Transurethral Resection of Prostate (TURP)
When bothersome urinary symptoms due to an enlarged prostate is diagnosed, and treatment with medications for symptom relief fails, a transurethral resection of the prostate (TURP) in Houston may be needed.
The prostate gland is a pelvic organ found in men – located just beneath the bladder – that has the potential to obstruct the urinary outlet, or urethra. The gland grows with age, but if it grows too large, it can exert pressure on the urethra and obstruct the flow of urine.
This condition is called benign prostatic hypertrophy. BPH causes urinary problems including:
- Difficulty emptying the bladder
- Urinary urgency and frequency
- Frequent trips to the bathroom disrupting sleep
- Inability of bladder to empty
- Weakening of the urine stream
- Difficulty starting to urinate
- Stopping and starting again while urinating
What Is a Transurethral Resection of Prostate (TURP)?
Transurethral resection of the prostate (TURP) is a procedure that involves the surgical removal, or resection, of the inside of an enlarged prostate gland. This is achieved using a surgical instrument called a resectoscope (thin metal tube with light source, camera and cutting tool). TURP is performed through the urethra without any cuts or incisions necessary.
Bipolar TURP is a newer technology that allows for less bleeding, quicker recoveries, and minimal complications from fluid shifts seen in earlier versions of TURP with monopolar technology.
Am I an Ideal Candidate for Transurethral Resection of the Prostate (TURP)?
If you have bothersome urinary problems due to an enlarged prostate, you may be a good candidate for transurethral resection of the prostate (TURP). Typically, men who opt for TURP have failed more conservative management, such as decreasing fluids prior to bed, weight loss, and pelvic floor exercises like Kegels.
Medications are often prescribed to help relax or shrink the prostate – if these drugs are not helpful a TURP may be recommended. TURP is the gold-standard procedure for BPH treatment; it has been performed safely and effectively for over a decade by Dr. Dhir. The first TURP was performed in 1926!
In addition to a TURP improving bothersome urinary symptoms, a TURP is highly recommended in the following situations:
- Recurring blood in the urine
- Complete inability to urinate – or urinary retention – necessitating a drainage tube called a foley catheter
- Presence of Bladder stones
- Hydronephrosis – a condition where urine backs into the kidneys because the bladder does not properly drain
- Recurring urinary tract infections from BPH
Speak with your Dr. Dhir if you have other medical issues, such as chronic heart or lung diseases, which may increase your risk for any surgical procedure, including TURP.
Patients on blood thinners would need to have a clearance note from their cardiologist; they would also need to be off their blood thinner for 5 days prior to the procedure and to continue off these medications for at least 28 days after the TURP.
What are the surgical steps of a TURP?
TURP is performed under general or spinal anesthesia. Your surgeon inserts the resectoscope into the penis and advances it through the urethra. The cutting tool is guided through the resectoscope and is heated with the help of an electric bipolar energy current. The heated wire is used to cut and remove the blocking internal prostate tissue in what is called the transition zone. The whole prostate is not removed, as the outer shell, or peripheral zone, remains untouched.
At the end of the procedure, the blood vessels are sealed back carefully, and the bladder is irrigated to flush out all resected pieces of tissue. This tissue is sent to a pathologist to identify any traces of prostate cancer.
The complete surgery takes about 1 hour. Dr. Dhir usually sends patients home the same day, but there is a small chance you may have to stay in the hospital overnight for observation.
What are possible complications from a TURP?
TURP may be associated with certain complications including:
- Dry orgasm. Semen does not ejaculate from the penis but instead flows into the bladder. This is also known as retrograde ejaculation. You will still be able to have an orgasm during sex after a TURP.
- Urinary incontinence. Loss of bladder control after TURP is a very rare complication. The sphincter muscle below the prostate that holds urine is avoided during a TURP.
- Urinary tract Infection. Antibiotics will be given during and after the procedure to minimize this risk.
- Temporary irritative urinary symptoms. Includes burning with urination and worsening urinary urgency or frequency. These symptoms improve quickly after TURP, and most symptoms completely resolve after 4 weeks.
- Scar tissue formation. Bladder neck contractures or urethral scars occur in < 5% of cases.
- Erectile dysfunction: weakening of erections in about 10% of patients.
- Need for repeat TURP. Although TURP is usually a life-long relief of BPH symptoms, a minority of patients may need the procedure repeated due to regrowth of obstructing tissue.
What is the Post-Operative Recovery like after TURP?
The recovery period takes 4 to 6 weeks. A foley catheter, or drainage tube, will be in your bladder for about 3 days after procedure and removed in the clinic. Once removed, patients usually experience a very quick improvement of urinary symptoms. Irritative voiding symptoms are managed with medication and increasing fluids.
You will be able to walk around immediately after TURP, and pain medication is never necessary as there are no cuts or incisions made. Antibiotics during and after the procedure are used to prevent urinary tract infections.
Avoid strenuous exercise, heavy lifting over 10 pounds, and sexual intercourse for 6 weeks after a TURP to minimize risk of bleeding. As a general rule, blood thinners should not be taken until at least 4 weeks after the procedure.
What are Other Surgical Alternatives to TURP?
TURP is the gold-standard for BPH treatment after medication failure for bothersome urinary symptoms. Alternatives do exist, such as minimally-invasive procedures like UroLift or Rezum.
Furthermore, GreenLight Laser Vaporization of the Prostate, Robotic Simple Prostatectomy, and Prostatic Artery Embolization are also options in specific cases.
To learn more about these alternatives, please discuss this with Dr. Dhir to see if you are a candidate.
What is Needed in Consultation for a TURP?
Your consultation with Dr. Dhir at HTX Urology will involve a thorough evaluation of your overall health including a medical history and physical exam. Your symptoms and risk factors will be measured and discussed in-depth to ensure you are qualified for a TURP.
Diagnostic testing is needed to rule out prostate cancer or other urinary condition. A PSA blood test is drawn to rule out risk of prostate cancer. A cystoscopy, transrectal ultrasound of the prostate, and UroCuff are required to determine if you are a good surgical candidate. These tests usually take just a few minutes in the office with minimum discomfort. Nitrous Oxide, or laughing gas, is available for your comfort during these office tests.
Contact Us Today
Find out more about how effective a TURP in Houston, League City, and Clear Lake, Texas can be for relieving the symptoms of BPH. Contact us today to schedule your consultation with Dr. Dhir, who sees patients Monday through Wednesday in the clinic.