Transurethral resection of the prostate

Transurethral resection of the prostate (also known as TURP, plural TURPs and as a transurethral prostatic resection, TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients.

Indications

BPH is normally initially treated medically. This is done through alpha antagonists such as Flomax or alpha-1A reducatase inhibitors such as Proscar and Avodart. If medical treatment does not reduce a patient's urinary symptoms, a TURP may be considered- following a careful examination of the prostate/bladder through a cystoscope. As medical management of BPH improves, the numbers of TURPs have been decreasing. If TURP is contraindicated a Urologist may consider: a simple prostatectomy, in and out catheters, or a supra-pubic catheter to help a patient void urine effectively.

Risks

Because of bleeding risks associated with the surgery, TURP is not considered safe for many patients with cardiac problems.

Postoperative complications include ^[1]

• Bleeding (most common)
• Clot retention and clot colic
• Bladder wall injury such as perforation (rare)
• TURP Syndrome: Hyponatremia and water intoxication (symptoms resembling brain stroke in an elderly presenting patient) caused by an overload of fluid absorption from the open prostatic sinusiods during the procedure. This complication can lead to confusion, changes in mental status, vomiting, nausea, and even coma. To prevent TURP syndrome the 1) length of the procedure is limited to less than one hour in more centers, and 2) the height of the container of irrigating solution above the surgical table determining the hydrostatic pressure driving fluid into the prostatic veins and sinuses is kept to a minimum.
• Bladder neck stenosis
• Urinary incontinence due to injury of external sphincter system which may be prevented by taking the Verumontanum of the prostate as a distal limiting boundary during TURP
• Retrograde ejaculation due to injury of preprostatic (internal) sphincter system

Additionally, transurethral resection of the prostate is associated with a low risk of mortality.

See also

• Transurethral needle ablation of the prostate
• Transurethral incision of the prostate
• Prostatectomy
• Prostatic stent

References