Transurethral resection of the prostate (TURP) is an operation to treat urinary blockage caused by an enlarged prostate. The prostate can become enlarged for a number of reasons including benign prostatic hyperplasia (BPH) and prostatitis. Sometimes this operation is referred to as a "re-bore".
Urology Associates also offers laser prostatectomy or HoLEP (Holmium laser enucleation of the prostate). Your urologist will let you know if this option is right for you.
When the prostate tissue enlarges, it squeezes inward on the urethra causing some or all of the following symptoms:
- The need to urinate often (frequency)
- The need to urinate in a hurry (urgency)
- The need to get up at night to urinate (nocturia)
- Difficulty starting urination (hesitancy)
- Difficulty stopping urination (terminal dribbling)
- Weak stream
- Incomplete emptying of the bladder
- Urinary retention
Deciding to have a TURP or HoLEP
To assist in the decision-making process, your surgeon may:
- Get you to complete a symptom score questionnaire determining how bothersome your condition is
- Perform a digital rectal exam (DRE) to assess the size of your prostate
- Arrange a flow & residual test to record the rate at which you pass urine and to see if you are retaining any urine
- Ask for a urine specimen to check for infection
- Obtain PSA and creatinine blood tests to determine the likelihood of cancer and the health of the kidneys
- Look inside your bladder, a procedure called a flexible cystoscopy
Other factors including your general health will be taken into consideration when deciding whether to proceed with the operation. Occasionally a test called urodynamics may be recommended if it is thought that something other than prostate enlargement is the cause of your problems with passing urine.
Before your operation
The operation and outcomes will be explained to you by your surgeon. When you feel comfortable that you understand what is to be done and have had all your questions answered you will be asked to sign a consent form which needs to be signed by you and your surgeon.
As part of our standard surgery work up, you may require:
- Blood & urine tests in the days prior to surgery: you will be given a form to take to the laboratory for these
- Electrocardiogram (ECG) test to check the electrical activity of your heart, if you are over 60 or have other medical conditions
It is important to avoid constipation. Try to establish and maintain a regular, soft bowel habit leading up to your operation. Identify the foods that can help you maintain a regular bowel habit for your post op period.
You will usually be advised of your admission time the day before your operation. Follow the instructions given to you in your operation pack about when to stop eating and drinking, usually 6 hours before surgery. Bring all your own medications with you to hospital.
The choice of spinal or general anaesthetic will be decided after discussion with the anaesthetist. You may be given a pre-medication tablet to help you relax. You will be encouraged to commence deep breathing and coughing exercises pre-operatively. This prevents any breathing complications or chest infection occurring following the surgery and anaesthetic.
During the operation a telescopic instrument called a resectoscope is passed up the urethra. In a TURP, this is used to 'chip' away the enlarged prostate with an electrical wire loop that cuts and seals blood vessels. In a HoLEP, a laser fibre is passed through the instrument which cuts away the inside of the prostate gland.
After the operation, the bladder is flushed with a solution to remove the chippings of prostate tissue. A catheter is then inserted through the urethra into the bladder to drain your urine into a catheter bag. The operation usually takes from 30-60 minutes, depending on the size of the prostate gland. Hospital stay is usually one night, occasionally two nights.
When the operation is completed, you will go to the recovery room for a short while where you will be cared for until you are ready to be transferred to your room. When you wake up it is common to feel an urgent desire to pass urine. This is due to the catheter in your bladder.
Your nurse will monitor your catheter drainage. You may have continuous bladder irrigation (instillation of sterile fluid into the bladder, flushing blood and debris out through the catheter).
Your catheter usually is left in overnight and removed the day after surgery. The catheter is removed by deflating the balloon holding it in place. Once the balloon is deflated, the catheter slides out easily causing little discomfort.
Once the catheter comes out you may at first have a burning sensation when passing urine.
After surgery, you may or may not experience some of the following symptoms:
- A burning sensation and a strong desire to go to the toilet. These symptoms are due to the passage of urine over the healing area of the urethra following the removal of the prostate tissue. This can be easily treated with mild pain relievers and medication which change the acidity of the urine. These symptoms should resolve after a 4-6 week period.
- A stinging or burning sensation at the tip of the penis where the catheter enters. This is generally due to irritation and may be relieved by increasing fluid intake or ensuring the catheter is well supported.
- A follow-up appointment will be arranged to see your surgeon approximately 6 weeks after your operation.
- Drink extra fluids after your surgery and for a few weeks after you are discharged. This helps flush the bladder, clears up bleeding and washes away debris.
- It takes time for the surface inside the prostate cavity to heal. Until it does you may have some discomfort passing urine and experience some urgency, frequency and nocturia. These symptoms will subside as healing progresses and can be relieved with the help of mild pain relievers and other medication that you will be informed about.
- You may notice that you pass blood when going to the toilet: this is usually at the beginning of the urine stream. This is normal after this surgery and may last for up to 6 weeks.
- You can do most activities after your operation except any heavy lifting, straining, intercourse or strenuous activity which should be avoided for 2-3 weeks after surgery. You will be able to continue with your normal daily routines as you feel able.
Bleeding severe enough to bring you back to the hospital is rare. This risk disappears when healing is complete, 6-8 weeks after surgery. If you have fresh heavy bleeding that does not stop or if you are unable to pass your urine at all it may be due to a blood clot blocking the urethra. If either of these unlikely events should occur you should contact your surgeon or GP immediately, or go to your nearest Emergency Department.
Incontinence, or leakage of urine without control, may occur temporarily and last for a few weeks. Urgency is common. If you have any incontinence after your operation you will be given information and instructions about exercises that you can do to strengthen the pelvic floor muscles.
In a small number of cases, narrowing may develop in the urethra. This may occur either near the tip of the penis or further up the urethra several months after the operation. You may notice your urinary stream, which was better after the operation, slows down again. Please mention this problem to your doctor. If detected early, and treated with gentle stretching under local anaesthetic, most strictures resolve. An operation to cut open the tight area may be appropriate.
If you are sexually active before the operation, once your recovery is complete, you should expect a return to your sexual function. Loss of sexual function is very rare after this surgery.