TURP for BPH
TURP for BPH
Transurethral resection of the prostate (TURP) is an endoscopic surgery used to treat urinary problems that are caused by an enlarged prostate. An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra).
There are times when medications may not work and when the disease has already progressed to a very severe state. For this an endoscopic procedure will be required.
Your urologist can discuss on the various procedures that may be required, which in general is TURP (Transurethral Resection of the Prostate) or its various modifications of the procedure including TUIP, TUNA, bipolar TURP, laser TURP, etc.
TURP involves placing in a scope into the urethra under anesthesia, and then resecting or scraping the prostate. It is a relatively painless procedure done under anesthesia.
There are many other minimally invasive procedures for BPH, but most of them have not been as beneficial and effective as TURP in the treatment of BPH.
Transurethral resection of the prostate (TURP). Tissue is removed from the prostate using a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the urethra. Prostate tissue that is blocking the urethra is cut away and removed through the resectoscope.
TURP procedure – Pic from National Cancer Institute NCI
Pic from Urology Care Foundation
TURP Procedure – prostate gradually resected to create a channel
Risks – Transurethral resection of the prostate (TURP)
Transurethral resection of the prostate (TURP) is generally a safe procedure. However, as with all types of surgery, there are potential risks.
Retrograde ejaculation is the most common long-term complication of TURP and can occur in as many as 90%-100% 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 of an orgasm. However, your fertility may be affected, so you should speak to your surgeon if this is a concern.
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.
Urge incontinence risk varies from 10%-40%, depending on what stage a patient presents to the doctor.
A number of treatments are available for incontinence, including lifestyle changes, medication and surgery.
Complete incontinence due to sphincter incontinence is rare, less than 1%, and will require pelvic physiotherapy and possible artificial sphincter if it persists.
Up to 5% of men who have a TURP have erectile dysfunction afterwards. This can be either temporary or permanent.
The effect of TURP on erectile function is still controversial, and the available evidence is conflicting. Erection is a complex phenomenon that involves neurological, hormonal, arterial, venous, and muscular components and that is further influenced by psychogenic, cognitive, and environmental factors
In general, TURP does not affect the erectile function of the patient. Patients could be affected negatively as a result of worrying about the invasive procedure. Furthermore, patients could be affected by feeling pain during erection as the result of injury to the urethra. As time goes by, however, these problems are solved, and the change can most likely be attributed to improvement in the quality of urination.
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.
Narrowing of the urethra (urethral strictures) is estimated to develop in up to 4% of cases. It can occur if the urethra is injured during surgery (using the instruments) 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.
Some of the other risks of a transurethral resection of the prostate include:
- Bleeding – in around 5% of cases there may be persistent bleeding during or after the operation that means a blood transfusion is required
- Perforation of the bladder (injury) – usually the perforation, if it occurs, is usually small. For this, your urinary catheter may be required to be kept longer, for about a week or so to allow healing.
- Urinary tract infection (UTI) – in around 5% of cases, a UTI could develop after surgery; UTIs can usually be successfully treated with antibiotics. At times infection can be bad, known as sepsis, and will be managed aggressively with antibiotics and supportive management.
- urinary retention – in around 2%-5% of cases, the muscles that control the bladder may be temporarily weak, 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
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
- swelling of your tummy
- slow heartbeat (bradycardia)
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.
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. These new techniques nowadays use saline as the irrigation fluid during TURP, and hence the TURP syndrome nowadays is very rare..