What Is TURP?
TURP is a surgery done on male patients with urinary problems caused due to an enlarged prostate. The prostate is an organ in males, it is situated below the urinary bladder and wraps itself around the urethra (urine-carrying duct). The average prostate is around 33 grams, and it secretes alkaline solutions that liquefy ejaculation. Almost 30% of the ejaculate is composed of prostatic secretions.
As men age, the prostate enlarges due to testosterone, a condition known as benign prostate hyperplasia (BPH). The enlarged prostate compresses the urethra and obstructs urine flow. The clinician will initially prescribe medication to lower the urinary tract symptoms; if that does not solve the problem, the next best available option is TURP. During TURP, the surgeon will trim away the excess prostate using a resectoscope, facilitating easy urine flow.
Who Needs TURP?
It is indicated in patients with BPH, TURP is done to relieve the symptoms, not to cure the problem itself; the surgeon may also prescribe TURP in conditions mentioned below-
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Lower Urinary Tract Symptoms- These include difficulty in emptying the bladder, frequent urinary tract infections, bladder control issues, extremely slow urination, and getting up often at night to urinate.
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Bladder Stones And Kidney Damage- In patients with BPH, prolonged urinary obstruction leads to stones (also known as vesicles or calculi) in the urinary bladder, followed by kidney damage. In these patients, TURP is often combined with vesicolithotomy (removal of bladder stones) to relieve the symptoms.
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Prostate Abscess- It is the result of an infection to the prostate and, if untreated, often leads to pus discharge, urosepsis, and septic shock
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Prostate Cancer- It is one of the most common types of cancer in men, with symptoms like blood in the urine and semen, erectile dysfunction, and bone pain. In patients with prostate cancer, TURP is done to relieve the symptoms if prostate removal is not an option. TURP is contraindicated in patients who are on Anticoagulants like Aspirin and Warfarin.
What Investigations Are Done Before TURP?
Aside from the routine physical examination, a few tests are done before TURP; they are-
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Computed Tomography (CT ) Scan- Helps to identify any midline defects in the prostate.
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Magnetic Resonance Imaging (MRI)- Helps to determine the prostate volume and the distribution of the hyperplastic prostate.
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Abdominal Ultrasound- Also known as transabdominal ultrasonography (TAUS), helps to determine the amount of urine left in the bladder after voiding.
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Urodynamic Testing- Not done by all urologists, but if done, it helps to know the urgency and frequency of urination.
How Is the Procedure Done?
A urologist performs TURP after careful evaluation of the patient. It can be performed in three ways-
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Transurethral Resection of the Prostate (TURP)- It is the gold standard to remove the hypertrophic (enlarged) prostate in patients with BPH. The surgeon reviews the risks and complications involved, followed by anesthesia.
The patient is then placed in a lithotomy position (on the back with legs flexed at 90 degrees at the hips), and a resectoscope is inserted through the urethra using a visual obturator. Once the entire bladder is visualized, the obturator is removed, and in its place, a resection loop (either bipolar or monopolar) is inserted. This loop resects the excess prostate, one small piece at a time, without damaging the prostate capsule. Care is taken that hemostasis (to prevent and stop bleeding) is maintained throughout the procedure.
Patients are kept in the hospital till the urine remains clear, and urine voiding is complete and pain-free. If the patient is unable to void, a Foley catheter is placed, and the patient is called after a week for a trial voiding.
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Transurethral Vaporesection of the Prostate (TUVRP)- Similar to a TURP but instead of a resection loop, a special wire loop is placed inside the resectoscope that heats the prostate and turns it to vapor.
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Holmium Laser Enucleation of the Prostate (HoLEP)- This technique is preferred in patients who are on anticoagulants.
What Are the Complications of TURP?
Every surgery comes with a certain level of risks involved; a few are specific to TURP; they are-
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Difficulty In Avoiding- The rectoscope inserted during the procedure will cause post-operative pain and difficulty in urinating, even though the underlying cause is resected. The pain is temporary in nature, and a catheter is placed into the penis to facilitate easy urination.
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Urinary Tract Infection- Having a catheter increases the chances of urinary tract infections post-op. It is easily managed with maximum medical therapy (MMT).
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Dry Orgasm- Also known as retrograde ejaculation, where the semen gets released into the bladder after ejaculation. It is not harmful and does not affect sexual pleasure; however, it prevents the ability to father a child.
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Erectile Dysfunction- The inability to get and keep an erection firm enough for sex is known as erectile dysfunction and is occasionally seen in patients who have undergone TURP.
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Bleeding- Extreme care is taken to make sure that patients do not lose enough blood to require a transfusion, but patients with large prostate appear to be at a higher risk of blood loss.
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Difficulty In Holding Urine- Incontinence (loss of control) is rarely seen after TURP; if it does occur, the patient will experience leakage of urine involuntarily during normal activities like coughing and sneezing.
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Retreatment- TURP occasionally causes narrowing of the urethra and the neck of the bladder, which might need retreatment.
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TURP Syndrome- During TURP, continuous bladder irrigation is done for visualization and efficient resection. In a few patients, the body absorbs too much of this irrigating fluid leading to a drop in the sodium level, which can be life-threatening. This can be avoided by using a bipolar TURP.
Conclusion:
The TURP is a well-tolerated elective procedure that requires an integrated interprofessional team that can effectively communicate with the patient and set proper expectations. Since most prostate problems are age-related and inevitable, early detection of the signs and symptoms helps with a better prognosis and outcome of the procedure.
