TURP Surgery: Complete Guide to Prostate Reduction

What Is TURP Surgery?

TURP (Transurethral Resection of the Prostate) is a surgical procedure that removes excess prostate tissue blocking urine flow. The surgeon inserts a thin instrument through the urethra and uses an electrical loop to cut away prostate tissue piece by piece, creating a wider channel for urine to pass through.

Transurethral Resection of the Prostate, commonly known as TURP, is the most widely performed surgical treatment for benign prostatic hyperplasia (BPH), also called enlarged prostate. This condition affects the majority of men as they age, with studies showing that approximately 50% of men over 50 and up to 90% of men over 80 have some degree of prostate enlargement.

The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. When the prostate enlarges, it can compress the urethra and obstruct urine flow, leading to bothersome urinary symptoms. TURP addresses this problem by removing the obstructing prostate tissue from the inside, much like coring an apple.

TURP has been performed for over 80 years and remains the gold standard surgical treatment for moderate to large prostates. According to the European Association of Urology (EAU) guidelines, TURP is recommended for prostates between 30 and 80 mL in volume, though experienced surgeons may treat larger prostates as well.

Why Is TURP Performed?

TURP is typically recommended when medication therapy for BPH has not adequately controlled symptoms, or when complications have developed. Your doctor may recommend TURP if you experience any of the following conditions despite medical treatment:

• Persistent urinary symptoms: Weak urine stream, difficulty starting urination, frequent urination, or urgent need to urinate
• Urinary retention: Inability to completely empty the bladder or episodes of complete inability to urinate
• Recurrent urinary tract infections: Caused by incomplete bladder emptying
• Bladder stones: Formed due to stagnant urine in the bladder
• Blood in urine: Caused by enlarged prostate blood vessels
• Kidney damage: From back-pressure of urine that cannot drain properly

How Does TURP Compare to Other Treatments?

Several treatment options exist for BPH, ranging from medications to various surgical procedures. TURP occupies an important middle ground, offering significant and durable improvement while maintaining a well-established safety profile. Understanding how TURP compares to alternatives helps patients and doctors choose the most appropriate treatment.

Medications such as alpha-blockers (tamsulosin, alfuzosin) and 5-alpha reductase inhibitors (finasteride, dutasteride) are typically tried first. While effective for many men, medications require lifelong use and may not provide adequate relief for moderate to severe symptoms or larger prostates.

Newer minimally invasive procedures such as UroLift, Rezum, and prostatic artery embolization offer quicker recovery but may not be suitable for all prostate sizes and have less long-term outcome data. Laser procedures like HoLEP can treat very large prostates but require specialized equipment and expertise.

How Should You Prepare for TURP Surgery?

Preparing for TURP surgery involves stopping certain medications one to two weeks before the procedure, fasting from midnight before surgery, and washing with antibacterial soap. Your surgeon will provide specific instructions based on your health conditions and the type of anesthesia planned.

Proper preparation before TURP surgery helps ensure the best possible outcome and reduces the risk of complications. Your surgical team will provide detailed instructions, but understanding the general preparation process helps you plan accordingly.

The preparation period typically begins two to four weeks before your scheduled surgery date. During this time, you will have preoperative assessments including blood tests, urine tests, and possibly an electrocardiogram (ECG) to ensure you are fit for surgery. Your surgeon may also perform a cystoscopy to directly examine your prostate and bladder.

Medications to Stop Before Surgery

Certain medications increase the risk of bleeding during and after surgery and must be stopped in advance. Your doctor will provide specific guidance based on your complete medication list, but general recommendations include:

• Blood thinners: Warfarin, rivaroxaban, apixaban, and dabigatran typically need to be stopped 3-7 days before surgery
• Antiplatelet medications: Aspirin and clopidogrel usually need to be stopped 7-10 days before surgery
• Anti-inflammatory medications: Ibuprofen, naproxen, and similar NSAIDs should be stopped 7 days before surgery
• Herbal supplements: Fish oil, vitamin E, garlic, ginkgo, and ginseng can increase bleeding and should be stopped 2 weeks before surgery

The Day Before Surgery

The evening before your scheduled TURP, you will need to complete several preparation steps. Most importantly, you should wash your entire body, particularly the genital area, with antibacterial soap as instructed by your surgical team. This reduces bacteria on the skin and decreases infection risk.

You will typically need to fast from midnight before your surgery. This means no food, drinks, or even chewing gum. Fasting is essential for safe anesthesia - an empty stomach prevents aspiration of stomach contents during the procedure. Your surgical team will tell you which medications you may take the morning of surgery with a small sip of water.

What to Bring to the Hospital

Pack a bag with items you will need during your hospital stay. Consider bringing comfortable, loose-fitting clothing for going home, as you may have some abdominal sensitivity. Bring a list of your current medications, your identification and insurance information, and contact information for someone who can drive you home after discharge.

How Is TURP Surgery Performed?

During TURP surgery, the surgeon inserts a resectoscope through the urethra to the prostate. Using an electrical loop, the surgeon removes prostate tissue piece by piece while viewing through a camera. The procedure takes 60-90 minutes, and continuous irrigation flushes away tissue and blood.

Understanding what happens during TURP surgery can help reduce anxiety and help you know what to expect. The procedure follows a well-established sequence that urologists have refined over decades of practice.

On the day of surgery, you will first meet with the anesthesia team who will discuss your anesthesia options. TURP can be performed under general anesthesia (you are completely asleep) or spinal anesthesia (you are awake but numb from the waist down). Spinal anesthesia allows the surgeon to detect potential complications earlier and may be preferred in patients with certain health conditions. Your anesthesiologist will recommend the best option based on your specific situation.

The Surgical Procedure Step by Step

Once anesthesia takes effect, the surgical team positions you on your back with your legs raised in stirrups. This position provides optimal access to the urethra. The surgical area is cleaned with antiseptic solution, and sterile drapes are placed around the surgical field.

The surgeon begins by inserting a resectoscope into the urethra. The resectoscope is a specialized instrument approximately 7-8 mm in diameter, equipped with a light source, camera, and working channel. Through this instrument, the surgeon can see the prostate on a video monitor and pass surgical tools.

Using an electrical wire loop at the end of the resectoscope, the surgeon systematically removes prostate tissue that is blocking urine flow. The loop cuts tissue using electrical current while simultaneously cauterizing blood vessels to minimize bleeding. Irrigation fluid continuously flows through the resectoscope, flushing away tissue chips and providing a clear view.

The surgeon removes tissue until an adequate channel is created through the prostate. The goal is not to remove the entire prostate, but to remove enough tissue to relieve the obstruction. The surgeon carefully preserves the external sphincter muscle, which controls urinary continence, located just beyond the prostate.

At the End of the Procedure

Once sufficient tissue has been removed, the surgeon performs a final inspection to ensure adequate hemostasis (bleeding control) and no residual obstructing tissue. A urinary catheter is then inserted through the urethra into the bladder. This catheter, called a three-way catheter, has three channels: one to drain urine, one to inflate a balloon that holds it in place, and one for continuous bladder irrigation.

The removed prostate tissue is collected and sent to the pathology laboratory for examination. This analysis confirms the tissue is benign (non-cancerous) and helps rule out any incidental prostate cancer. You will typically receive these results within one to two weeks.

What Happens During Recovery from TURP?

Recovery from TURP involves 1-3 days in the hospital with a catheter, followed by 4-6 weeks of gradual return to normal activities. Expect some burning during urination and blood in urine initially. Most men experience significant symptom improvement within 4-6 weeks after surgery.

The recovery process after TURP surgery follows a predictable pattern for most patients. Understanding what to expect at each stage helps you prepare for the recovery period and recognize what is normal versus what might require medical attention.

The First 24-48 Hours

Immediately after surgery, you will be monitored in a recovery area as the anesthesia wears off. The urinary catheter will remain in place, connected to a bag that collects urine. In most cases, continuous bladder irrigation is used during the first 24 hours - saline solution flows through the catheter to prevent blood clots from forming and blocking the catheter.

Your urine will appear red or pink from blood, which is completely normal. The color typically transitions from dark red to pink to clear over the first few days. Some blood in the urine can persist for several weeks, particularly after bowel movements or physical activity.

Pain after TURP is usually mild and well-controlled with standard pain medications. You may feel bladder spasms - sudden, uncomfortable urges to urinate caused by the catheter and healing bladder. These are normal and typically treated with medications that relax the bladder muscle.

Catheter Removal

The urinary catheter is typically removed 1-3 days after surgery, once the urine has cleared sufficiently. Catheter removal is quick and causes brief discomfort. Some patients go home the same day the catheter is removed, while others may stay an additional night for observation.

In some cases, the catheter may need to stay in place longer, or you may go home with the catheter if swelling prevents normal urination. If this happens, a nurse will teach you how to care for the catheter at home, and you will return in a few days to have it removed.

The First Few Weeks at Home

Once home, you will experience a gradual improvement in symptoms over several weeks. Common experiences during this period include:

• Burning during urination: This is normal and typically improves over 1-2 weeks as the surgical site heals
• Frequent urination: You may need to urinate more often initially, but this improves as swelling decreases
• Urgency: Strong, sudden urges to urinate are common initially and gradually decrease
• Urinary leakage: Some men experience temporary leakage, especially with coughing or sneezing. This typically resolves within a few weeks
• Blood in urine: Episodes of blood-tinged urine can occur for up to 6 weeks, especially after activity

Activity Restrictions During Recovery

To promote healing and minimize the risk of complications, certain activities should be avoided during the recovery period. Following these restrictions carefully is important for optimal outcomes.

During the first 4-6 weeks after surgery, you should avoid:

• Heavy lifting: Nothing over 5 kg (10 pounds)
• Strenuous exercise: No running, cycling, or gym workouts
• Sexual activity: Wait at least 4 weeks to allow adequate healing
• Bathing or swimming: Showers are fine, but avoid baths, hot tubs, and swimming pools
• Straining: Avoid constipation by eating fiber-rich foods and staying hydrated
• Driving: Usually can resume after 1-2 weeks if not taking narcotic pain medication

How Does TURP Affect Sexual Function?

TURP does not affect your ability to have erections or experience orgasm. However, 70-75% of men develop retrograde ejaculation where semen enters the bladder instead of exiting the penis. This is harmless but means natural conception requires medical assistance.

Sexual function is a common concern for men considering TURP surgery. Understanding how the procedure affects different aspects of sexual function helps set realistic expectations and allows for informed decision-making.

The prostate plays an important role in reproduction but is not essential for erection or orgasm. During TURP, the surgeon removes tissue from the central portion of the prostate while preserving the nerves responsible for erections, which run along the outside of the prostate capsule. As a result, TURP does not cause erectile dysfunction.

Retrograde Ejaculation Explained

The most significant change in sexual function after TURP is retrograde ejaculation, which affects approximately 70-75% of men who undergo the procedure. During normal ejaculation, the bladder neck closes, directing semen forward through the urethra and out of the penis. TURP removes tissue at the bladder neck, preventing it from closing completely.

As a result, during orgasm, semen takes the path of least resistance into the bladder rather than forward out of the penis. This is sometimes called a "dry orgasm" because little or no semen exits the penis. The semen harmlessly mixes with urine and is eliminated during the next urination.

Importantly, retrograde ejaculation does not change the sensation of orgasm for most men. The physical pleasure of orgasm remains the same - only the direction of semen flow changes. However, if you wish to father children after TURP, you should discuss fertility preservation options with your doctor before surgery, as natural conception becomes unlikely with retrograde ejaculation.

When to Resume Sexual Activity

Most surgeons recommend waiting at least 4 weeks before resuming sexual activity after TURP. This allows the surgical site to heal adequately and reduces the risk of bleeding. When you do resume sexual activity, it is normal to notice blood in the semen for several weeks - this is not harmful and gradually resolves.

What Are the Risks and Complications of TURP?

TURP is generally safe, but potential complications include bleeding requiring transfusion (2-5%), urinary tract infection (2-5%), urinary incontinence (1-3% temporary, less than 1% permanent), and need for reoperation (10-15% within 10-15 years). TUR syndrome, once common, is now rare with modern techniques.

Like any surgical procedure, TURP carries certain risks. Understanding these potential complications allows you to make an informed decision and recognize warning signs that require medical attention. The good news is that serious complications are uncommon, and TURP has an excellent safety record built over decades of experience.

Common Complications

Some complications occur with some frequency but are usually minor and resolve with appropriate treatment:

• Bleeding: Some bleeding is expected and normal. Approximately 2-5% of patients require blood transfusion. Bleeding may temporarily increase 2-3 weeks after surgery when the scab over the surgical site falls off.
• Urinary tract infection: Occurs in 2-5% of patients despite preventive antibiotics. Symptoms include fever, burning with urination, and cloudy or foul-smelling urine. Treated with antibiotics.
• Temporary urinary symptoms: Burning, frequency, and urgency are common initially and typically resolve within weeks.
• Difficulty urinating initially: Swelling may temporarily make urination difficult. Some patients need the catheter reinserted for several days.

Less Common but Serious Complications

Some complications are less frequent but require prompt recognition and treatment:

• Urethral stricture: Scar tissue can form in the urethra, narrowing it and making urination difficult. Occurs in approximately 3-7% of patients and may require additional treatment.
• Urinary incontinence: Temporary stress incontinence (leakage with coughing or sneezing) affects 1-3% of patients and usually resolves within weeks to months. Permanent incontinence is rare, occurring in less than 1%.
• Bladder neck contracture: Scar tissue at the bladder neck can cause obstruction. Occurs in 1-3% of patients and may require minor additional treatment.
• TUR syndrome: Historically, absorption of irrigation fluid could cause dangerous fluid and electrolyte imbalances. Modern bipolar TURP techniques use saline irrigation, making this complication very rare.
• Need for reoperation: Approximately 10-15% of men require repeat TURP within 10-15 years due to regrowth of prostate tissue.

What Results Can You Expect from TURP?

TURP provides excellent outcomes for most patients. Studies show 85-90% of men experience significant improvement in urinary symptoms, with the International Prostate Symptom Score (IPSS) improving by 70-80%. Maximum urinary flow rate typically doubles or triples after surgery.

TURP has decades of outcome data confirming its effectiveness as a treatment for BPH. Understanding what results you can expect helps set realistic expectations and provides benchmarks for evaluating your own recovery.

The improvement in symptoms after TURP is typically substantial and noticeable within the first few weeks after surgery, though it may take up to three months to experience the full benefit. As post-surgical swelling resolves and healing completes, urination becomes progressively easier and more comfortable.

Symptom Improvement After TURP

Clinical studies consistently show that TURP produces significant, durable improvement in urinary symptoms. Key findings from major studies include:

• International Prostate Symptom Score (IPSS): Average improvement of 70-80% from baseline. Most men move from severe symptoms to mild or no symptoms.
• Maximum urinary flow rate: Typically increases from 8-10 mL/second before surgery to 18-25 mL/second after surgery - often doubling or tripling.
• Post-void residual volume: The amount of urine left in the bladder after urinating decreases substantially, often to near zero.
• Quality of life: Most men report significantly improved quality of life, with less disruption from urinary symptoms.

While results are excellent for most patients, outcomes depend on several factors including prostate size, severity of symptoms, and presence of other conditions affecting bladder function. Your urologist can provide a more personalized estimate based on your specific situation.

Long-Term Durability

TURP provides durable results for most patients. Studies following patients for 10-15 years show that approximately 85-90% do not require repeat surgery. When regrowth does occur and symptoms return, the procedure can be repeated with similar success rates.

Frequently Asked Questions About TURP Surgery