Transurethral resection of prostate (TURP)

The prostate is a small gland, about the size of a walnut, which lies just below the bladder (see diagram below) and is only present in men. It is part of the male reproductive system.

One of the main functions of the prostate is to squeeze fluid into the urethra as sperm move through during ejaculation. This fluid contains nutrients for the sperm, activates them and has other roles in sexual reproduction. The prostate provides much of the volume of what is ejaculated. The prostate gland can be felt by a healthcare professional with a finger examination of the rectum.

Prostate enlargement (hyperplasia) is a non-cancerous (benign) overgrowth of the prostate gland. This is a common condition in men as they get older.

The prostate gland surrounds the outlet of the bladder (the urethra) and when enlarged it squeezes the urethra and narrows the opening, preventing the urine from easily leaving the bladder.

Early

• The urine does not flow as fast or as strong as it used to.
• Passing urine is carried out more frequently.
• When there is an urge to pass urine, it is urgent, and needs to be done without delay.
• Many men have to get up more often at night to urinate.

Later

• The bladder does not empty completely.
• The flow of urine weakens and slows to a dribble.
• Other problems may include blood in the urine and infection of the bladder or kidney.

Usually the diagnosis can only be made by taking a record of past and present events (history) carrying out a physical examination, and taking some blood samples.

Other investigations can include:-

Uroflowmetry

• To measure how fast the urine is passed.

Residual urine

• Residual urine is the amount of urine that is left in the bladder after urinating is finished - this can be measured using an ultrasound scan.

Cystoscopy

• The urethra and bladder can be examined by using a special telescope (called a cystoscope).

An operation is usually advisable if any of the following occur:

• Severe obstruction.
• Early signs of kidney damage.
• Repeated urinary tract infections.
• Retention of urine (unable to pass urine).
• Repeated bleeding when passing urine.
• Very bothersome symptoms.

This is an operation to create a larger channel through the prostate gland. This will prevent or relieve obstruction to the flow of urine.

An instrument (resectoscope) is inserted via the urethra and through the prostate gland, into the bladder.

It has a telescope and light guide, which allows the Urologist to see inside the bladder and prostate.

The resectoscope uses a wire loop to remove areas of tissue from the prostate that are blocking the urethra and allows blood vessels to be sealed (cauterised) to reduce the risk of bleeding afterwards.

TURP is performed using either a general anaesthetic (where you are asleep) or a spinal anaesthetic (where you have no feeling below the waist).

This will be discussed with you beforehand. You should expect to stay in hospital for between two – four days, the procedure is minimally invasive and does not involve any external cuts.

TURP normally takes between 30 – 40 minutes to perform, although having an anaesthetic makes this time longer. The whole procedure takes about 60 minutes.

Any operation and anaesthetic carry risks, these are generally small and not doing the operation may carry a greater risk. Risks of anaesthetic can be discussed with the anaesthetist who will be looking after you during the procedure.

Retrograde ejaculation This occurs in nearly all men after TURP. Rather than sperm being ejaculated out through the penis during sexual climax, the sperm pass back into the bladder and are passed out in the urine. This will reduce the ability to have children, but is not a means of contraception.

Impotence There is a reported risk (approximately 7-10%) of impotence after the operation.

If this is a problem, treatments are available e.g. Viagra, Vacuum Devices.

Regrowth of the prostate gland Because only the areas of prostate gland that are causing the obstruction are removed then the remaining gland may regrow and need a further operation, a number of years later.