TURP

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TURP (transurethral prostate resection) is a surgical procedure in which the prostate is completely or partially removed via the urethra. A benign enlargement of the prostate (benign prostatic hyperplasia) is the most common reason for TURP. Read everything about the TURP, how it works and what risks it entails.

What is a TURP?

The TURP (also TUR-P) is a standard operative procedure. The prostate is completely or partially removed. TURP stands for transurethral resection of the prostate or transurethral prostate resection. Transurethral means that the prostate is ablated and removed with the help of a special instrument via the urethra (urethra).

prostate

The prostate (prostate gland) lies below the urinary bladder and surrounds part of the urethra. It produces a fluid that is used to ensure sperm survival after ejaculation.

TURB

The TURB (also TUR-B) is the transurethral resection of the urinary bladder. It is mainly used to treat tumors of the urinary bladder. The operational steps are basically the same as for TURP.

When do you do a TURP?

TURP is the standard therapy for the treatment of benign prostatic hyperplasia (BPH). In men, there is often a benign enlargement of the prostate in old age, which leads to so-called lower urinary tract symptoms (LUTS) and bladder outlet obstruction (BOO). The enlarged prostate and narrowing of the urethra can cause the following symptoms:

frequent urination in small amounts (pollakiuria)
urinating at night (nocturia)
constant urge to urinate (urge symptoms)
weakened urine stream
Dripping urine
Residual urine sensation

If the BPH cannot be treated with medication or if one of the following complications occurs, a transurethral resection of the prostate is necessary:

Urinary retention - inability to empty the bladder with a build-up of urine
Bladder stones
Postrenal renal insufficiency ("after the kidney" e.g. obstruction of the drainage of the ureter) or enlargement of the kidney ducts (hydronephrosis)
Overflow bladder - the bladder remains largely full while additional urine flows out in droplets

In addition, the TURP can also be used to obtain prostate tissue for a more detailed examination (diagnostic TURP).

What do you do at a TURP?

TURP is a minimally invasive procedure in which only the smallest injuries to the skin and soft tissues occur. First, the doctor will discuss your medical history with you and examine you in detail. This includes a physical exam, urine and prostate-specific antigen (PSA) exam. The doctor will also ask you to fill out a specific questionnaire (IPSS questionnaire). The evaluation of the IPSS questionnaire helps the doctor to determine the severity of the symptoms caused by BPH. In addition, there is in-depth personal advice and clarification. Ruling out a urinary tract infection is particularly important. As a preventive measure, you will also be given an antibiotic. You must also stop taking anticoagulant medication before the TURP to avoid bleeding as much as possible.

The TURP can be performed under general or partial anesthesia. For the TURP, the patient lies on his back while the legs are bent at 90 degrees in the hip joint and the knees are bent on supports (lithotomy position). At the beginning, an instrument is inserted into the urethra with the help of lubricant, which the surgeon can use to inspect the prostate and bladder. Using a so-called electrical high-frequency loop, he cuts through the tissue and at the same time obliterates the interfaces. During the TURP, the operating area is continuously rinsed so that the prostate parts are flushed out. After the instruments are removed, a catheter is placed.

What are the risks of a TURP?

In addition to the general surgical risks, specific complications can occur with TURP. However, these are rare, as TURP is basically a gentle procedure with few complications. These include:

Bleeding
Perforation of the prostate capsule
Injuries to neighboring organs
Flushing of rinsing fluid into the circulation (TUR syndrome)

TUR syndrome

If irrigation fluid gets into the bloodstream through opened vessels or wounds, changes in the electrolyte balance can occur. This leads to dangerous circulatory stress, which manifests itself in a slow heart rate (bradycardia), high blood pressure or low blood pressure and neurological symptoms such as visual disturbances, nausea, fatigue, headache and impaired consciousness. So that the flushing fluid is excreted again, water tablets (diuretics) are administered. The TUR syndrome occurs very rarely.

What do I have to consider after a TURP?

During the first 24 hours, the bladder is continuously flushed so that the surgical wound does not become infected. A few days after the TURP, the urine may still have blood or clots in it. Although the wound of the TURP is not visible, you should take it easy in the first few weeks and avoid both heavy physical exertion and sexual intercourse.

The TURP leads to an immediate and mostly long-lasting improvement of the symptoms and a significant increase in the quality of life. However, urinary incontinence can result from scarring or damage. A TURP can lead to infertility if the seminal fluid is expelled backwards (retrograde) into the bladder and remains there until the next urination. Both the ability to have an erection and an orgasm remain intact. Follow-up checks with urine tests ensure the success of the TURP.

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