Fast Facts On Bph Surgery:
- Surgery is rarely the first line of treatment for BPH.
- A doctor who specializes in the urinary tract does most TURP surgeries.
- TURP is considered a fairly safe, effective procedure for treating BPH.
According to the American Urological Association, transurethral resection of the prostate or TURP is the most common type of surgery used to treat BPH. Every year, doctors perform it on around 150,000 American men.
Surgeons perform most TURP procedures when the patient is under general anesthesia and unconscious or asleep.
Alternatively, they use spinal anesthesia, where a needle is placed in the spine to stop any sensation below the waist.
Potential Side Effects / Risks Of Turp Surgery
In addition to the risks associated with any surgery, some of the potential risks of TURP surgery include:
Difficulty Urinating: A temporary problem associated with post-surgery swelling. A catheter may be placed until youre able to urinate on your own.
Urinary Tract Infection : After any prostate surgery, there is a risk of a UTI. The longer a catheter is kept in place, the greater likelihood of infection. Some men experience recurring UTIs following TURP surgery.
Retrograde Ejaculation: Also known as dry orgasm, this effect causes semen to travel into the bladder instead of out the penis during ejaculation. While this doesnt normally affect sexual pleasure and isnt harmful, it can affect fertility.
Erectile Dysfunction: ED is a rare side effect of TURP surgery, but is possible.
Retreatment: Over time, the prostate may continue to grow and the need for additional treatment may arise. Its also possible that retreatment may be necessary to treat urethral stricture caused by the TURP.
This is not an exhaustive list of potential risks associated with TURP surgery. Talk to your doctor about all risks and complications prior to surgery.
Turp For Prostate Cancer
TURP, or transurethral resection of the prostate, is a surgical technique in which small portions of the prostate gland are removed through the penis. This procedure requires no external incision, unlike nearly every other prostate surgery. However, while other prostate surgeries are typically performed with the intention of removing the entire tumor from the body, a TURP is generally only performed to alleviate symptoms. For example, if a patient is having difficulties passing urine due to an enlarged prostate gland, his oncologist may recommend a TURP to help make urination easier. The surgery is done in an operating room and can be done under general anesthesia or with an epidural. Most men are able to go home a few days after the procedure.
Transurethral resection of the prostate is just one of the prostate cancer surgery options offered by Moffitt Cancer Center. Committed to comprehensive patient care, our surgical team is here to provide:
Medically reviewed by Monica Chatwal, MD.
Our expert oncologists can help you determine if a transurethral resection of the prostate would be an appropriate procedure for your specific needs. No referral is required to make an appointment. To learn more about our approach to TURP, call or request to schedule a visit online.
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What To Expect After Surgery
The hospital stay after TURP is commonly 1 to 2 days.
Following surgery, a is used to remove urine and blood or blood clots in the that may result from the procedure. When the urine is free of significant bleeding or blood clots, the catheter can be removed and you can go home.
Strenuous activity, constipation, and sexual activity should be avoided for about 4 to 6 weeks. Symptoms such as frequent urination will continue for a while because of irritation and inflammation caused by the surgery. But they should ease during the first 6 weeks.
What To Think About
TUR syndrome doesn’t happen when TURP is done using a bipolar tool compared to a monopolar resectoscope. You may want to ask your doctor which kind of tool he or she uses.
Surgery usually is not required to treat BPH, although some men may choose it because their symptoms bother them so much. Choosing surgery depends mostly on your preferences and comfort with the idea of having surgery. Things to think about include your expectation of the results of the surgery, the severity of your symptoms, and the possibility of having complications from the surgery.
Men who have severe symptoms often have great improvement in quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life. Men with only mild symptoms may want to think carefully before deciding to have surgery to treat BPH.
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What Are The Side Effects
Initially, the urethra and surrounding area will be inflamed, and it will be difficult to urinate. The catheter and flushing process can also be uncomfortable and cause bladder cramping.
The urethra, penis, and lower abdominal area will be tender, red, and swollen for a few weeks after surgery, which can interfere with urination. Most people also feel very weak and tire easily for several weeks.
Common side effects of TURP surgeries include:
- difficulty completely emptying the bladder
- urinary urgency or the sudden urge to urinate
- discomfort during urination
- small dribbles or clots of blood in the urine, for up to 6 weeks
The minor side effects associated with TURP surgeries usually go away as the urethra and prostate tissues become less inflamed, usually within a few weeks.
Though TURP surgeries may or may not be associated with erectile difficulty in some people, they can decrease the volume of semen produced during ejaculation.
As with any medical procedure, especially those involving anesthesia, the surgery for BPH is associated with some medical complications.
Possible but rare risks associated with TURP procedures include:
- excessive bleeding
Why Might I Need A Turp
TURP is most often done to ease symptoms caused by an enlarged prostate. This is often due to benign prostate hyperplasia . BPH is not cancer. It is a common part of aging. When the prostate gland is enlarged, it can press against the urethra and interfere with or block the passage of urine out of the body.
Sometimes a TURP is done to treat symptoms only, not to cure the disease. For example, you may be unable to urinate because of prostate cancer, but surgery to remove the prostate isnt an option. Then you may need a TURP.
There may be other reasons for your healthcare provider to recommend a TURP.
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What To Be Careful About
Even though you have no visible incision and may have little pain, you are recovering from surgery. Don’t try to overdo it getting back into your normal activities. Discuss what to expect during recovering with your doctor. The following guidelines will help you have a smoother recovery:
- Avoid straining, especially when moving your bowel. Eat a balanced, high-fiber diet to prevent constipation. If constipation occurs, ask your doctor if you can take a laxative.
- Don’t do any heavy lifting.
- Avoid sudden movements.
- Drink plenty of water to flush the bladder and help prevent infection.
- Don’t drive or operate machinery.
How Do I Get Ready For A Turp
Some things you can expect before the procedure include:
- Your healthcare provider will explain the procedure and you can ask questions.
- You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything isnt clear.
- Your healthcare provider will review your medical history, and do a physical exam to be sure youre in good health before you have the procedure. You may also need blood tests and other tests.
- You will be asked not to eat or drink anything for 8 hours before the procedure, generally after midnight.
- Tell your healthcare provider if you are sensitive to or allergic to any medicines, latex, iodine, tape, contrast dyes, or anesthesia.
- Make sure your healthcare provider has a list of all medicines herbs, vitamins, and supplements that you are taking. This includes both prescribed and over-the-counter.
- Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines , aspirin, or any other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
- If you smoke, stop as soon as possible to improve recovery and your overall health.
- You may be given a sedative before the procedure to help you relax.
Based on your medical condition, your healthcare provider may request otherspecific preparation.
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Enhancing Healthcare Team Outcomes
TURP is typically an elective procedure used in the treatment of BOO. Because of this, appropriate indications and discussion of the complications associated with the procedure require an integrated interprofessional team to communicate effectively and initiate treatment plans, so the patient has proper expectations. This approach will ensure that patients are prepared for their procedure and what to expect. When patients are better informed, they are more invested in their decision and are happier with their outcome.
Collaboration shared decision making and communication are key elements for a good outcome. The interprofessional care provided to the patient must use an integrated care pathway combined with an evidence-based approach to planning and evaluation of all joint activities. The earlier signs and symptoms of a complication are identified, the better is the prognosis and outcome of the procedure.
Common Side Effects Of Turp
Common side effects after surgery include:
- bleeding after the operation this usually reduces over time and should stop after four weeks
- retrograde ejaculation most men are able to have erections and orgasms after surgery to treat an enlarged prostate. However, they may not ejaculate because the bladder neck is removed along with prostate tissue. This causes the ejaculate to collect with urine and pass out of the body in the next urination.
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Recovery From A Transurethral Resection
After the procedure, you will be transferred to a recovery room and monitored closely. Once your vital signs are stable, you will be moved to a hospital room. While in the hospital, you may need pain medication, and you will slowly begin to eat solid foods. You will likely be in the hospital one to two days until you are discharged.
At discharge, your doctor will give you detailed instructions such as:
- Catheter – you may still need the catheter in place to allow the prostate to heal.
- Blood in urine – you may find blood in your urine after surgery, but it will gradually stop over a few days.
- Drink plenty of water to flush the bladder out
- Eat high-fiber foods
- Get your doctors approval before taking blood-thinning medications
- Avoid heavy lifting or strenuous activity
- Do not drive until you are not taking pain medications
If you notice any of the following symptoms, contact your doctor:
- Difficulty or inability to urinate
- Bright red blood in the urine after a few days post-surgery
- Fever over 100.4 degrees F
What Are The Risks Of A Turp
As with any surgery, certain complications can occur with TURP. Somepossible complications may include:
- Bladder injury
- Painful or difficult urination
- Retrograde ejaculation
There may be other risks depending on your condition. Be sure to discussany concerns with your healthcare provider before the procedure.
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What To Expect After The Procedure
After the procedure, a urinary catheter will be in place to drain urine. This urine will probably have blood in it.
While the catheter is in place, some men feel bladder spasms or contractions. The catheter is usually removed the following day. A drip may also be in place overnight to help to flush the blood out of the bladder.
At first, you may experience a burning sensation when urinating, or need to urinate frequently. These symptoms should settle with time.
Your doctor is likely to recommend that you avoid strenuous activity, straining and heavy lifting for 6 to 8 weeks after surgery. It is also important to avoid constipation by eating plenty of fibre and drinking 2 to 3 litres of fluid per day.
What Does The Procedure Involve
During the TURP procedure, your surgeon will remove a portion of your prostate. You will likely be placed under general anesthesia, so youll be unconscious and unable to feel pain. Or you may receive spinal anesthesia, which numbs the nerves in your lower body so you wont feel pain.
Your surgeon will use a long thin scope, called a resectoscope, which will allow them to see your prostate gland. They will insert it through the end of your penis. Then they will insert a surgical tool through the scope to remove a portion of your prostate. The amount removed will depend on the shape and size of your prostate.
Once your surgeon removes the scope, they will insert a catheter into your penis to allow urine to flow following surgery. It will also help remove any blood clots that may form.
The entire procedure typically lasts one hour.
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Minimally Invasive Procedures For Bph
Minimally invasive surgical therapies for BPH, such as free-beam laser therapy, radiofrequency ablation, transurethral needle ablation, prostatic urethral stents , and alcohol injection, are relatively simple procedures that can usually be performed in an outpatient setting, often with decreased postoperative catheterization time.
For patients at very high medical risk who cannot safely undergo significant anesthesia or surgery, these minimally invasive treatments may offer some benefit. Prostatic urethral stents, for example, have been suggested as a reasonable BPH treatment alternative when medical therapy has failed and the medical risks of surgery are unacceptably high. Stent migration, dysuria, and pain are relatively common complications but are easily reversible with stent removal.
These minimally invasive methods do not allow tissue to be saved for pathological analysis and do not remove the entire adenomatous prostate thus, retreatment and even TURP is sometimes required later. Up to 25% of patients who receive these minimally invasive treatment alternatives ultimately undergo a TURP within 2 years.
Prior to surgical intervention for LUTS attributed to BPH, clinicians should do the following:
- Consider assessment of prostate size and shape via abdominal or transrectal ultrasound, cystoscopy, or by preexisting cross-sectional imaging
- Assess post-void residual
- Consider pressure flow studies when diagnostic uncertainty exists
What Does The Recovery Process Involve
Your surgeon will likely advise you to stay in the hospital for one to three days following your surgery. During this time, you will be given intravenous fluids to promote urine flow. And you can expect some blood and blood clots to appear in your urine.
It usually takes three to six weeks to recover. During this time, you should refrain from strenuous activity. And notify your physician if you experience:
- persistent bleeding
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What Are The Alternatives To Turp
If you have an enlarged prostate, there are a number of options, including:
- do nothing some men will find the symptoms get no worse
- take medicines
- laser therapy, using heat to remove tissue from the prostate
- microwave treatment, using microwave energy to shrink the prostate
- other operations, such as transurethral incision of the prostate or open or retropubic prostatectomy
You should think about the benefits and risks of all approaches.
Immediately After A Prostatectomy
After the operation, you can expect that:
- Nurses will monitor your vital signs.
- You may be given oxygen for up to 24 hours following surgery.
- You will probably be given antibiotics to prevent infection.
- For a day or so, you will have a catheter in your urethra and bladder with a continuous wash-out. This is to prevent blood building up and clotting, which could cause a blockage.
- If you had an open prostatectomy, your wound will be dressed and you will have a tube draining your abdomen. The tube will be removed after several days.
- Pain will be managed with injections, tablets or both. Pain is rarely a significant problem following TURP.
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Transurethral Electro Resection Of The Prostate
Removing the enlarged part of the prostate is usually the best long-term treatment for an enlarged prostate gland. The portion of the gland that is not squeezing the urethra stays in place. The outside capsule around the gland is also untouched.
Transurethral electro-resection of the prostate is the traditional way to remove prostate tissue using minimally invasive surgical techniques. No outside incision is needed. There’s less pain, fewer complications and faster healing.
With TURP, an instrument called a resectoscope is inserted through the penis. This device is about 12 inches long and half an inch around. It has a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. During the surgery, the surgeon uses the wire loop to remove the tissue one piece at a time. The pieces are carried by the fluid into the bladder and then flushed out at the end of the operation. The surgery lasts about 90 minutes.
Other Forms Of Treatment For Benign Prostate Disease
Other forms of treatment may include:
- monitor symptoms the condition is monitored closely. Treatment only begins once the condition has progressed and is causing problems
- medical treatment symptoms of benign enlargement can be treated by medications that relax the muscles around the bladder or that shrink the prostate and delay the need for surgery.
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Who Might Need Turp
TURP is sometimes recommended when a man has an obstructed flow of urine due to benign prostatic hypertrophy or benign prostatic hyperplasia , which is a common cause of an enlarged prostate. It is used to treat prostate enlargement only if other non-surgical treatments such as medication have not worked.
The prostate is a gland that surrounds the top part of the urethra and in young men is normally the size of a walnut. It often starts to get bigger from about the age of 40 on. Eventually, it can get big enough to block the flow of urine. Symptoms include
- a weak urinary stream
- feeling that the bladder isnt empty after urinating
- having to pass urine frequently day and night
- having to pass urine urgently
TURP is an option only for men who have severe symptoms from prostate enlargement and whose quality of life is affected.