Transurethral Resection of the Prostate (TURP) is a surgical procedure primarily used to treat symptoms associated with benign prostatic hyperplasia (BPH), a common condition affecting the prostate gland in men as they age. This procedure involves removing part of the prostate gland through the urethra, relieving urinary symptoms and improving quality of life.
Indications for TURP
TURP is indicated for men who experience significant urinary symptoms due to BPH that have not improved with conservative treatment options, such as medication. The typical symptoms that might warrant a TURP include:
Persistent Symptoms
- Frequent urination, especially at night (nocturia)
- Urgency to urinate
- A weak urine stream
- Difficulty starting urination (hesitancy)
- Stopping and starting again while urinating
- The feeling of incomplete bladder emptying
Complications from BPH
- Recurrent urinary tract infections
- Bladder stones
- Bladder damage
- Kidney damage
- Severe urinary retention
TURP is also considered for patients who are unable to tolerate medications due to side effects or for whom medical therapy has failed to alleviate symptoms effectively. The decision to proceed with TURP considers the severity of symptoms and their impact on the patient’s quality of life.
Preparing for TURP Surgery
Before undergoing TURP, patients must complete several preparatory steps to ensure the safety and effectiveness of the procedure. These preparations include:
- Pre-Surgical Assessment: Includes a detailed medical history review, physical examination, blood tests to evaluate overall health, urine tests to check for infections or other urinary issues, ultrasound of the kidneys and bladder, urodynamic tests, and cystoscopy to examine the urethra and bladder.
- Medication Management: It is necessary to adjust or discontinue certain medications, especially blood thinners such as warfarin or aspirin, to decrease bleeding risks. Managing medications that could affect blood pressure is also important because stable blood pressure is crucial during surgery.
- Lifestyle Adjustments: Recommendations include ceasing smoking several weeks before surgery to improve recovery, avoiding alcohol consumption for at least a week before the procedure, and arranging for post-surgery home assistance as mobility may be temporarily limited.
- Day Before Surgery: Depending on the anaesthetic used, patients may need to fast for 8-12 hours. They must also follow specific instructions related to hydration or bowel preparation.
The TURP Procedure: What to Expect
TURP procedure is performed under general or spinal anaesthesia, ensuring that the patient experiences no pain during the surgery. Here is what typically happens during a TURP procedure:
- Anaesthesia: Before the procedure, the patient receives general anaesthesia to induce sleep or spinal anaesthesia to numb the lower body.
- Procedure Start: The urologist inserts a resectoscope through the urethra. This instrument is equipped with a light, camera, and loop of wire. No external incisions are made.
- Resection of the Prostate: The wire loop is heated with an electric current and used to shave off enlarged prostate sections that block urine flow. The irrigating fluid carries these pieces of the prostate into the bladder, which are then flushed out at the end of the procedure.
- Monitoring: Throughout the procedure, vital signs such as blood pressure, heart rate, and oxygen levels are closely monitored.
- Procedure End: The total duration of the procedure typically ranges from 60 to 90 minutes, depending on the size of the prostate and the amount of tissue to be removed.
- Recovery Room: After the surgery, the patient is moved to a recovery room, closely monitored as the anaesthesia wears off.
Patients typically spend 1 to 2 nights in the hospital following TURP, although this can vary based on the person’s circumstances. They receive pain management and support to ensure comfort and monitor any immediate post-operative complications. This procedure has a high success rate in relieving urinary symptoms caused by BPH, and many patients experience a significant improvement in their quality of life.
Postoperative Care and Recovery
After undergoing TURP, effective postoperative care is crucial for a smooth recovery and optimal outcomes. Here are the key aspects of postoperative care and recovery:
- Catheter Care: A catheter is usually in place for several days after the surgery to aid in urination while the prostate and urethra heal. Proper care of the catheter is essential to prevent infections and ensure it functions correctly.
- Pain Management: Patients may experience mild to moderate discomfort after the procedure. Pain management typically involves prescribed medications to alleviate any discomfort.
- Activity Restrictions: To promote healing, patients are advised to avoid strenuous activities and heavy lifting for several weeks. A gradual increase in activity is recommended based on the person’s recovery.
- Hydration: Increased fluid intake is encouraged to help flush the bladder and reduce the risk of urinary tract infections.
- Monitoring for Complications: Patients should monitor for signs of complications, such as severe pain, fever, difficulty urinating, or bleeding. Immediate medical consultation is required if any of these symptoms occur.
- Follow-Up Visits: Regular follow-up visits with the urologist are necessary to monitor recovery and manage any lingering or emerging symptoms. These visits are also important to assess the procedure’s effectiveness in relieving urinary symptoms.
- Long-Term Care: Lifestyle adjustments such as maintaining a healthy diet, regular exercise, and avoiding excessive fluid intake in the evening can help sustain the procedure’s benefits.
The recovery period can vary, but most patients notice improvement in urinary symptoms within a few weeks, with continued improvement over the following months. Patients must follow all postoperative instructions and attend all scheduled follow-up appointments to ensure the best possible outcome.
Potential Risks and Complications
While TURP is generally safe and effective, like any surgical procedure, it carries potential risks and complications. Patients considering TURP should be aware of these possible issues:
- Bleeding: One of the more common complications of TURP is bleeding. In some cases, significant bleeding might require blood transfusions or additional interventions.
- Infection: There is a risk of urinary tract infections or, more rarely, infections that can spread to the bloodstream (sepsis). Prophylactic antibiotics are often prescribed to mitigate this risk.
- TURP Syndrome: Although rare due to improvements in surgical techniques, TURP syndrome can occur when the body absorbs too much of the fluid used to irrigate the prostate during surgery. This can lead to fluid overload, low sodium levels, and other metabolic disturbances.
- Urinary Incontinence: Some patients may experience temporary or, rarely, long-term urinary incontinence following the procedure. This is generally manageable with medical therapies and pelvic floor exercises.
- Retrograde Ejaculation: Most men undergoing TURP will experience retrograde ejaculation, where semen enters the bladder instead of exiting through the urethra during ejaculation. This condition is usually harmless but can affect fertility.
- Urethral Stricture: Scar tissue can form in the urethra or bladder neck after TURP, leading to a narrowing that can obstruct urine flow. This may require additional treatment.
- Erectile Dysfunction: While TURP primarily affects urinary function, it can sometimes impact sexual function, although this is a less common complication.
Conclusion
TURP is a surgical technique for alleviating symptoms of BPH. It is recognised for its efficacy in improving many patients’ urinary function and overall quality of life. Prospective patients should engage in detailed discussions with their urologist to weigh the benefits against potential risks.
