Transurethral resection of the prostate (TURP) is a surgery used to treat complications caused by an enlarged prostate gland in men. The prostate gland is located just below the bladder, in front of the rectum, and surrounds the urethra only in the male anatomy(i.e only men have it). It’s about the size of a walnut. If the prostate gland enlarges, it can press against the urethra, interfering with or blocking the passage of urine out of the body.
An enlarged prostate gland can occur due to existing conditions like Benign Prostatic Hyperplasia( BPH) a condition common in older men and non-cancerous. Another reason for an enlarged prostate gland is a condition called cancer of the prostate.
Your surgeon/urologist will advise for a TURP to be performed if you present with an enlarged prostate and moderate urinary problems that fail to resolve with just medications.
How is a TURP done?
During the surgery, no incision is required. The patient is immobilized and placed under anesthesia, then an instrument called a resectoscope is guided into the body through the penis, urethra, and into the prostate gland. This instrument has a light camera and an electrical wire loop that cuts tissue and seals blood vessels which allows the surgeon to see and scrape away excess tissue blocking urine flow. It also has valves that pass irrigation fluids, the most commonly used is the normal saline. This fluid is used in moving pieces of the tissue being trimmed out from the prostate gland into the bladder during the surgery and flushed out at the end of the procedure.
When is a TURP considered an option?
A TURP is often performed solely to treat symptoms rather than to cure the disease. For example, if you can’t urinate due to enlargement caused by prostate cancer, you may require a TURP while considering treatment options for cancer.
TURP is done to manage symptoms including frequent urination, difficult urination, the feeling you can’t completely empty your bladder, prolonged urination, or weak and prolonged urination amongst other symptoms. Also, TURP can be done to treat or prevent complications like recurrent urinary tract infections, bladder stones, or damage to the kidney due to an enlarged prostate.
Risks associated with TURP
Just like every surgical procedure, there are some possible complications that may occur but nothing that cannot be managed and corrected. Very rarely, the following issues may occur after getting a TURP done:
- Bleeding during surgery. Usually, men with larger prostate sizes are at risk of this
- Bleeding post-surgery
- Dry orgasm/ Retrograde ejaculation: This is a possible post-surgery effect. Semen is ejaculated into the bladder rather than passing through the penis in this case. This can cause infertility in men
- Inability to have erections
- Electrolyte imbalance/ TURP Syndrome
- Loss of bladder control/ Urine incontinence
How to prepare for a TURP
Here is what you can expect before, during, and after getting a TURP surgery.
Before the surgery
While preparing you for the surgery, your doctor in order to prevent or treat urinary tract infection may prescribe an antibiotic. Also, you will be required to stop taking certain medications Viz; anticoagulants, and antiplatelets.
You will also be advised to get an aide because you will need to refrain from doing a lot of activities like driving, running, or lifting heavy loads from the moment you step out of the theatre until at least 6 weeks after the surgery.
During the surgery
- The patient will be prepped by an OR/theatre nurse. You will be asked to change into a gown and empty your bowel.
- An I.V line will be set and when you are in the operating room, you will be positioned on the operating table.
- Anesthesia will be administered and heart rate, blood pressure, breathing, and blood oxygen level will be monitored throughout the surgery.
- Anesthesia may be in the form of general anesthesia or regional anesthesia (spinal, Epidural anesthesia)
- For General anesthesia, after you’ve been sedated, a breathing tube may be inserted through the patient’s throat and into the lungs, and you’ll be hooked up to a ventilator. This will help you breathe during surgery.
- The urethra and bladder may be examined first with an endoscope. The resectoscope is then inserted into the urethra and bladder to resect any prostate tissue that is obstructing the urethra. The fragments are flushed into the bladder before being drained through the urethra.
- Finally, a flexible tube called a catheter is passed into your bladder to drain urine.
After the surgery
Post-surgery, you may be taken to a recovery room and closely monitored. Once your blood pressure, pulse, and breathing are stable and you are awake, you will be transferred to your hospital room, where you will stay for at least 24 – 48 hours.
Pain medication will be administered as needed. You will start drinking liquids once you’re awake. As you gain strength, you will be able to eat solid foods.
The catheter will be left in place for 1 to 3 days to aid in urine drainage while your prostate gland heals. After surgery, you will most likely have blood in your urine. A bag of solution may be attached to the catheter to flush the blood and potential clots out of your bladder and the catheter. The bleeding will gradually stop, and the catheter will be removed. Once it is removed, urination might be painful, or you might have a sense of urgency or frequent need to urinate. Painful urination generally improves in six to eight weeks.
A follow-up visit with your doctor will be scheduled.
Conclusion
TURP usually eradicates symptoms quickly. Within a few days, one should notice a significant increase in urine flow. Sometimes, especially after having an enlarged prostate for several years, follow-up treatment may be required.
If you develop a fever, notice cloudy urine or traces of fresh blood and blood clots, or are unable to pass urine, see your doctor right away.
References
https://www.mayoclinic.org/tests-procedures/turp/about/pac-20384880
