Transurethral Resection of the Prostate (TURP) in Delhi, India

TURP prostate surgery is recommended in the following cases:

1. To reduce symptoms caused by benign prostatic hyperplasia such as:

1. 1. Frequent and urgent need to urinate

   2. Difficulty initiating urination

   3. Slow urination

   4. Increased frequency of urination at night

   5. Stopping and beginning again while urinating

   6. The feeling of not emptying the bladder entirely 

   7. Urinary tract infections

2. Recurring urinary tract infections
3. Kidney or bladder damage
4. Bladder stones
5. Blood in the urine
6. Prostate enlargement with troubling symptoms

Before the surgery, doctors perform a thorough medical history to assess any pre-existing medical conditions that may interfere with the surgery. The tests recommended by doctors before a TURP procedure are:

1. Ultrasound: This test helps assess the irregularity of the midline gap present in the prostate at the neck of the bladder.

2. MRI:  This scan allows the doctor to see an overall image of the area to be operated on.

3. VCUG shows a cone-like widening of the prostatic urethra.

4. RUG/VCUG allows for evaluation of possible post-TURP stricture.

First, anaesthesia is administered for the patient to be comfortable during surgery. The patient may be either sedated or given spinal anaesthesia to remain conscious. In addition, prophylactic antibiotics may be injected to prevent infection. The procedure usually requires about 60 to 90 minutes.

The resectoscope is pushed into the tip of the penis and extended through the urethra and into the prostate area. As a result, no cuts or incisions are required.

The resectoscope helps to trim the tissue one at a time from the inside of the prostate gland. The irrigating fluid carries the bits and pieces of the cut tissue into the bladder. Then, they are removed at the end of the procedure.

TURP is indicated to treat the following conditions:

• Acute urinary retention

• Recurrent urinary tract infection

• Recurrent hematuria

• Azotemia

• Symptomatic bladder outlet obstruction

• Obstructed urine flow due to benign prostatic hypertrophy or benign prostatic hyperplasia (BPH) is a common cause of an enlarged prostate

• The blocked flow of urine

• Severely enlarged prostate

TURP procedure is contraindicated in the following cases:

• Prostate cancer

• When the patient cannot tolerate the risks or the possible consequences of the procedure

• Anticoagulation

• Extremely large prostate that is greater than 100 g, in which a simple prostatectomy or HOLEP should be preferred.

Some things to expect before the TURP procedure are:

• The doctor will explain the surgery process and answer any queries at the consultation.

• A consent form that permits the doctor to do the procedure must be signed.

• Doctors review the medical history and perform a physical exam to evaluate the health status before the procedure. Certain blood tests and other tests may be advised.

• Avoid eating or drinking anything for 8 hours before the procedure to avoid complications from anaesthesia.

• Inform the doctor about any sensitivity or allergies to any medicines, iodine, latex, contrast dyes, tape, or anaesthesia.

• The doctors should be informed of all medicines being taken, inclusive of herbal medicines, vitamins, and supplements.

• Any history of bleeding disorders should be informed.

• Avoid smoking to improve health and recovery from surgery.

• A sedative is injected before the procedure to help the patient relax.

• Doctors advise stopping medications that increase the risk of bleeding, such as

  • Blood thinners like warfarin or clopidogrel 

  • Pain killers such as aspirin, ibuprofen or naproxen sodium

  • Antibiotics may be prescribed to prevent any infections of the urinary tract.

TURP is considered to be a safe procedure since most men show improvement in health after the procedure. However, every surgery carries some risks. Some of them include:

• Inability to urinate temporarily: Urinating may be difficult for the first few days after the surgery. A catheter may be placed into the penis to carry urine out of the bladder.

• Blood in the urine 

• Urinary tract infection: The infection may be caused due to the presence of the catheter. Some men may experience frequent episodes of urinary tract infection. 

• Fever

• Pain or redness in the calf, leg, or thigh, which could indicate the presence of a blood clot

• Dry orgasm: This is a common and long-term effect of prostate surgery. The semen releases into the bladder instead of the penis during ejaculation; a condition termed retrograde ejaculation. It is not harmful and doesn't affect sexual pleasure. However, it can affect the ability to father a child.

• Erectile dysfunction: The chances of erectile dysfunction after prostate treatments are slightly high.

• Heavy bleeding: Some patients may require a blood transfusion due to excessive blood loss during surgery. 

• Rarely do patients experience a loss of bladder control, which is a long-term complication of TURP.

• Seldom the body absorbs excess fluid that is used to wash the surgical area during the procedure, a condition known as TURP syndrome. It can be life-threatening. The risk of this condition can be eliminated with a technique called bipolar TURP.

• Some men may require re-treatment after TURP because the symptoms may not have improved or may have recurred despite treatment.

Hospitalization is required for two to three days. A urinary catheter is placed for 24 to 48 hours or until the swelling subsides. This catheter allows the passage of urine. This is because the swelling may block urine flow.

Some patients may notice red-coloured urine that indicates the presence of blood in the urine. This is normal unless the urine appears like thick ketchup, in which case, the doctor should be informed immediately.

For some, urination may be painful or sense an urgency to urinate. This condition improves in six to eight weeks.

To enhance recovery, doctors may suggest:

• To flush the bladder, increase the intake of water.

• Eating high-fibre foods prevents constipation and straining during a bowel movement. A stool softener can be taken if need be.

• Doctors will inform about when to resume the blood thinners if taken previously.

• Avoid strenuous activities like lifting heavy objects for four to six weeks.

• Avoid having sex for at least four to six weeks after the surgery.

Reviewed by Dr. Anil Kumar Varshney, Senior Director, Urology on 23-Sep-2022

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