Transurethral resection of the prostate (TURP) is the most common surgical procedure to treat men with enlarged prostates. The prostate, located at the base of a man's bladder, is a fibrous gland that surrounds the urethra (canal through which urine is discharged). Although it is usually performed on patients with noncancerous conditions, TURP can be performed on patients with prostate cancerprostate cancer who are not good candidates for curative surgery. For prostate cancer patients, TURP may relieve obstructive urinary difficulties in but the procedure cannot cure the disease.

TURP is an in-patient procedure, which means that the patient will be hospitalized after surgery. During the procedure, the patient receives an anesthetic before the surgeon inserts a narrow instrument called a resectoscope into the urethra and removes excess prostate tissue. This creates an opening that allows urine to flow out with less obstruction. Though TURP is considered a form of surgery, it does not require a surgical incision.

Transurethral resection of the prostate (TURP) is a surgical procedure that is performed on men with prostate problems. It is most often performed when the patient has a noncancerous (benign) enlargement of the prostate called benign prostatic hypertrophy (BPH).

However, TURP is also performed on patients with prostate cancer who are not good candidates for curative surgery. This may include elderly patients or patients whose disease is too far advanced to benefit from curative surgery. In such patients, TURP is a palliative procedure, which means it is designed to relieve symptoms rather than to cure cancer. It is often performed when a tumor is obstructing a patient’s ability to urinate. TURP may also be performed on cancer patients prior to treatment with other therapies.

The prostate is a fibrous gland that is located at the base of the bladder in men. It surrounds the urethra, the canal through which urine is discharged. The prostate gland secretes fluid that mixes with the sperm to make semen. When the prostate becomes enlarged, it compresses the urethra and causes urination difficulties. When enlargement is caused by a noncancerous overgrowth condition, it is known as benign prostatic hyperplasia (BPH). However, cancer of the prostate can also cause this enlargement.

TURP is one of three major procedures performed on the prostate gland. It is usually performed when the prostate is moderately enlarged. The other procedures are:

• Transurethral incision of the prostate (TUIP). Similar to TURP, but typically performed on men with small prostates. It is often performed on an outpatient basis and requires a small incision in the prostate tissue that enlarges the opening (urethra) of the bladder. Relatively few men have prostates small enough to qualify for the surgery.
  
  
• Open prostatectomy (suprapubic or retropubic prostatectomy). Often used to remove prostates too large to be removed through a TURP. It involves removing the prostate through an external surgical incision.

Symptoms that may indicate blockage of the urethra due to prostate enlargement include:

• Frequent urination with small amounts of urine
  
  
• Need to urinate at night (nocturia)
  
  
• Difficulty starting a stream of urine
  
  
• Slow stream of urine
  
  
• Urine dripping out of urethra after urination (dribbling)
  
  
• Feeling that bladder is never empty
  
  
• Recurrent urinary tract infection

Patients should notify their physician of any medications they are taking, including prescriptions, over-the-counter medications and vitamins. Patients will be instructed to refrain from eating or drinking after midnight the night before their surgery. Additional pre-operative instructions may be provided by the patient’s physician as well.

Transurethral resection of the prostate (TURP) is an in-patient procedure, which means that the patient will be hospitalized afterward. Therefore, patients should make arrangements, such as notifying their employer of a planned absence from work, ahead of time.

Before the procedure, the patient will be prepped for surgery and the adjacent areas of skin will be shaved and scrubbed with a disinfectant soap.  Patients will then receive a general anesthesia which will put the person asleep, or will be given a spinal anesthetic, which numbs the patient below the waste.

During the TURP, a resectoscope (a lighted tool with a small loop of wire on the end) is passed through the end of the penis and into the urethra (canal through which urine is discharged) as far up as the prostate. The surgeon then removes part of the prostate gland surrounding the urethra. This is accomplished by passing electricity through a wire that heats up and cuts or vaporizes tissue. The pieces of removed tissue are carried into the bladder by the fluid. At the end of the procedure, the tissues are flushed out of the body. This procedure does not require an incision, which means that the patient’s skin will not be cut with a surgical scalpel. TURP usually takes about one to two hours.

Following the procedure, a catheter is insterted into the urethra to help drain urine from the bladder while the prostate heals. The catheter is usually removed after one to three days. However, some patients will be discharged from the hospital with a catheter in place. It will be removed at the physician’s office at a later date. Patients may also be prescribed pain medication after the procedure, and those who experience constipation as a side effect of the medication may be given a laxative or daily stool softener.

The patient is typically allowed to leave the hospital when he is able to urinate on his own. In most cases, this will take one or two days. If there are no conmplications, the patient should be able to return to work within a week or two. Patients may be urged to refrain from drinking coffee, cola drinks and alcoholic beverages for a period of time, as these can cause irritation of the bladder and urethra. Strenuous activity, heavy lifting and sexual intercourse should be avoided after the procedure for several weeks. The patient will need to schedule a follow-up visit with their surgeon but should immediately report any of the following symptoms:

• Increased pain
  
  
• Pain that is not alleviated with medication
  
  
• Increase in bloody discoloration of urine
  
  
• Fever that exceeds 100.8 degrees Fahrenheit (38.2 degrees Celsius) or chills
  
  
• Persistent fatigue and depression
  
  
• Constipation that cannot be relieved
  
  
• Nausea or vomiting
  
  
• Inability to empty the bladder within six hours or frequent urination in small amounts

Transurethral resection of the prostate (TURP) usually provides effective relief within a short period of time. Patients typically report increased urine flow within a few days. Initially, patients may experience some pain or discomfort during urination, but this usually subsides.

General risks associated with anesthesia (e.g., allergic reaction or breathing difficulties) and surgery (e.g., infection or excessive bleeding) are also factors in TURP. In addition, patients often experience some post-operative blood in their urine.

TURP can cause impotence and loss of bladder control in some patients, but these side effects are usually temporary. Pelvic floor muscle exercises known as Kegel exercises often aid bladder control, while patients generally report normal sexual function a few weeks to months after surgery. However, in some cases it may take up to a year before the patient fully recovers these functions. Other difficulties may include:

• Retrograde ejaculation (passing the semen into the bladder instead of out through the urethra).This can cause orgasms without external ejaculation.
  
  
• Scarring and narrowing in the urethra or bladder neck.
  
  
• Need for repeat prostate surgery due to scar tissue or prostate tissue growing back.
  
  
• Infertility.

Preparing questions in advance can help patients to have more meaningful discussions with their physician regarding their condition. Patients may wish to ask their doctor the following questions about TURP:

1. Will TURP correct my prostate difficulties?
   
   
2. Which type of procedure is best for me?
   
   
3. How often have you performed TURP?
   
   
4. Will I receive a general or local anesthesia for the procedure?
   
   
5. What are the risks associated with the procedure?
   
   
6. What type of preparation do I need for the procedure?
   
   
7. How long will I be hospitalized?
   
   
8. When can I expect to see improvement in my condition?
   
   
9. Will I go home with a catheter? If so, how long will it be in place?
   
   
10. What are my restrictions following the procedure?
    
    
11. How will TURP affect my sexual function?
    
    
12. What can be done if I experience retrograde ejaculation?
    
    
13. What are my options if TURP does not improve my condition?
    
    
14. How will TURP help me as a cancer patient?