Transurethral resection of the prostate (TURP) is a surgical procedure by which portions of the prostate gland are removed through the urethra.
The prostate is a gland that is part of the male reproductive system. It consists of three lobes, and surrounds the neck of the bladder and urethra (tube that channels urine from the bladder to the outside through the tip of the penis). The prostate weighs approximately one ounce (28 g), and is walnut-shaped. It is partly muscular and partly glandular, with ducts opening into the urethra. It secretes an antigen called prostate-specific antigen (PSA), and a slightly alkaline fluid that forms part of the seminal fluid (semen) that carries sperm.
A common prostate disorder is called benign prostatic hyperplasia (BPH) or benign prostatic enlargement (BPE). BPH is due to hormonal changes in the prostate, and is characterized by the enlargement or overgrowth of the gland as a result of an increase in the number of its constituent cells. BPH can raise PSA levels two to three times higher than normal. Men with increased PSA levels have a higher chance of developing prostate cancer. BPH usually affects the innermost part of the prostate first, and enlargement frequently results in a gradual squeezing of the urethra at the point where it runs through the prostate. The squeezing sometimes causes urinary problems, such as difficulty urinating. BPH may progress to the point of generating a dense capsule that blocks the flow of urine from the bladder, resulting in the inability to completely empty the bladder. Eventually, this could lead to bladder and kidney malfunction.
Transurethral resection of the prostate (TURP) is the treatment of choice for BPH, and the most common surgery performed for the condition. "Transurethral" refers to the procedure being performed through the urethra. "Resection " refers to surgical removal.
Prostate disease usually occurs in men over age 40. BPH eventually develops in approximately 80% of all men. Prostate cancer occurs in one out of 10 men. In the United States, more than 30,000 men die of prostate cancer each year.
TURP is a type of transurethral surgery that does not involve an external incision. The surgeon reaches the prostate by inserting an instrument through the urethra. In addition to TURP, two other types of transurethral surgery are commonly performed, transurethral incision of the prostate (TUIP), and transurethral laser incision of the prostate (TULIP). The TUIP procedure widens the urethra by making small cuts in the bladder neck (where the urethra and bladder meet), and in the prostate gland itself. In TULIP, a laser beam directed through the urethra melts the tissue.
The actual TURP procedure is simple. It is performed under general or local anesthesia. After an IV is inserted, the surgeon first examines the patient with a cystoscope, an instrument that allows him or her to see inside the bladder. The surgeon then inserts a device up the urethra via the penis opening, and removes the excess capsule material that has been restricting the flow of urine. The density of the normal prostate differs from that of the restricting capsule, making it relatively easy for the surgeon to tell exactly how much to remove. After excising the capsule material, the surgeon inserts a catheter into the bladder through the urethra for the subsequent withdrawal of urine.
BPH symptoms include:
In evaluating the prostate gland for BPH, the physician usually performs a complete physical examination as well as the following procedures:
If the results of the DRE and PSA tests are indicative of a significant prostate disorder, the examining
To prepare for TURP, patients should:
When the patient awakens in the recovery room after the procedure, he already has a catheter in his penis, and is receiving pain medication via the IV line inserted prior to surgery.
The initial recovery period lasts approximately one week, and includes some pain and discomfort from the urinary catheter. Spastic convulsions of the bladder and prostate are expected as they respond to the surgical changes. The following medications are commonly prescribed after TURP:
When discharged from the hospital, patients are advised to:
Serious complications are less common for prostate surgery patients because of advances in operative methods. Nerve-sparing surgical procedures help prevent permanent injury to the nerves that control erection, as well as injury to the opening of the bladder. However, there are risks associated with prostate surgery. The first is the possible development of incontinence, the inability to control urination, which may result in urine leakage or dribbling, especially just after surgery. Normal control usually returns within several weeks or months after surgery, but some patients have become permanently incontinent. There is also a risk of impotence, the inability to achieve penile erection. For a month or so after surgery, most men are not able to become erect. Eventually, approximately 40–60% of men will be able to have an erection sufficient for sexual intercourse. They no longer ejaculate semen because removal of the prostate gland prevents that process. This effect is related to many factors, such as overall health and age. Other risks associated with TURP include:
TURP syndrome effects 2–6% of TURP patients. Symptoms may include temporary blindness due to irrigation fluid entering the bloodstream. On very rare occasions, this can lead to seizures, coma, and even death. The syndrome may also include toxic shock due to bacteria entering the bloodstream, as well as internal hemorrhage.
TURP patients usually notice urine flow improvement as soon as the catheter is removed. Other improvements depend on the condition of the patient's prostate before TURP, his age, and overall health status. Patients are told to expect the persistance of some pre-surgery symptoms. In fact, some new symptoms may appear following TURP, such as occasional blood and tissue in the urine, bladder spasms, pain when urinating, and difficulty judging when to urinate. TURP represents a major adaptation for the body, and healing requires some time. Full recovery may take up to one year. Patients are almost always satisfied with their TURP outcome, and the adaptation to new symptoms is offset by the disappearance of previous problems. For example, most patients no longer have to take daily prostate medication, and quickly learn to gradually increase the time between urinating while enjoying uninterrupted and more restful sleep at night.
Normal post-operative symptoms include:
To eliminate these symptoms, patients are advised to:
TURP reduces symptoms in 88% of BPH patients. TURP mortality rates are 0.2%, but they can be as high as 10% in patients over 80 years of age. Following surgery, inadequate relief of BPH symptoms occurs in 20–25% of patients, and 15–20% require another operation within 10 years. Urinary incontinence affects 2–4%, and 5–10% of TURP patients become impotent.
Conventional surgical alternatives for BPH patients include:
BPH patients have experienced improved prostate health from the following:
Recent developments in BPH treatment options include:
Barrett, D. M., ed. Mayo Clinic on Prostate Health: Answers from the World-Renowned Mayo Clinic on Prostate Inflammation-Enlargement Cancer. New York: Kensington Pub. Corp., 2000.
Blandy, J. P. & R. G. Notley. Transurethral Resection. Boston: Butterworth-Heinemann, 1992.
Childs, S. J. Laser-Assisted Transurethral Resection of the Prostate (TURP). Philadelphia: Lippincott, Williams & Wilkins, 1993.
Cimentepe, E., A. Unsal, and R. Saglam. "Randomized Clinical Trial Comparing Transurethral Needle Ablation with Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia: Results at 18 Months." Journal of Endourology 17 (March 2003): 103-7.
Kaplan, S. A. "Comparison of Long-term Results of Transurethral Incision of the Prostate with Transurethral Resection of the Prostate, in Patients with Benign Prostatic Hypertrophy." Journal of Urology 168 (October 2002): 1657.
Kumar, P. V., M. P. Gomes, B. L. Davies, and A. G. Timoney. "A Computer Assisted Surgical Trainer for Transurethral Resection of the Prostate." Journal of Urology 168 (November 2002): 2111-14.
Kursh, E. D., R. Concepcion, S. Chan, P. Hudson, M. Ratner, and R. Eyre. "Interstitial Laser Coagulation versus Transurethral Prostate Resection for Treating Benign Prostatic Obstruction: A Randomized Trial with 2-year Follow-up." Urology 61 (March 2003): 673-8.
McAllister, W. J., O. Karim, R. O. Plail, D. R. Samra, M. J. Steggall, Q. Yang, and C. G. Fowler. "Transurethral electrovaporization of the Prostate: Is it Any Better than Conventional Transurethral Resection of the Prostate." British Journal of Urology International 91 (February 2003): 211-14.
Merrill, R. M., & C. L. Wiggins. "Incidental Detection of Population-based Prostate Cancer Incidence Rates through Transurethral Resection of the Prostate." Urologic Oncology 7 (September/October 2002): 213-19.
van Melick. H. H., G. E. van Venrooij, M. D. Eckhardt, and T. A. Boon. "A Randomized Controlled Trial Comparing Transurethral Resection of the Prostate, Contact Laser Prostatectomy and Electrovaporization in Men with Benign Prostatic Hyperplasia: Analysis of Subjective Changes, Morbidity and Mortality." Journal of Urology 169 (April 2003): 1411-16.
Yung, P. M., S. Chui-Kam, P. French, and T. M. Chan. "A Controlled Trial of Music and Pre-operative Anxiety in Chinese Men Undergoing Transurethral Resection of the Prostate." Journal of Advanced Nursing 39 (August 2002): 352-9.
Cancer Information Service. National Cancer Institute, Building 31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800)4-CANCER.  .
"Anatomy of the Prostate Gland." University of Maryland Medicine. http://www.umm.edu/prostate/panat.htm .
"Prostate Disease Awareness." Monash University. http://www.med.monash.edu.au/healthpromotion/pamphlets/prostate/index.html .
Monique Laberge, Ph.D.
Transurethral resection of the prostate is performed in hospitals by experienced urologic surgeons who are specialized in prostate disorders and in performing the TURP procedure.