Definition The prostate gland is located in the pelvis just below the bladder. Its main role is to secrete substances into the semen that help sperm fertilise a woman's egg. As men age, it is not uncommon for the prostate gland to become enlarged. When enlarged, the gland can press against the urethra, which is the tube that allows urine to pass from the bladder to the outside of the body. This can interfere with a man's ability to urinate. A transurethral resection of the prostate (TURP) is an operation to relieve this problem.
Who is a candidate for the procedure? TURP is advised for some men with an enlarged prostate and problems with urination. Medications are usually tried first. TURP is often advised for men who cannot tolerate medications, do not want to take medications or are not helped by medications.
TURP is sometimes used when there are urinary problems caused by prostate cancer. The goal of the operation in this case is to treat the blockage, not to manage the cancer. Other treatments are needed for the cancer.
How is the procedure performed? The surgery is performed in the hospital. A urologist performs the operation. A urologist is a surgeon who treats people with diseases of the kidney and urinary tract. The man first goes to the surgery preparation area. There, an IV, or thin tube, is placed into an arm vein. This allows fluids and drugs to be given during the procedure. The anaesthetist, or pain specialist, and the surgeon usually see the person just before surgery. The person is then taken to the operating or procedure room. Pain medication is given to prevent pain. The man may be awake or completely asleep during the procedure. This depends on the type of pain control, or anaesthesia, used.
Next, the doctor inspects the urethra and bladder with an endoscope. An endoscope is a special tube with a camera on the end of it. This scope allows the surgeon to see the inside of the body. The scope is passed through the tip of the penis, then into the urethra and bladder. This is to double check that the planned operation is correct. It is also to look for any unplanned problems such as bladder tumours or stones in the bladder.
Next, an electrical loop is passed into the urethra. The loop is placed near the part of the urethra that is surrounded by the prostate. The loop is used to cut out pieces of tissue from the prostate that bulge into or block the urethra. This process is similar to coring an apple. Electricity is applied through the same loop to stop bleeding.
After the procedure is over, the pieces of the prostate that were trimmed away are removed. The tissue is sent to the laboratory to make sure that an unsuspected cancer is not present. A urine catheter, or hollow tube to drain urine from the bladder, is then inserted through the penis and into the bladder.
What happens right after the procedure? The man usually stays in the hospital for at least a day after the procedure. Urine from the bladder is drained through the catheter. The urine contains a fair amount of blood at first. The catheter can be removed when the amount of blood in the urine is minimal. Sometimes, the catheter is irrigated with water to help keep the urine clear. The urine usually clears between several hours to 2 days after the procedure. If possible, the catheter is removed before the man leaves the hospital. Men may need to go home with the catheter still in the bladder. It can be removed later when the swelling from the operation resolves.
What happens later at home? Once home, the individual should drink plenty of fluids. This helps wash any remaining blood out of the bladder. This is important since clotting of the blood could create a urinary blockage. The man should also avoid heavy lifting for several weeks after this procedure. This activity could result in bleeding. Pain medication can be used as directed if needed.
What are the potential complications after the procedure? The main side effect of TURP is retrograde ejaculation. This is when semen flows back into the bladder during ejaculation. Normally, semen is ejected out through the end of the penis. For the most part, this problem does not affect a man's ability to have an erection or an orgasm. It does, however, make him infertile. Men who wish to father children should understand this side effect before considering the procedure.
Symptoms such as weak urine stream and inability to completely empty the bladder go away quickly following a TURP procedure. Other symptoms such as the need to urinate frequently and incontinence may take longer to clear up. Sometimes, certain drugs, such as oxybutynin or tolterodine, can be used to "calm" the bladder until these symptoms go away. Most of the time this medication is needed only temporarily. Occasionally, these drugs may have to be taken long term.
Roughly 15% of men do not have good results with a TURP. Sometimes this is because not enough of the prostate gland was removed at the time of the surgery. In other cases, the procedure fails because the person was not a good candidate for the operation in the first place. This is often true for men who have suffered lasting bladder damage from the effects of an enlarged prostate. The bladder muscle may be too weak to push out the urine.
Following TURP, a catheter may need to be put back into the bladder temporarily after the procedure. This probably occurs because of swelling at the site. This problem comes up in 4 to 6% of cases. The catheter is usually needed only for a few days.
Less than 3% of patients will require a blood transfusion following TURP because too much blood was lost from the procedure.
Other complications include urinary incontinence, or the inability to control urine and impotence. An abnormal narrowing, or stricture of the urethra may cause trouble with urination.
Author: Stuart Wolf, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
