TURP Surgery for BPH: Transurethral Resection of the Prostate – Complete Guide

What is TURP?

Transurethral Resection of the Prostate (TURP) is the traditional gold standard surgical treatment for benign prostatic hyperplasia (BPH). It has been performed for over 50 years and remains one of the most common surgeries for enlarged prostate.

During TURP, a surgeon inserts a scope through the urethra and uses a wire loop to remove excess prostate tissue that is blocking urine flow. No external incisions are made.

How does TURP work?

TURP works by physically removing obstructing prostate tissue:

The technique:

• A resectoscope (thin scope with a wire loop) is inserted through the urethra
• The wire loop is heated with electrical current
• The surgeon uses the loop to shave off pieces of prostate tissue (chips)
• The chips are flushed out with irrigating fluid
• The procedure creates a wider channel for urine to pass

Anaesthesia:

• Spinal anaesthesia (epidural) – most common (awake but numb from waist down)
• General anaesthesia – asleep

Who is a good candidate for TURP?

Ideal candidates for TURP meet the following criteria:

• Prostate size: 30-100 mL (moderate to large enlargement)
• Symptoms: Moderate to severe BPH symptoms (IPSS ≥12) that affect quality of life
• Medication failure: Poor response or intolerance to BPH medications
• Complications: Acute urinary retention, recurrent UTIs, bladder stones, or hematuria
• Willing to accept retrograde ejaculation (70-80% rate)

Who is NOT a good candidate?

• Very large prostates >100 mL (consider HoLEP or open prostatectomy)
• Active urinary tract infection
• Urethral stricture (narrowing) that prevents scope passage
• Known prostate cancer (requires different treatment)
• Men who want to preserve ejaculation (consider UroLift)

The TURP procedure – what to expect

Before the procedure:

• Stop blood thinners (aspirin, warfarin, clopidogrel, apixaban) as directed by your doctor
• Antibiotics may be prescribed to prevent infection
• Clear liquid diet the day before (in some cases)
• Bowel preparation (enema) may be required

Day of procedure:

• Performed in a hospital operating room
• Anaesthesia: Spinal or general anaesthesia
• Duration: 30-60 minutes
• Hospital stay: 1-2 days

Step-by-step:

1. A resectoscope is inserted through the urethra
2. Irrigating fluid is used to distend the bladder and flush tissue
3. The wire loop resects (shaves off) excess prostate tissue
4. Resected tissue chips are flushed out
5. A urinary catheter (Foley) is placed at the end of the procedure

Recovery and downtime

Immediate post-procedure (first week):

• Catheter: Required for 1-3 days (all patients)
• Hospital stay: 1-2 days overnight
• Blood in urine (hematuria): Very common – lasts 1-2 weeks
• Burning with urination (dysuria): Common – lasts 1-2 weeks
• Increased frequency/urgency: Temporary, improves over 2-4 weeks

Return to activities:

• Desk work: 1-2 weeks
• Physical labour: 3-4 weeks
• Exercise (light): 2 weeks
• Sexual activity: 3-4 weeks (after catheter removal and discomfort resolves)
• Heavy lifting: Avoid for 4-6 weeks

Symptom improvement timeline:

• Week 1-2: Temporary worsening due to swelling (normal)
• Week 4: Significant improvement begins
• Month 3: Maximum benefit achieved

Effectiveness – symptom improvement and durability

TURP is highly effective with excellent long-term results:

Clinical outcomes:

• IPSS reduction: 60-70% (e.g., 22 → 7-8)
• Peak flow rate (Qmax) increase: 100-150% (e.g., 9 → 18-22 mL/s)
• Prostate tissue removed: 20-30 grams on average

Durability:

• 5-year success rate: 85-90%
• 10-year re-treatment rate: 10-15% (some men need repeat TURP or other treatment)
• Most durable of all BPH treatments (along with HoLEP)

Patient satisfaction:

• 85-90% of men report being satisfied or very satisfied at 5-10 years

Side effects – retrograde ejaculation, ED, incontinence

TURP has a predictable side effect profile that should be discussed before surgery:

Common side effects (occur in >10%):

• Retrograde ejaculation: 70-80% – semen goes into bladder instead of out (harmless but causes infertility)
• Hematuria (blood in urine): 90-100% – resolves in 1-2 weeks
• Dysuria (painful urination): 60-80% – resolves in 1-2 weeks
• Urinary frequency/urgency: 50-70% – temporary

Less common side effects (2-10%):

• Erectile dysfunction (ED): 5-10% (higher than MISTs)
• Urinary tract infection: 5-10%
• Urethral stricture: 2-5% (narrowing of the urethra – requires dilation)
• Bladder neck contracture: 2-5% (scarring at bladder neck – requires dilation)

Rare side effects (<2%):

• Urinary incontinence: <1% (permanent leakage)
• TUR syndrome (fluid overload): <1% (rare with modern bipolar TURP)
• Blood transfusion: <2% (less common with bipolar TURP)

TURP vs. HoLEP vs. Rezum vs. UroLift

如何看待Excellent (90-95%)如何看待Good (80-85%)如何看待Good (80-85%)

Feature	TURP	HoLEP	Rezum	UroLift
Prostate size	30-100 mL	30-200+ mL	30-80 mL	30-80 mL
Hospital stay	1-2 days	1-2 days	None	None
Catheter required	1-3 days (100%)	1-2 days (100%)	1-3 days (10-15%)	Rare (5-10%)
Return to work	2-4 weeks	2-4 weeks	1-3 days	1-3 days
Retrograde ejaculation	70-80%	70-80%	20-30%	<2%
Erectile dysfunction risk	5-10%	5-10%	<2%	<1%
10-year durability如何看待Excellent (85-90%)

TURP variations – bipolar TURP, TUIP

Bipolar TURP (Transurethral Resection in Saline – TURis):

• Uses saline instead of non-conductive irrigating fluid
• Lower risk of TUR syndrome (fluid overload)
• Less bleeding than traditional monopolar TURP
• Now the standard of care in most centres

TUIP (Transurethral Incision of the Prostate):

• Less invasive than TURP – makes small incisions in the prostate rather than removing tissue
• For smaller prostates (<30 mL)
• Lower retrograde ejaculation rate (20-30%)
• Less durable than TURP (higher re-treatment rate)

Interactive FAQ – TURP surgery for BPH

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Disclaimer: This information is for educational purposes. TURP is a surgical procedure with risks and benefits. Discuss with a urologist at Vivekananda Hospital to determine if TURP is right for you.