Transurethral Resection of Prostate (TURP)

Transurethral Resection of the Prostate (TURP) is a surgical procedure in which a surgeon removes excess prostate tissue through the urethra (the tube that carries urine out of the body), without making any cuts on the skin.

The prostate is a small gland that sits just below the bladder in men. When it grows too large, it squeezes the urethra and makes urination difficult. During TURP, the surgeon passes a thin instrument called a resectoscope through the tip of the penis and up into the urethra. A small wire loop at the end of the resectoscope uses electrical energy to shave away the extra prostate tissue bit by bit, opening up the channel so urine can flow freely again.

TURP is most often used to treat benign prostatic hyperplasia (BPH) — a non-cancerous enlargement of the prostate — when symptoms are severe enough to affect daily life or when other treatments have not worked well enough.

• Benign prostatic hyperplasia (BPH) causing a weak or slow urine stream
• Difficulty starting or stopping urination
• Frequent need to urinate, especially at night (nocturia)
• Feeling that the bladder never fully empties
• Complete inability to urinate (urinary retention) requiring a catheter
• Recurrent urinary tract infections caused by urine pooling in the bladder
• Bladder stones that formed because of incomplete bladder emptying
• Kidney damage caused by long-term urine backflow

TURP is not suitable for every patient. Your doctor will consider other options if any of the following apply.

• The prostate is very large — other surgical approaches may be safer
• Untreated or unstable bleeding disorders (conditions that prevent normal blood clotting)
• Severe heart or lung disease that makes general or spinal anaesthesia too risky
• Active, untreated urinary tract infection — this is usually treated first before surgery
• Prostate cancer that requires a different type of treatment

TURP is a well-established procedure, but like all surgery it carries risks that your surgical team will discuss with you beforehand.

• Retrograde ejaculation (semen travels backwards into the bladder instead of out of the penis during orgasm) — this is very common and does not affect sexual pleasure or urinary health, but it does reduce fertility
• Temporary difficulty urinating or burning sensation after the catheter is removed
• Bleeding during or after surgery, sometimes requiring a blood transfusion
• Urinary tract infection, usually treatable with antibiotics
• TUR syndrome — a rare condition where the body absorbs too much of the fluid used during surgery, affecting salt levels in the blood
• Urinary incontinence (leaking urine), usually temporary
• Narrowing (stricture) of the urethra or the bladder opening, which can develop weeks to months later
• Erectile dysfunction (difficulty getting or keeping an erection) — less common than retrograde ejaculation
• Need for a second procedure if not enough tissue was removed or if the prostate regrows over time
• Rare but serious risks include heavy bleeding requiring emergency treatment or injury to nearby structures

Preparation for TURP usually begins several days before the surgery. Your care team will give you specific instructions, but the points below describe what is typically expected.

Before the procedure, patients are usually asked to fast (not eat or drink) for a number of hours beforehand — your anaesthetist (the doctor who manages your pain and sedation) will specify exactly how long. Blood thinners and some other regular medications are often paused in the days leading up to surgery; your doctor will advise which medicines to stop and for how long. Smoking and alcohol are best avoided in the weeks before any surgery, as both can slow healing and increase anaesthetic risk.

Your doctor will usually arrange the following tests before confirming the surgery:

• Urine flow test (uroflowmetry) to measure how slowly or weakly urine is passing
• Ultrasound (USG) of the prostate and bladder to measure size and check for retained urine
• Blood tests, including kidney function and a full blood count
• PSA (prostate-specific antigen) blood test to help rule out prostate cancer
• Urine culture to check for infection that must be treated before surgery
• ECG (electrocardiogram, a heart tracing) if you are older or have a heart condition
• Cystoscopy (a thin camera passed into the bladder) in some cases, to inspect the urethra and bladder directly

On the day of surgery, the procedure itself generally follows these steps:

• 1. You change into a hospital gown and a nurse checks your vital signs.
• 2. An anaesthetist gives you either spinal anaesthesia (a numbing injection in the lower back that blocks feeling from the waist down) or general anaesthesia (medicine that puts you fully to sleep) — the choice depends on your health and your surgeon's preference.
• 3. You are positioned lying on your back with your legs raised in stirrups.
• 4. The surgeon gently inserts the resectoscope through the tip of the penis into the urethra.
• 5. A continuous flow of sterile fluid is used to keep the operating area clear and to wash away removed tissue.
• 6. The wire loop is used to trim away the overgrown prostate tissue in small pieces, creating a wider channel.
• 7. Electrical energy seals bleeding blood vessels as the work proceeds.
• 8. The tissue pieces are flushed out and may be sent to a laboratory to be examined.
• 9. A urinary catheter (a thin flexible tube) is placed through the urethra into the bladder to drain urine and allow healing.
• 10. You are moved to a recovery area where nurses monitor you as the anaesthesia wears off.

Recovery after TURP takes time, and what is 'normal' varies from person to person. Most patients stay in hospital for one to a few days while the catheter is in place and urine output is monitored. The urine will often look pink or red from blood for a short time — this is expected. The catheter is usually removed once the urine clears and the bladder is working again, though your surgeon will decide the right timing for you.

• Expect some burning or urgency when urinating after the catheter is removed — this usually settles within a few weeks
• Avoid heavy lifting, strenuous exercise, and sexual activity for several weeks, as directed by your surgeon
• Drink plenty of fluids (unless your doctor advises otherwise) to help flush the bladder and reduce infection risk
• Avoid constipation — straining puts pressure on the surgical site; a high-fibre diet or stool softeners may be recommended by your doctor
• Do not drive while the catheter is still in place, and follow your surgeon's guidance on when driving is safe again
• Keep all follow-up appointments — your doctor will check urine flow, look for signs of infection or narrowing, and review any laboratory results from removed tissue
• Blood in the urine can increase temporarily with activity, especially in the first few weeks; rest usually helps it settle
• Return to hospital promptly if you are unable to urinate, have heavy bleeding, develop a high fever, or experience severe pain
• Full recovery and maximum improvement in urine flow usually takes several weeks to a few months; your doctor will track your progress at follow-up visits