Transurethral Resection of the Prostate

About Transurethral Resection of the Prostate

Transurethral resection of the prostate, known as TURP, is a surgical treatment for urinary symptoms caused by benign prostatic hyperplasia, the noncancerous enlargement of the prostate that commonly occurs with age. Although medications have reduced the number of men who need surgery, TURP has long been regarded as a reference standard operation for moderately sized prostates. No external incision is made: a resectoscope is passed through the urethra and an electrically heated wire loop is used to cut away obstructing prostate tissue in small chips, which are flushed out and examined under the microscope, occasionally revealing an unsuspected cancer. A urinary catheter is left in place briefly afterward. TURP syndrome, caused by absorption of large amounts of low sodium irrigation fluid during monopolar resection, can lead to dangerously low sodium levels; bipolar resection, which uses saline irrigation, largely avoids this problem. Alternatives include holmium laser enucleation of the prostate, which is suitable even for very large glands, photoselective laser vaporization, prostatic urethral lift implants, water vapor thermal therapy and open or robotic simple prostatectomy. The most common long term effect of TURP is retrograde ejaculation, in which semen passes back into the bladder. Other complications include bleeding, urethral stricture, narrowing of the bladder neck and, uncommonly, incontinence or erectile problems. Some men need a repeat procedure years later as the prostate continues to grow.