Transurethral Resection Of The Prostate
Transurethral Resection of the Prostate (TURP) is a surgical procedure that treats benign prostatic hyperplasia (BPH) symptoms. TURP is considered a standard treatment for moderate to severe BPH symptoms and has been widely performed for decades. This operation helps restore normal urine flow in most patients and significantly improves their quality of life.
How Transurethral Resection of the Prostate Works?
Transurethral Resection of the Prostate (TURP) is a surgical technique used to treat urinary problems due to benign prostatic hyperplasia (BPH). During the procedure, a resectoscope is inserted through the urethra, equipped with a light, camera, and a loop that cuts tissue. Then the excess prostate tissue blocking urine flow is carefully trimmed away.
This precise removal ensures that only the obstructive tissue is excised, leaving the rest of the urethra intact. The procedure aims to restore normal urinary function by enlarging the urethral passage, thus relieving BPH symptoms.
Indications for TURP
Transurethral Resection of the Prostate (TURP) is typically indicated for men with moderate to severe urinary symptoms due to benign prostatic hyperplasia (BPH) that has not improved with medication. Here are the specific conditions that might warrant this surgical procedure:
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Persistent Urinary Symptoms
Such as frequent urination, urgency, urinary retention, and weak urine stream that significantly impair quality of life.
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Recurrent Urinary Tract Infections
Occurring due to incomplete bladder emptying.
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Bladder Stones
Formed as a consequence of chronic urinary retention.
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Haematuria
Presence of blood in the urine due to severe BPH.
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Intolerance or Ineffectiveness of Medications
For patients who cannot tolerate BPH medications or in cases where such drugs are ineffective.
Preoperative Considerations
Before undergoing Transurethral Resection of the Prostate (TURP), several important preoperative considerations must be addressed to ensure patient safety and optimal surgical outcomes:
- Medical and Medication Review: A comprehensive health assessment, including a review of all current medications, especially blood thinners, may need adjustments or temporary cessation to minimise surgical bleeding risks.
- Urinary Tract Assessment: This includes tests such as urine analysis to rule out infections and imaging studies to evaluate the bladder and kidneys.
- Anesthesia Evaluation: Consult with an anesthesiologist to determine the safest form of anaesthesia based on the patient’s health.
The TURP Procedure
The Transurethral Resection of the Prostate (TURP) procedure is a minimally invasive surgical technique used to treat urinary symptoms from benign prostatic hyperplasia (BPH). The following describes the TURP procedure in detail:
- Anaesthesia: The procedure typically requires either general or spinal anaesthesia to ensure that the patient feels no pain during the operation.
- Insertion of the Resectoscope: A resectoscope, which is a thin, tube-like instrument with a light, camera, and loop at the end, is inserted through the tip of the penis into the urethra.
- Resection of the Prostate: Using a loop, pieces of the enlarged prostate blocking urine flow are carefully shaved off. This tissue is cut into small pieces and is flushed out of the bladder with irrigation fluid.
- Hemostasis: During the procedure, surgeons control bleeding by cauterising blood vessels using an electric current or laser.
- Catheter Insertion: After the procedure, a catheter is typically inserted to help drain the bladder and allow healing. The catheter usually remains in place for several days after the operation.
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Postoperative Care and Recovery
Key aspects in postoperative care and recovery include:
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Catheter Care
Patients may need to manage a catheter at home, typically removed within a few days.
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Monitoring for Complications
Watch for fever, severe pain, difficulty urinating, or unusual discharge, indicating potential complications.
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Pain Management
Prescribed medications help manage mild to moderate discomfort.
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Activity Restrictions
Avoid strenuous activities and heavy lifting for 4-6 weeks to ensure proper healing.
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Follow-Up Appointments
Regular check-ups monitor recovery and assess the procedure's effectiveness.
Potential Complications of TURP
While Transurethral Resection of the Prostate (TURP) is generally safe, it does carry potential risks and complications, similar to any surgical procedure. Key complications include:
- Bleeding: Some patients may experience significant bleeding during or after surgery, which might require blood transfusions.
- Infection: A risk of urinary tract infections or sepsis following TURP, necessitating prompt treatment.
- Urinary Incontinence: Some men may suffer temporary or, rarely, permanent loss of bladder control.
- Urethral Stricture: Scar tissue can form in the urethra, causing narrowing and obstructed urine flow, which may require further treatment.
- Retrograde Ejaculation: Many men experience retrograde ejaculation after TURP, where semen flows into the bladder instead of exiting the penis during orgasm.
Dr Lee Fang Jann 
Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders
He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).
- Bachelor of Medicine and Bachelor of Surgery (Singapore)
- Membership of The Royal College of Surgeons (Edin)
- Master of Medicine (Surgery) (Singapore)
- Fellowship of the Academy of Medicine (Urology)
- Clinical fellowship at Oxford Transplant Centre in the UK
Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.
Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.
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Frequently Asked Questions
How long does the TURP surgery take?
Typically, TURP takes about 60 to 90 minutes to perform, depending on the size of the prostate and the amount of tissue to be removed.
When can I expect to return to normal activities?
Most patients can resume normal, non-strenuous activities within a few weeks post-surgery. However, full recovery and the ability to undertake heavy lifting or strenuous activities can take up to six weeks.
Will TURP affect my sexual function?
TURP primarily affects ejaculatory function due to retrograde ejaculation but usually does not impact erectile function.
Can BPH recur after TURP?
TURP removes the tissue causing symptoms at the time of surgery, but it does not stop the prostate from growing. In some cases, additional treatment may be needed if symptoms reoccur due to continued prostate growth.