Transurethral resection of the prostate gland (TURP)

Transurethral resection of the prostate gland (TURP) is a surgical procedure used to remove prostate tissue due to an enlargement of the gland.


Understanding the prostate gland
The prostate is a male gland located at the base of the bladder. It surrounds the urethra (the tube that drains urine from the bladder and semen to the outside of the body) and has ducts that open into the urethra. The main function of the prostate gland is to pass a specific fluid into the urethra during climax to improve the overall performance of sperm. This fluid also helps make the vagina more receptive to the sperm.
The prostate is normally the size of a walnut, but it often becomes enlarged with age. An enlarged prostate can block the flow of urine from the bladder through the urethra. Symptoms of an enlarged prostate may include frequent, urgent urination, and a weak or hesitant urine flow. If the bladder can't empty completely, you may develop a bladder or kidney infection. If you have a prostate problem, your doctor may refer you to a urologist (a doctor who specializes in the medical care of the male genital tract and the urinary tract in both men and women).


Purpose/indications
TURP is the most common surgical procedure used to treat an enlarged prostate. It's used to relieve an obstruction of the bladder outlet, and may also be used in prostate cancer treatment.

Patient preparation
Although every surgery has its own set of standards, your individual health history could play a role in any variation to the procedure. Discuss these issues with your doctor.
Before surgery, you'll meet with the anesthesiologist to discuss the anesthesia you'll receive during the surgery -- either a spinal or epidural block (you'll be awake but numb from about the waist down) or general anesthesia (you'll be unconscious). Your doctor or anesthesiologist will offer you additional details on any eating, drinking or other restrictions that may be required before surgery.

You may also need the following tests:

complete blood cell count (a series of blood tests that analyze the cellular components of a blood sample)
prothrombin time and partial prothrombin time (PT and PTT, tests that measure blood clotting time)
urinalysis
electrocardiogram (a recording of the electrical activity of the heart)
chest X-ray

Procedure
In the operating room, you'll lie on your back with your knees bent and legs apart. After the anesthesia is given, a pencil-like instrument called a resectoscope will be inserted into the urethra. An incision isn't necessary. This instrument is equipped with a tiny telescope that allows your doctor to see the tissue that needs to be removed. A thin, wire loop at the end of the resectoscope is used to cut away prostate tissue. An electrical current is used to heat up the wire, which eases tissue removal and helps prevent bleeding.
Once the excess prostate tissue is removed, the resectoscope is carefully removed and a special catheter (flexible tube) is inserted. This catheter helps direct the flow of an irrigating solution into the bladder and allows excess tissue, blood clots and fluid to be flushed out of the bladder. Tissue samples from the prostate are sent to a lab to be examined for abnormalities such as cancer. The surgery takes about an hour.


Postprocedure care
Your doctor may recommend bedrest shortly after surgery. Later, you may sit in a chair or take a short walk with assistance. The color and amount of drainage from the catheter will be monitored. The drainage should gradually become less bloody, and the catheter will be left in place until the bleeding stops. You may feel a burning sensation when you urinate after the catheter is removed, but this should gradually disappear. While you're recovering, it's important to drink plenty of water. To avoid constipation, be sure to eat foods high in fiber, such as whole grains, fruits and vegetables. Barring complications, you will probably be released from the hospital within a day or two.
Strenuous activity should be avoided for about six to eight weeks after surgery. Be sure to discuss with your doctor when you may drive, engage in light activity, and return to work. Sexual activity can usually be resumed when healing is complete, which is about four to six weeks.

After surgery, call your doctor if:

you're unable to urinate
pain or bleeding increases
you notice any signs of infection (fever, redness, any unusual drainage or an increase in swelling)
you can't have an erection or can't keep one long enough to have sex
you have any related questions or concerns

Benefits
TURP doesn't require an incision. Compared to an "open" surgery, the hospital stay after TURP is typically shorter.

Risks
As with all surgical procedures, there are risks associated with TURP. These risks include bleeding, infection or disturbances in electrolytes (substances that transmit electrical impulses which control many bodily functions). Damage to the bladder or muscle around your urethra can also occur, which can cause urinary problems such as incontinence (loss of bladder control). If your prostate enlarges again, you may need another surgery.
Many men worry that TURP will affect their sexual functioning. Studies indicate that most men eventually return to the same level of sexual functioning they had before surgery, although it may take up to a year for healing to be complete. Retrograde or backward ejaculation (when the semen empties into the bladder instead of out through the penis) after TURP is a common complication. Retrograde ejaculation can be a permanent condition that can also make you infertile since your sperm never reach the vaginal canal. Retrograde ejaculation isn't harmful, and the semen is eliminated when you urinate.

Rarely, complications from anesthesia may lead to a serious allergic reaction or nerve damage. Many serious anesthesia complications are typically linked with preexisting conditions, such as heart disease. As with any type of surgery, discuss any concerns you may have with your doctor.


Considerations
Careful observation or medications may be all that's needed for mild symptoms of prostate enlargement. Surgery is often recommended for more severe cases. In addition to TURP, various less invasive surgeries are available. Your symptoms, age and urinary tract condition will help the doctor determine if TURP is appropriate for you.