Transurethral resection of the prostate (also known as TURP, plural TURPs and as a transurethral prostatic resection, TUPR) is a urologicaloperation.

It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients.
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1 Indications 2 Risks 3 See also 4 References

[edit]Indications BPH is normally initially treated medically. This is done through alpha antagonists such as Flomax or alpha-1A reducatase inhibitors such as Proscar andAvodart. If medical treatment does not reduce a patient's urinary symptoms, a TURP may be considered- following a careful examination of the prostate/bladder through a cystoscope. As medical management of BPH improves, the numbers of TURPs have been decreasing. If TURP is contraindicated a Urologist may consider: a simple prostatectomy, in and out catheters, or a supra-pubic catheter to help a patient void urine effectively. [edit]Risks Because of bleeding risks associated with the surgery, TURP is not considered safe for many patients with cardiac problems. Postoperative complications include [1]     Bleeding (most common) Clot retention and clot colic Bladder wall injury such as perforation (rare) TURP Syndrome: Hyponatremia and water intoxication (symptoms resembling brain stroke in an elderly presenting patient) caused by an overload of fluid absorption from the open prostatic sinusiods during the procedure. This complication can lead to confusion, changes in mental status, vomiting, nausea, and even coma. To prevent TURP syndrome the 1) length of the procedure is limited to less than one hour in more centers, and 2) the height of the container of irrigating solution above the surgical table determining the hydrostatic pressure driving fluid into the prostatic veins and sinuses is kept to a minimum. Bladder neck stenosis

 

Urinary incontinence due to injury of external sphincter system which may be prevented by taking the Verumontanum of the prostate as a distal limiting boundary during TURP Retrograde ejaculation due to injury of preprostatic (internal) sphincter system

Additionally, transurethral resection of the prostate is associated with a low risk of mortality.
A Trans-urethral Resection of the Prostate (TURP) is an minimally-invasive operation, performed by your urologist, to remove the parts of your prostate gland that are pressing on your urethra in order to allow urine to flow more freely. The urologist passes a special tube through your urethra and uses a heated wire loop to shave off the overgrown areas of your prostate gland. In this way TURP is not an open surgery, and there will be no incisions or scars. Not everybody with an enlarged prostate gland will require a TURP; however your urologist may recommend this procedure to you on the basis of your symptoms and the results of special investigations they have carried out. By allowing urine to flow more freely, a TURP can often relieve or reduce your symptoms. Know about your prostate gland- Your prostate (see diagram) is a walnut-sized gland that lies at the base of your bladder (where urine is stored) surrounding the urethra (the tube that passes urine from your bladder, along your penis and out of your body).

The prostate gland is found only in males, and is part of the reproductive system. It produces nutrients for the sperms and produces components that make up the milky fluid (semen) that you produce when you ejaculate. The most common cause of prostate gland enlargement is 'Benign Prostatic Hyperplasia', often shortened to 'BPH', which means extra-growth of normal (non-cancerous) cells. This process often begins at the age of 40, causing your prostate to gradually increase in size as you get older. BPH is very common and often exists with few or no symptoms. However as the prostate surrounds the urethra, the enlargement can squeeze the urethra making it difficult for you to pass urine. This may lead to symptoms that can include: Weak flow of urine Needing to strain to pass urine Not being able to empty the bladder completely, so needing to use the toilet more often both day and night. To relieve the above symptoms of an enlarged prostate - TURP is carried out. Without TURP, your prostate gland may continue to enlarge, leading to worsening of your symptoms. It may also increase the risk of

damage to your bladder and/or kidneys due to the increased pressure and stress that is required to pass urine through the squeezed urethra. Although there are other ways of treating the enlarged gland, TURP is the commonest type of surgery to treat an enlarged prostate gland.

Read more: Trans-Urethral Resection of the Prostate (TURP) http://www.medindia.net/surgicalprocedures/turp.htm#ixzz1jDhQyFNR

Transurethral resection of the prostate (TURP) is surgery to remove all or part of the prostate gland, to treat anenlarged prostate. See also: y y y Benign prostatic hypertrophy Prostate resection - minimally invasive Simple prostatectomy

Description
The surgery takes about 1 hour. You will be given medicine before surgery so you don't feel pain. You may get one of the following: y y General anesthesia: You are asleep and pain-free Spinal anesthesia: You are awake, but relaxed and pain-free

The surgeon will insert a scope through the tube that carries urine from your bladder out of the penis. This tube is called the urethra. A special cutting tool is placed through the scope. It is used to remove part of your prostate gland using electricity.

Why the Procedure is Performed

Your doctor may recommend this surgery if you have benign prostatic hyperplasia (BPH). The prostate gland often grows larger as men get older. The larger prostate play causes problems with urinating. Removing part of the prostate gland can often make these symptoms better. Prostate removal may be recommended if you have: y y y y y y Difficulty emptying your bladder (urinary retention) Frequent urinary tract infections Bleeding from the prostate Bladder stones with prostate enlargement Extremely slow urination Damage to the kidneys

Before you have surgery, your doctor will suggest you make changes in how you eat or drink. You may also be asked to try taking medicine. Your prostate may need to be removed if these steps do not help. TURP is one of the most common type of prostate surgery. But other procedures are available.

Your doctor will consider the following when deciding on the type of surgery: y y y Size of your prostate gland Your health What type of surgery you may want

Risks
Risks for any surgery are: y y y y y y Blood clots in the legs that may travel to the lungs Breathing problems Infection, including in the surgical wound, lungs (pneumonia), or bladder or kidney Blood loss Heart attack or stroke during surgery Reactions to medications

Additional risks are: y y y y y y y Problems with urine control (incontinence) Loss of sperm fertility (infertility) Erection problems (impotence) Passing the semen into the bladder instead of out through the urethra (retrograde ejaculation) Urethral stricture (tightening of the urinary outlet from scar tissue) Transurethral resection (TUR) syndrome (water buildup during surgery) Damage to internal organs and structures

Before the Procedure

You will have many visits with your doctor and tests before your surgery. This includes: y y Complete physical exam Treating and controlling diabetes, high blood pressure, heart or lung problems, and other conditions

If you are a smoker, you should stop several weeks before the surgery. Your doctor or nurse can give you tips on how to do this. Always tell your doctor or nurse what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription. During the weeks before your surgery: y You may be asked to stop taking medicines that can thin your blood, such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and others. Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery: y y y Do not eat or drink anything after midnight the night before your surgery. Take the drugs your doctor told you to take with a small sip of water. Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will stay in the hospital for 1 to 3 days. After surgery, you will have a small tube, called a Foley catheter , in your bladder to remove urine. The urine will look bloody at first, but will go away in a few days. Special solution may be used to flush out the catheter and keep it from getting clogged with blood. The catheter will be removed within 1 to 3 days. You will be able to go back to eating a normal diet right away. You will need to stay in bed until the next morning. Afterwards, you will be asked to move around as much as possible. Your health care team will: y y y Help you change positions in bed Teach you exercises to keep blood flowing Recommend coughing/deep breathing techniques. You should do these every 3 to 4 hours.

You may need to wear tight stockings and use a breathing device to keep your lungs clear. You may be given medication to relieve bladder spasms.

Outlook (Prognosis)
TURP usually relieves symptoms of an enlarged prostate. You may have burning with urination, blood in your urine, urinate often, and need to urgently urinate.

Transurethral resection of the prostate (TURP)

y y y

Information Common questions Resources

Published by Bupas Health Information Team, March 2011. This factsheet is for men who are having a type of prostate surgery called transurethral resection of the prostate (TURP), or who would like information about it. TURP is a common operation for men who have an enlarged prostate gland (benign prostatic hyperplasia).

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

y y y y y y y

About TURP What are the alternatives to TURP? Preparing for your operation What happens during TURP What to expect afterwards Recovering from TURP What are the risks?

About TURP
If you have an enlarged prostate gland, you may find it difficult to pass urine, as your prostate gland can obstruct the flow of urine from your bladder. Your surgeon may suggest that you have a procedure known as TURP to remove a section of your prostate gland and reduce the pressure on your bladder.

What are the alternatives to TURP?

You will usually only be advised to have surgery if your symptoms havent improved after taking medicines. There are alternative types of surgery to TURP, including the following. The type you are advised to have will depend on the severity of your condition.

y y y

Transurethral incision of the prostate this is a similar operation to TURP, but involves making one or two small cuts in the neck of your bladder and prostate rather than removing part of the prostate. It is usually only suitable for men whose prostate is only moderately enlarged. Open prostatectomy a cut will be made in your abdomen (tummy) and the outer portion of your prostate will be removed. This is usually only carried out in men who have a very large, benign (non-cancerous) prostate and is rarely done. Minimally invasive surgery (such as electrovaporisation and laser prostatectomy) in these types of operation, laser or electrical energy will be used to burn off excess tissue. Your surgeon will discuss which procedure is most suitable for you.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery. Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the operation to go ahead, which you may be asked to do by signing a consent form. The operation is usually done under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may have the surgery under spinal or epidural anaesthesia. This completely blocks feeling from the waist down and you will stay awake during the operation. You may be offered a sedative with a spinal anaesthetic this relieves anxiety and helps you to relax. Your surgeon or anaesthetist will advise which type of anaesthesia is most suitable for you. If youre having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, its important to follow your anaesthetists or surgeons advice. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What happens during TURP

The operation will take about an hour. Your surgeon will insert a narrow, rigid, metallic, tube-like telescopic camera called an endoscope into your urethra. He or she will then cut out and remove the middle of your enlarged prostate using specially adapted surgical instruments that use heat energy to remove tissue.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic. You may need pain relief to help with any discomfort as the anaesthetic wears off. You will have a catheter to drain urine from your bladder into a bag. The catheter will also be used to wash out your bladder with a sterile solution. This will help to flush out any blood clots in your bladder. The catheter will be removed when your urine begins to run clear. This is usually within 24 to 48 hours. Occasionally, you may need to keep the catheter in for a while after you go home if so, your nurse will show you how to look after it. You may have a drip in your arm to prevent you getting dehydrated this will be removed once youre drinking enough fluids. You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs. You may be able to go home after about one to three days. You will need to arrange for someone to drive you home. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If youre in any doubt about driving, contact your motor insurer so that youre aware of their recommendations, and always follow your surgeons advice.

Recovering from TURP

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. You may be advised to increase your fluid intake. This is to flush out your bladder and help you to recover.

It can take up to four weeks to recover fully from TURP. After two to three weeks you can resume your normal activities. Dont do any strenuous activity for about four weeks after the operation. You can have sex as soon as you are comfortable this will probably be at least three to four weeks after your operation.

What are the risks?

As with every procedure, there are some risks associated with TURP. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects
Side-effects are the unwanted but mostly temporary effects you may get after having the operation. Some specific side-effects of TURP include the following.

y y y y

Blood in your urine this should clear up fully within about two weeks. If it continues for longer than this, see your GP. An urgent need to pass urine sometimes accompanied by a burning sensation when you do pass urine this usually clears up after a few weeks. Incontinence (urine leakage) talk to your GP if this happens, but it nearly always clears up with time. Impotence this isnt usually a problem and most men arent affected if they had normal erections before surgery.

Complications
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Specific complications of TURP include the following.

y y y

Retrograde ejaculation this is where semen passes into your bladder during an orgasm instead of out of your penis. You will then pass the semen mixed with urine the next time you urinate. Although retrograde ejaculation is permanent and can affect your fertility, it isnt usually a problem for most men. Infection. You may be given antibiotics before the operation to prevent infection. TURP syndrome. This is where the fluid used to flush your bladder during the operation is absorbed into your body. This can cause changes in your blood pressure and you may feel sick or vomit. However, this is becoming less common nowadays as surgeons can use a different type of fluid to flush your bladder, which is less likely to cause TURP syndrome. Your prostate may grow again and you may need to have another operation you may also need another operation if too little was removed during the first operation.