What is a TURP?
A TURP is an operation that removes the obstructing part of the prostate gland that is causing your urinary symptoms. This allows a free flow of urine.
What is the Prostate?
The prostate is a walnut-sized gland that sits at the base of the bladder surrounding the urethra, the tube through which you urinate. As you get older, the prostate gland grows and can cause an obstruction to the flow of urine leaving the bladder thus causing problems urinating.
Why do I need a TURP?
You are having significant problems or bother passing water, and may have stopped passing water altogether (urinary retention).
How is a TURP performed?
The operation is performed under general or local (spinal) anaesthesia. It is performed through a telescope passed up the pipe of the penis, and therefore there are no external cuts or scars. An electrical loop is used to cut away small parts of the central portion of the gland, until there is a wide cavity with no obstructing tissue. The pieces of the prostate are sent away to the pathologist for examination. When I have finished the operation, I pass a catheter in to the bladder, which drains the urine and helps to wash away any blood. This catheter stays in for 24-48 hours.
What are the risks, consequences and alternatives associated with having a turp?
Most procedures are straightforward; however as with any surgical procedure there is a chance of side effects or complications.
Serious or frequently occurring risks
Common (greater than 1 in 10)
- Temporary mild burning, bleeding or frequency of urination after the procedure.
- No semen is produced during orgasm in 80% patients after the procedure (retrograde ejaculation).
- May not relieve all prostatic symptoms 10-20%.
Occasional (between 1 in 10 and 1 in 50)
- Temporary loss of urinary control (incontinence) which improves over time
- Erectile dysfunction – difficulty in achieving or maintaining an erection (5-10%). Some men’s sexual function improves after surgery.
- Urine infection requiring antibiotics.
- Bleeding requiring return to theatre and / or blood transfusion.
- Finding unsuspected cancer in the removed tissue, which may necessitate further treatment.
- Possible need to re-operate in future due to recurrent obstruction (10%).
- Failure to pass urine after surgery requiring another catheter.
Rare (less than 1 in 50)
- Permanent loss of urinary control (incontinence) which may require additional surgery to correct 1%
- The need to self-catheterise after the procedure to fully empty the bladder.
- Delayed scar formation in the urethra or opening into the bladder which can cause recurrent obstruction (urethral or bladder neck stricture)
- Absorption of irrigation fluids causing confusion.
- Very rarely perforation of the bladder requiring temporary insertion of a catheter or open surgical repair.
Alternatives to TURP
TURP is still considered the gold standard for management of urinary obstruction due to an enlarged prostate. The alternatives are:
- Medication (alpha blocker, Proscar, Duodart)
- Urolift Procedure.
- Laser Prostatectomy
- Open prostate operation (for very large prostates >200 cc)
- Prostatic arterial embolisation
- Observation of symptoms
- Long-term catheter or intermittent self-catheterisation
What type of anaesthetic will I have?
TURP can be performed under a general anaesthetic or a spinal anaesthetic where you will be numb from the waist down. The anaesthetist will visit you before the operation to discuss the alternatives. The anaesthetist will also check that you are fit enough for the anaesthetic.
Getting ready for the operation
If you smoke, try and cut down or preferably stop, as this reduces the risks of heart and chest complications during and after the operation. If you do not exercise regularly, try and do so for at least half an hour per day e.g. brisk walk or swimming.
You will be given a form to have routine pre operative blood tests and a urine test to exclude infection before your surgery – if you have lost your a form please contact Dr Nathan’s rooms.
If you are on medication to thin the blood such as warfarin, aspirin, Plavix, Iscover, Brilinta, Pradaxa, Xarelto or supplements such as fish oils please let Dr Nathan know at least 2 weeks before surgery as these medications may need to be discontinued to prevent excessive bleeding at the time of surgery. You can continue to take your other medications as normal.
Speak to the anaesthetist about your anaesthetic (details available form my receptionist)
What should I expect after the operation?
After your operation you will normally go back to the surgical ward. You can start eating and drinking as soon as you recover from the anaesthetic.
Because there are no external cuts, this procedure is relatively pain free. You may experience some discomfort from the catheter, but this is usually easily treated with mild painkillers.
A urinary catheter is a tube that runs from the bladder out through the tip of the penis and drains into a bag. It is important to drain the urine in this way until the urine as clear. Your catheter is usually removed 24-48 hours after your operation.
Before you are allowed home
- You must be passing water without difficulty.
- You must have had your bowels open.
- Mild painkillers such as Paracetamol must adequately control any pain.
- Your temperature must be normal.
Discharge information and home advice
It is quite normal to see an occasional show of blood during the first month after surgery – this is due to the healing of the operation site. If you see blood, simply increase your fluid intake. If you have prolonged bleeding (>24 hours) or increasing difficulty passing water, please contact your GP or Urologist. In case of emergency call attend your nearest emergency department or call an ambulance.
Mild painkillers such as Paracetamol should be enough to deal with any pain
It is important that you do not get constipated. There are no dietary restrictions but you should try and eat plenty of fruit and vegetables and wholemeal bread. If you feel that you may be constipated, see your GP.
You should take it easy for a month, although it is important to take some gentle exercise like walking, as you will be at a slight risk of developing a blood clot in your legs if you do not keep mobile.
During the first 2 weeks you should not:
- Lift or move heavy objects.
- Dig the garden.
- Carry shopping.
It is safe to resume normal sexual activity 2 weeks after your surgery.
Recovery takes 4-6 weeks from your operation date; I will be able to advise you when it will be safe to return to work as this depends on your occupation – you may be able to resume a sedentary office job after only a week or two but may need to take a month off if you have a strenuous job. A sick note for your hospital stay and recovery period can be obtained from your family doctor or my rooms.
You may resume driving a motor vehicle after 1-2 weeks if you feel well and do not have significant pain or discomfort. You should initially commence this with small trips and you should avoid any long car trips for at least four weeks.
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.