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TURP Content Supplied by NHS Choices
Introduction

A transurethral resection of the prostate (TURP) is a surgical procedure that involves cutting away a section of the prostate.

The prostate is a small gland in the pelvis only found in men. It's located between the penis and bladder, and surrounds the urethra (the tube that carries urine from the bladder to the penis).

If the prostate becomes enlarged, it can place pressure on the bladder and urethra. This can cause symptoms that affect urination.

Why TURP is carried out

TURP is often recommended when prostate enlargement (benign prostatic hyperplasia) causes troublesome symptoms and fails to respond to treatment with medication.

Symptoms that may improve after TURP include:

  • problems starting to urinate
  • a weak urine flow or stopping and starting
  • having to strain to pass urine
  • a frequent need to urinate
  • waking up frequently during the night to urinate (nocturia)
  • a sudden urge to urinate
  • being unable to empty your bladder fully

How TURP is performed

TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire. This is passed along your urethra until it reaches your prostate, which means no cuts (incisions) need to be made in your skin.

The loop of wire is then heated with an electric current and is used to cut away the section of your prostate that is causing your symptoms. A thin tube called a catheter is then inserted into your urethra to pump fluid into the bladder and flush away pieces of prostate that have been removed.

General or spinal anaesthesia is used during the procedure so you don't feel any pain while it's carried out.

Read more about how TURP is performed.

Recovering from TURP

You'll usually need to stay in hospital for one to three days after your operation.

The catheter used during the operation will be left in place while you're in hospital because your urethra will be swollen and you may not be able to urinate normally at first.

It's common to feel tired and under the weather for a week or two after going home. Most men are up and about after this time, but you'll need to take things easy for four to eight weeks.

You'll usually be advised to stay off work and avoid lifting heavy objects, doing strenuous exercise, driving and having sex for at least a few weeks.

It's normal to have some difficulties urinating and some blood in your urine for a few weeks. These problems should get better as you recover, but you should contact the hospital clinic or your GP if you're concerned.

Read more about recovering from TURP.

What are the risks

In most cases, TURP is a safe procedure and the risk of serious complications is very small.

However, many men who have a TURP lose the ability to ejaculate semen during sex or masturbation, although they still have the physical pleasure associated with ejaculation (orgasm). This is known as retrograde ejaculation.

Many men also temporarily lose the ability to control their bladder (urinary incontinence), although this usually passes in a few weeks. In rare cases, it may be persistent and need further treatment.

There's also a small risk of problems such as erectile dysfunction, difficulties passing urine and urinary tract infections (UTIs).

Read more detailed information about the risks of TURP.

Alternatives to TURP

There are a number of alternatives to TURP that can be just as effective with a lower risk of complications.

They include:

  • holmium laser enucleation of the prostate (HoLEP) - a laser attached to a resectoscope is used to cut away excess prostate tissue
  • transurethral laser resection or vaporisation of the prostate - a thin tube called a cystoscope is inserted into the urethra and a laser attached to the cystoscope fires pulses of energy to burn away prostate tissue

However, these procedures aren't suitable for all men with prostate enlargement and may not be widely available.

They may be more suitable for men with very large prostates, older men who are not fit enough to have TURP, and those using blood-thinning medication such as warfarin.

Read more about the alternatives to TURP.

What happens during TURP

A transurethral resection of the prostate (TURP) is carried out in hospital under anaesthetic. You'll usually need to stay in hospital for one to three days.

Preparing for surgery

You'll usually be asked to attend a pre-admission appointment a few weeks before your operation so a doctor or nurse can make sure the operation is suitable for you and that you're well enough to have an anaesthetic.

This may involve tests such as blood tests and an electrocardiogram (ECG) to check your general health. An ECG is a simple test to check the electrical activity of your heart.

You can also use this appointment as an opportunity to ask any questions about the procedure and discuss any concerns you have.

Make sure you tell your doctor or nurse if you're currently taking medication to prevent blood clots, such as aspirin, warfarin or clopidogrel. These medications could cause heavy bleeding during surgery, so you may be advised to stop taking them in the lead-up to your operation.

If you smoke, you should try to cut down or give up completely before your operation, as this can help reduce your risk of potentially serious complications such as chest infections and blood clots.

Read more advice about stopping smoking.

Before the procedure

You'll usually be asked to come into hospital on the day of the operation or the day before.

You'll be asked to stop eating and drinking around six hours before surgery. Depending on the results of your pre-admission assessment, you may be given compression stockings to help prevent blood clots.

Just before the operation is carried out, you'll be given an anaesthetic to stop you feeling any pain during the procedure. The type of anaesthetic used may be either:

  • a general anaesthetic - this means you'll be unconscious throughout the procedure
  • a spinal or epidural anaesthetic - this means you'll be awake during the procedure, but won't be able to feel anything below your waist

The operation

A TURP is usually carried out using a device called a resectoscope. This is a thin metal tube containing a light, camera and loop of wire.

The surgeon will insert the resectoscope into your urethra (the tube that carries urine out of the body) before guiding it to the site of your prostate with the help of the light and the camera.

An electric current is used to heat the loop of wire, and this is used to cut away a section of your prostate. After the procedure, a catheter (a thin, flexible tube) is used to pump fluid into the bladder and flush away pieces of prostate that have been removed.

A TURP can take up to an hour to perform, depending on how much of your prostate needs to be removed.

Once the procedure has been completed, you'll be moved back to your hospital ward so you can recover. The catheter will be left in place for a few days until you're able to urinate normally.

Read more about recovering from TURP.

Recovering from a TURP

Following a transurethral resection of the prostate (TURP), you'll usually need to recover in hospital for one to three days before you can go home.

While in hospital, you may be given fluids directly into a vein (intravenously) until you've recovered from the anaesthetic and you're able to eat and drink.

You shouldn't experience any severe pain, but there may be some discomfort and bladder spasms (contractions) from the catheter, which is left in place because your urethra (the tube that carries urine out of the body) will be swollen and sore.

You'll be able to go home once you're catheter is removed and you're able to urinate normally. Before you're discharged, you'll be given advice about your recovery. A follow-up appointment to check your progress should be made for a few weeks later.

Urinating after TURP

You'll be unable to urinate normally at first because your urethra will be swollen. The catheter used to flush out your bladder during the operation will be left in place for a while to allow you to pass urine until the swelling goes down.

During the day after the operation, water may be pumped through the catheter to clean your bladder and get rid of any blood clots and other debris. This isn't usually painful, but may make your bladder feel uncomfortably full.

After around 24 to 48 hours, the catheter will be removed to check if you can pass urine and are able to go home. It's normal to find urinating uncomfortable and difficult to control for at least a few days after the catheter is removed.

If you're still unable to pass urine, a catheter may need to be reinserted temporarily. You'll be able to go home with the catheter still in place and an appointment will be made to remove it a few days or weeks later.

See living with a urinary catheter for information about looking after your catheter.

Recovering at home

It's common to feel tired and under the weather for a week or two after having a TURP. Most men are up and about after this time, but you'll need to take things easy for up to two months.

For the first few weeks, you shouldn't lift or move any heavy objects (including shopping) or do any strenuous exercise. If possible, ask friends or family members if they can help around the house.

Once you feel able, gentle exercise such as walking will help keep your blood circulating and lower your risk of getting a blood clot in your legs.

Drinking plenty of water while you're recovering may help reduce the risk of getting a urinary tract infection (UTI) and can help clear any blood from your urine. You may also be advised to do some pelvic floor exercises to help improve your bladder control.

Any pain can usually be treated by taking over-the-counter painkillers, such as paracetamol or ibuprofen.

Returning to your normal activities

It usually takes between three and six weeks to fully recover from a TURP. Your surgeon or GP will advise you about when it's safe to return to your normal activities.

Work

When you can return to work will largely depend on your job. For example, someone who works in an office may be able to return to work sooner than someone who does heavy manual work.

In most cases, you'll be advised to take around three or four weeks off work.

Driving

Your surgeon or GP will tell you when they feel it's safe for you to drive again, which will usually be when you can comfortably carry out an emergency stop.

Some people reach this stage after about a week, while others may not be able to drive for a month or more.

Having sex

It will probably be around three or four weeks after your operation before you feel comfortable enough to have sex.

Blood in your urine

After having a TURP, it's normal to occasionally notice some blood in your urine. Around a week or two after the operation the amount of blood may increase as the scab on your prostate falls off.

Drinking plenty of fluids will help flush any blood or small blood clots out of your bladder.

If the increased blood in your urine continues for longer than 48 hours, you should contact the hospital.

When to seek medical advice

While you're recovering, you should contact the hospital clinic or your GP if you develop:

  • a high temperature (fever) of 38C (100.4F) or above
  • severe pain while urinating
  • an inability to urinate
  • persistently severe or worsening blood in your urine

These symptoms can be a sign of a problem such as internal bleeding or a urinary infection that needs to be treated.

Risks of TURP

Transurethral resection of the prostate (TURP) is generally a safe procedure. However, as with all types of surgery, it is associated with potential risks.

The main risks are described below.

Retrograde ejaculation

Retrograde ejaculation is the most common long-term complication of TURP and can occur in as many as 90% of cases.

This is where semen doesn't come out of your penis during sex or masturbation, but flows into your bladder instead. It's caused by damage to the nerves or muscles surrounding the neck of the bladder, which is the point where the urethra connects to the bladder.

Retrograde ejaculation isn't harmful and you'll still experience the pleasure associated with ejaculation (orgasm). However, your fertility may be affected, so you should speak to your surgeon if this is a concern.

It may be possible to have an alternative procedure called transurethral incision of the prostate (TUIP) instead, which carries a lower risk of causing retrograde ejaculation. It's also sometimes possible to reduce the risk when performing a TURP by leaving prostate tissue near the urethra intact.

Urinary incontinence

Some degree of urinary incontinence is quite common after TURP. It usually gets better in the weeks following surgery, but can very occasionally be a long-term problem.

It usually takes the form of urge incontinence - where you have a sudden urge to pass urine and lose control of your bladder if you do not find a toilet quickly enough.

A number of treatments are available for incontinence, including lifestyle changes, medication and surgery. Read more about non-surgical treatments for urinary incontinence and surgical treatments for urinary incontinence.

Erectile dysfunction

Up to 10% of men who have a TURP find it difficult getting and maintaining an erection (erectile dysfunction) afterwards. This can be either temporary or permanent.

Medication can be prescribed to help reduce the problem if necessary, but you should speak to your surgeon if this is a concern. Your surgeon may be able to provide more information on your individual risk.

Urethral strictures

Narrowing of the urethra (urethral strictures) is estimated to develop in up to 4% of cases. It can occur if the urethra is damaged during surgery and becomes scarred.

Symptoms of a urethra stricture include:

  • straining to pass urine
  • spraying of urine or a "split-stream" of urine
  • dribbling drops of urine once you have finished going to the toilet
  • mild pain when passing urine

If the narrowing of the urethra is mild, it can usually be treated by inserting a rod to widen the urethra. More extensive narrowing may require surgery.

Other risks

Some of the other risks of a transurethral resection of the prostate are described below.

  • bleeding - in around 2% of cases there may be persistent bleeding during or after the operation that means a blood transfusion is required
  • urinary tract infection (UTI) - in around 5% of cases, a UTI could develop after surgery; UTIs can usually be successfully treated with antibiotics (read more about treating UTIs)
  • urinary retention - in around 2% of cases, the muscles that control the bladder may be temporarily damaged, which can lead to problems fully emptying the bladder; in some cases the bladder muscles regain their normal function within a few weeks
  • the prostate becoming enlarged again - about 10% of men need to have a TURP again within 10 years

TURP syndrome

A rare but potentially serious risk associated with a TURP is known as TURP syndrome. This occurs when too much of the fluid used to wash the area around the prostate during the procedure is absorbed into the bloodstream.

Initial symptoms of TURP syndrome include:

  • feeling or being sick
  • disorientation
  • dizziness
  • headache
  • swelling of your tummy
  • slow heartbeat (bradycardia)

Left untreated, life-threatening problems can develop, such as seizures (fits), shortness of breath, blue skin (cyanosis) and coma.

If you experience the symptoms of TURP syndrome during your procedure, the surgeon will stop the surgery and inject you with a diuretic, which is a type of medication used to remove fluid from the body. Tell hospital staff immediately if you develop any symptoms after returning to the ward.

Nowadays, the risk of TURP syndrome is estimated to be less than 1% and is likely to reduce even further as new techniques that avoid pumping water into the bladder are increasingly used.

Death

TURP carries a very small risk of causing death. The risk of dying as a result of the procedure is now estimated to be less than 1 in 1,000. The risk usually arises from complications involving the heart or a serious postoperative infection.

Alternatives to TURP

There are several alternatives to a transurethral resection of the prostate (TURP). Your options will depend on how severe your symptoms are and which treatments are available.

Active observation

If you have an enlarged prostate but don't find your symptoms particularly troublesome, you may decide to just wait and keep an eye on your symptoms.

This means you will not receive any immediate treatment, but will have the option of having a TURP in future if your symptoms get worse.

If you do not have a TURP, lifestyle changes such as limiting your consumption of alcohol and taking regular exercise may be recommended to improve your symptoms.

Read more about treating prostate enlargement.

Alternative procedures

Newer techniques

There are a number of newer surgical techniques that are generally as effective as TURP and may lead to fewer side effects, a shorter stay in hospital, and a quicker recovery.

However, as these treatments are still fairly new, they may not be available and their long-term effectiveness is not always clear.

Some of the main modern techniques are:

  • bipolar transurethral resection of the prostate - different instruments and fluids are used to perform the procedure, which is thought to lead to a lower risk of TURP syndrome (see risks of TURP)
  • holmium laser enucleation of the prostate (HoLEP) - a laser attached to a resectoscope is used to cut away excess prostate tissue
  • transurethral resection or vaporisation of the prostate (TUVP) - a thin tube called a cystoscope is inserted into the urethra, and a laser attached to the cystoscope fires pulses of energy to cut or burn away prostate tissue
  • sling procedure - where mini-slings are inserted to pull the excess prostate tissue away from the urethra

Open prostatectomy

An open prostatectomy is a bigger operation where a cut (incision) is made in your tummy to access and remove the outer part of your prostate.

This procedure may be more effective than a TURP if you have very severe prostate enlargement, although it's rarely used nowadays because of modern alternatives such as HoLEP and because it carries a higher risk of long-term complications, such as erectile dysfunction and urinary incontinence.

 
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