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TURP - transurethral resection of the prostate

Transurethral resection of the prostate is a surgical procedure used to treat lower urinary tract symptoms caused by an enlarged prostate. A combined optical and surgical instrument (resectoscope) is inserted through the tip of the penis into the urethra. Using an electric bipolar resectoscope, the doctor removes excess prostate tissue that is blocking the flow of urine. TURP is considered the most effective method of treating lower urinary tract symptoms caused by an enlarged prostate.

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Preparing for the procedure

What is the prostate?

The prostate is a gland located in the lower urinary tract, just below the bladder and surrounding the urethra (Figure 1a). The prostate is found only in men. It produces a fluid that helps transport semen. It contains smooth muscle that pushes semen out during ejaculation. A healthy prostate is about the size of a large walnut and has a volume of 15–25 milliliters. The gland slowly enlarges with age.

Benign prostatic hyperplasia

Prostate disease is usually associated with aging and can cause bothersome symptoms in the lower urinary tract in men over 50 years of age. A thin stream, dribbling, interruptions, a feeling of incomplete bladder emptying, frequent urination, and straining during urination are typical lower urinary tract symptoms. They are one of the most common clinical problems in older men.

Symptoms may be caused by an enlarged prostate – a condition known as benign prostatic hyperplasia (BPH) (Figure 1). These symptoms may also be caused by other medical conditions, and your doctor will take this into account. Benign prostatic hyperplasia is a common condition associated with hormonal changes that occur as a man ages. Prostate problems can be a cause for concern, but it is important to remember that BPH is not prostate cancer. BPH never develops into cancer, even if the condition is left untreated. However, both benign prostatic hyperplasia and prostate cancer can develop with age, and it is possible to have both at the same time.

Benign prostatic hyperplasia

Why is surgery necessary?

TURP helps reduce lower urinary tract symptoms associated with an enlarged prostate. 

Absolute indications for surgery are:

complete obstruction of urination with an inserted urinary catheter
bladder stones
renal impairment
blood in the urine
severe/recurrent urinary tract infections

Relative indications for surgery are:

thinner stream, prolonged, intermittent urination
dripping, interruption
feeling of incomplete bladder emptying
frequent urination, feeling of urgency, nighttime urination
straining when urinating
urinary tract infections.

Possible complications of TURP

Internal medicine complications

Although it is a small, minimally invasive surgical procedure that usually does not last longer than 60 minutes, the procedure can cause internal medical complications such as DEEP VEIN THROMBOSIS, PULMONARY EMBOLISM and ACUTE MYOCARDIAL INFARCTION. The risk of developing deep vein thrombosis with or without pulmonary embolism is increased in elderly patients with arrhythmias - atrial fibrillation and in people with blood clotting disorders. The risk is also increased in patients who are bedridden for a long time due to pain. As a rule, you will receive medication to prevent the above-mentioned events. The best protection is early postoperative getting up and walking. If such a complication should occur during treatment, our professional staff is trained to recognize and treat it correctly, and in case of the need for invasive diagnostics or therapy, we will immediately transfer you to the nearest adequately equipped internal medical center.

Temporary difficulty urinating

For a few days after the procedure and removal of the urinary catheter, you may have difficulty urinating. Your urethra may burn, you may feel a slight urge to urinate, you may have pain in your lower abdomen and perineum, and your urine may still be bloody. If the problems are very severe, we will reinsert the urinary catheter for a few days.

Urinary tract infection

Urinary tract infection is a possible complication after any prostate surgery. During the procedure, you will receive antibiotic therapy, which will be prescribed for the postoperative period of 5-10 days. In case of increased body temperature, chills and malaise, an immediate consultation with the urologist-operator is necessary!

Dry orgasm

During TURP, the surgeon removes excess prostate tissue, which is also located in the bladder neck area. This area contains the internal urinary sphincter, which is responsible for ejaculation, among other things. This is why after prostate surgery, semen is released into the bladder during orgasm instead of from the penis. This condition is called retrograde ejaculation or dry orgasm and is not harmful and does not affect sexual pleasure, but it may affect the ability to conceive.

Erectile dysfunction

The risk is very small, but erectile dysfunction can occur after TURP.

Heavy bleeding

During prostate surgery, the patient bleeds, but in very rare cases so much that blood transfusion is necessary. Men with an enlarged prostate and urinary tract infection are at higher risk of bleeding. After surgery, a perfusion catheter will be placed through which the bladder is continuously irrigated. This prevents blood clots from forming in the bladder and clogging the urinary catheter.

Urinary incontinence

In very rare cases, damage to the external urinary sphincter and urinary incontinence may occur during TURP.

Recurrence of symptoms

Some men need to have repeat treatment after TURP because symptoms return over a long period of time or never improve sufficiently. Rarely, the surgery needs to be repeated due to regrowth of prostate tissue or resulting narrowing of the urethra/bladder neck.

How do I prepare for the procedure?

You should not consume any liquids or food on the day of the procedure! You should stop taking medications that increase the risk of bleeding a few days before the surgery.

These are: MARIVARIN, MAREVAN, SINTROM, apixaban (ELIQUIS), dabigatran (PRADAXA) or rivaroxaban (XARELTO). Before surgery, pre-treatment in an antithrombotic clinic is NECESSARY.

Bring a written report with you stating that the INR is 1.3 or less and the report should not be older than one or two days. Patients receiving PLAVIX may discontinue therapy only with the permission of a cardiologist or neurologist.

If discontinuation is not possible, we will try to adjust the date of the surgery. It is not NECESSARY to discontinue Aspirin 100 Protect before surgery, but it is advisable not to take it for at least 7 days before the procedure. Be sure to bring a list of all medications you are taking with you.  

You will receive antibiotic therapy during and after surgery.

Arrange transportation home, as you will not be able to drive yourself and excessive physical activity would increase the risk of postoperative bleeding. We advise against heavy physical activity for 4-6 weeks after surgery.

What can I expect?

TURP usually takes 60 to 90 minutes. The operation is performed under general or partial (spinal) anesthesia. You will be given antibiotics during and after the operation to prevent infection and medicine to prevent thromboembolic events.

During the procedure

The resectoscope is inserted into the tip of the penis and passed through the urethra into the prostate area. The surgery is performed entirely inside the body (endoscopically). The surgeon cuts the prostate tissue with a bipolar electrical loop in small pieces, which are pushed into the bladder during the surgery. After the surgery, the pieces of prostate tissue are removed from the bladder and are usually sent for histopathological examination.

After the procedure

After the surgery, you will be transferred to the recovery room, where you will be monitored until the effects of the chosen anesthesia wear off.

You will receive pain medication. You will usually stay in the hospital for up to two days. After the operation, a perfusion catheter will be placed, through which your bladder is continuously irrigated. This prevents blood clots from forming in the bladder and clogging the urinary catheter. The urinary catheter will usually remain in place for 24 to 48 hours after the operation, or until you are able to urinate on your own.

You might also notice

Blood in the urine. This is normal. When the surgeon cuts out excess prostate tissue, a wound is left in the gland, which is cleaned when urine flows out. It takes some time for the wound to heal and be covered with normal mucous membrane. Bleeding may occur during the healing process.
Sensation of urinary tract irritation. Urination may be painful/burning. You may feel an urgent or frequent need to urinate. Painful urination generally improves within six to eight weeks after surgery, when the surgical wound has fully healed.

We advise

Drink plenty of fluids. Eat cooked foods rich in fiber for a few weeks after surgery to avoid constipation and bloating. In case of constipation, use Donat Mg or suppositories for constipation.
You can start taking blood-thinning medications again 2-4 weeks after surgery, as long as your urine is completely clear.
Avoid strenuous exercise, driving, and sex for at least 4-6 weeks after surgery.

Results

TURP usually relieves symptoms quickly, within a few days or weeks after surgery. Most men experience a significant improvement in their urine flow. Continued treatment to relieve lower urinary tract symptoms may be necessary for several years after surgery.

Author: asst. Simon Hawlina, MD, FEBU, urologist specialist

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Expert team

Urology clinic

Dejan Galič, MD, FEBU, FECSM

urology specialist

He deals with general urology, especially urological oncology and prostate problems, as well as sexual medicine.

Assoc. Prof. Dr. Simon Hawlina, MD, FEBU

urology specialist

He performs a wide range of urological surgical procedures, focusing on minimally invasive techniques.

Prof. Dr. Andrej Kmetec, Dr. med.

urology specialist

He deals with the comprehensive treatment of urinary tract problems.

Opinions of satisfied customers

Our patients' opinions testify to the trust, professionalism, and personal approach that we implement in our work every day.

MD Medicina has friendly and, above all, professional staff. The anesthesiologists make sure you feel really safe. The surgeon gives you all the information and does his job professionally, taking care of you until you leave and of course afterwards. The nurses, physiotherapist and others make sure you don't miss anything, even if you really can't do anything at that time. Professionalism, friendliness, homeliness. This is probably all that we as patients want and deserve when we need surgery. And that's how I felt too, because everything, from the preparation for the procedure, the surgery and the postoperative care, was carried out superbly. Thank you to the entire team and all the best!

Katarina Sinkovec

Thank you to all of you who use the latest medical devices, methods and forms of work in your medical work. At the same time, you are training a new generation of doctors because you are personally convinced that a collaborative approach with the patient is not only beneficial for you, but also for us. This makes us feel "important".

Alenka Čurin Janžekovič & Marijan Janžekovič

When you enter the MD medicine building, you feel more comfortable than not, because you don't immediately have that familiar and unpleasant feeling and smell of a hospital. You are greeted by a friendly nurse who greets you kindly and explains everything you are interested in. Everything has a relaxing effect, so that that last feeling of anxiety before a doctor's examination or surgery really goes away. The doctor you visit is a top expert who devotes himself entirely to you, really listens to you, has time for you and, in the end, gives you professional advice. I always leave the premises of MD medicine calm and with a clear picture that there are people here who will always take care of you. Therefore, a sincere thank you to all of you.

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I have had a personal doctor at MD medicine since 2017. From the very first visit, I entered the above-standard world of the health concession: a polite reception at the clearly arranged main entrance, a bright waiting room without crowds, an examination time at the agreed time in a modern and pleasantly equipped clinic, a friendly nurse who knows me by name, a relaxed and highly professional doctor who has time both to listen and to treat me. In the same building, I can also have a laboratory and many other health services performed. I can arrange orders, referrals, prescriptions, advice via email or by phone, which someone always answers... The high-quality system of MD medicine works not only for the benefit of the patient's health, but also dignity.

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