically treat men with significant symptoms. This procedure is performed under a general or spinal anaesthetic. Antibiotics prophylactic dose is given during the operation to reduce the risk of infection.

Before the operation:

You should have nothing to eat 6 hours before your operation, but you can drink clear fluids up to one hour before your operation. If you are on anti-coagulation therapy you should stop taking it 3-10 days before your operation. Please speak to your anti-coagulation nurse about this.

During the operation:

A small operating telescope is inserted in the penis up through the urethra. The instrument is then used to remove the middle of the prostate in small pieces. These pieces are sent to the laboratory for analysis to confirm benign prostatic hyperplasia.

At the end of the operation, the surgeon will place a urethra catheter in your bladder. This will allow you to pass urine easily, and bladder wash out performed with fluid to prevent blood clots if indicated. The surgery takes about one hour.

The catheter is removed the next day and the amount of urine passed normally is measured to ensure you are emptying your bladder completely. A scan of your bladder will be performed by a nurse to check your bladder residual after urinating.

If you are unable to pass urine after removal of catheter, you will be re-catheterised and discharge home on an alpha blocker for 1 week before a retrial. Hospital stay is 2-3 days.

Potential Complications of TURP

  1. Complications of anaesthesia
  2. General complications:
    • Pain - can be controlled with pain relief.
    • Bleeding - during or after surgery. Blood stained urine or rose haematuria is expected. It is advisable you maintain a good fluid intake to flush out the bladder. Bladder washouts can be performed to wash out blood and blood clots. If the urine output is very bloody, your haemoglobin (Hb) level will be checked. If Hb > 8, you will need blood transfusion (risk: less than 1 in 20) and rarely, further surgery. Your bladder will be irrigated with fluid to flush out your bladder.
    • Infection - This is treated with antibiotics (risk: 1 in 10). The risk increases if you have a catheter inserted before surgery.
    • Blood clots in the legs (deep-vein thrombosis - DVT). It is wise to get out of bed soon after your operation. DVT can also be prevented wearing TEDs stockings, been given anti-coagulation medication or injections.

Specific complications of this operation:

  • Impotence-problems maintaining and sustaining an erection (risk: 1 in 20). This is more common in older men who may already have problems with impotence.
  • Retention of urine - (risk 1 in 50) you may need re-catheterising for 1 to 2 weeks while at home.
  • Urinary incontinence - this may happen a short while after the operation. This may be permanent (risk of permanent incontinence: less than 1 in 50).
  • Reduction in fertility, caused by retrograde ejaculation. This is where the fluid produced at ejaculation passes back into the bladder rather than out of the penis (risk: 9 in 10).
  • Narrowing of the urethra (stricture) caused by scar tissue forming. You may need further surgery (risk: less than 3 in 100).

Recovery period to return to normal activities is usually 2 weeks.