Preparing for Transurethral Resection of Prostate (TURP)

What is Transurethral Resection of Prostate (TURP)?

Transurethral Resection of Prostate (TURP) is a procedure in which part of the prostate is surgically removed through the urethra (urine tract) of the penis using endoscopy. There is no skin incision for this procedure. There are modifications to the TURP technique which include:

Transurethral Enucleation Resection of Prostate (TUERP): this involves more thorough removal of the prostate tissue while preserving the prostatic covering or capsule.

Transurethral Incision of Prostate/Bladder Neck (TURBNI): this involves making cuts in the prostate as it meets the bladder. This reduces tension in the bladder neck area, which will result in smoother urine flow out of the bladder.

Why do I need this surgery?

Your doctor may offer this surgery if you have urinary symptoms that are attributed to an enlarged prostate gland, termed as benign prostate hyperplasia (BPH). You have either taken a course of medicine that did not improve your symptoms, or you have developed complications from BPH. The urinary symptoms and arising complications include:

How is it performed?

Prior to the operation, you will have to undergo a urine test to ensure that you do not have urinary tract infection. This is to minimize the risk of developing sepsis (blood infection) after the procedure.

The surgery is carried out under general anaesthesia (GA) or more commonly regional anaesthesia (you will be awake). A bladder scope is passed through the urethra to allow the doctor to see the enlarged prostate gland. A cutting instrument using high energy electrical current then trims away the obstructing prostate tissue, coagulating any bleeding vessels in the process to stop haematuria. A urinary catheter is inserted at the end of procedure for continuous washing of the bladder.

What precautions must I take for the surgery?

Please inform your doctor if you have any medical illnesses, or if any of the following are applicable:

You have a history of allergy or reaction to any medications, drugs, or food
You have a history of bleeding or clotting disorders
You are taking blood thinning medications (e.g. Aspirin, Clopidogrel, Warfarin, and Rivaroxaban) or supplements (e.g. Cordyceps, Ginkgo Biloba, and Lingzhi), as these may increase the risk of bleeding. If you are taking any of these, your doctor will advise you accordingly.
You have symptoms of a urinary tract infection (as the procedure may need to be postponed), such as:

Increased frequency of passing urine
Painful urination
Lower abdominal pain
Blood-stained urine
Foul-smelling urine

You should also inform your doctor if you are feeling unwell on the day of the procedure.

What are the possible risks and complications of the surgery?

As with all surgical procedures, complications can occur. Some of these risks and complications are inherent in any operative procedure. You should ask your doctors about these risks. The following are potential complications of the procedure (non-exhaustive):

Common:

Bleeding
Abnormal ejaculation
Urinary Tract Infection
Urinary Retention
Less common:
Erectile Dysfunction
Urethral stricture
Rare (less than 1%):
Transurethral Resection (TUR) syndrome
Injury to bladder
Urinary Incontinence

What can I expect after the surgery?

If you have regional anaesthesia, you will need to lie in bed for at least 6 hours or until you recover normal sensation in your legs before you are allowed to walk.

You will have a urinary catheter inserted into the bladder for continuous irrigation. The duration for irrigation and timing for removal of the catheter will be decided by your attending surgeon. You should be able to resume normal drinking and eating after the surgery.

You may experience some discomfort upon passing urine following the procedure for a few days, which can be treated with simple analgesia (painkillers). You may also notice small blood clots in your urine which should resolve after a couple of days or weeks.