Transurethral Resection of Prostate (TURP)

Endoscopic prostate resection, commonly known as TURP (Transurethral Resection of the Prostate), is a surgical procedure used to treat benign prostatic hypertrophy (BPH), a condition in which the prostate becomes enlarged and can cause urinary problems. This guide will give you a complete overview of the TURP procedure, including its purposes, pre-operative preparation, surgical process, postoperative period, and associated risks.

Purpose of the TURP:

TURP is primarily used to relieve symptoms associated with benign prostatic hypertrophy, including:

Reduced urine flow: An enlarged prostate can compress the urethra, reducing urine flow and causing difficulty urinating;
Frequent, urgent urination: BPH can cause increased urinary frequency and a sudden urge to urinate;
Urinary retention: In some cases, an enlarged prostate can lead to a complete inability to urinate, causing a condition known as urinary retention.

Pre-operative preparation:

Before TURP, the patient will undergo a series of diagnostic tests and preparations, which may include:

Physical exams and laboratory tests: These may include blood tests, including PSA, urinalysis, and evaluations of kidney function.
Urological evaluation: The patient will undergo a complete urological examination, including a digital rectal examination (DRE) and, in some cases, a prostate ultrasound.
Discontinuation of anticoagulant drugs: If the patient is taking anticoagulant or antiplatelet drugs, it may be necessary to discontinue or adjust the dose under the doctor's supervision.

Surgical process:

The TURP procedure is performed using an instrument called a resectoscope inserted through the urethra to the prostate. The surgical process includes the following steps:

Anesthesia: TURP can be performed using general anesthesia or spinal anesthesia, depending on patient and surgeon preference;
Insertion of the operating instrument: the resectoscope is inserted into the urethra and guided up to the prostate;
Prostate tissue removal: Using specialized instruments attached to the endoscope, the surgeon removes excess prostate tissue, often using a technique called electrovaporization or electroresection;
Irrigation: During the procedure, an irrigation fluid is used to drain the removed prostate tissue and to keep visibility clear;
Bleeding control: Your surgeon may use electrosurgical tools to cauterize blood vessels and reduce the risk of excessive bleeding.

Post-operative period:

After TURP, medical personnel will monitor the patient and receive appropriate post-operative care. This can include:

Monitoring: The patient will be monitored closely to check for any post-operative complications, such as bleeding;
Pain management: The patient may receive pain medications, if necessary, to relieve any discomfort after the procedure;
Catheter: It is common for the patient to be left with a urinary catheter for 2-3 days after the procedure to allow urine to drain, control bleeding, and promote healing; after removal of the bladder catheter, the patient is monitored for 24 hours to check for the resumption of spontaneous urination;
Discharge and Follow-up: upon discharge, a post-operative visit will be scheduled to discuss the histological examination of the removed prostatic tissue and verify the correct bladder emptying.

Risks associated with TURP:

Although TURP is considered safe and effective, there are some associated risks and complications, including:

Bleeding: Bleeding during or after the procedure may require blood transfusions or additional interventions to control it;
Infection: There is a risk of infection of the urinary tract or the prostate itself after TURP;
Retrograde ejaculation: After TURP, some men may experience retrograde ejaculation, where semen enters the bladder instead of being expelled through the urethra during orgasm; this side effect does not entail any danger;
Erectile dysfunction: Although rare, TURP can cause erectile dysfunction in some patients.

Risks associated with non-execution of the TURP

Not performing endoscopic resection of the prostate (TURP) when indicated may result in several risks and complications associated with untreated benign prostatic hypertrophy (BPH). Here are some of the main risks:

Worsening of urinary symptoms: Without treatment, the symptoms associated with benign prostatic hypertrophy tend to worsen over time. These symptoms, as already mentioned on this site, include difficulty in starting urination, weak urinary flow, urination and frequent and urgent, sensation of incomplete emptying of the bladder, and frequent awakenings at night to urinate. Worsening symptoms can significantly reduce quality of life and lead to problems such as acute urinary retention;
Acute urinary retention: Without treatment, enlargement of the prostate can progress to cause a complete inability to urinate, known as acute urinary retention. This condition requires emergency medical intervention and can lead to severe complications, such as kidney damage, serious urinary infections, and other bladder-related complications;
Urinary tract infections: Accumulation of urine in the bladder due to reduced urine flow increases the risk of developing urinary tract infections. These infections, as is known, can cause painful and unpleasant symptoms, such as burning during urination, urinary urgency, frequent urination, and sometimes fever and pelvic pain;
Kidney damage: Accumulation of urine in the bladder due to untreated prostatic hypertrophy can increase pressure on the upper urinary tract, including the kidneys. Over time, this can lead to kidney damage, kidney failure, and other serious kidney complications;
Sexual complications: Untreated benign prostatic hypertrophy can negatively affect sexual function. It can cause problems such as erectile dysfunction, painful ejaculation, and reduced libido.

Conclusions:

TURP is an effective surgical procedure to treat the symptoms of benign prostatic hypertrophy and improve the quality of life of patients suffering from this condition. However, as with any surgery, patients need to understand the risks and benefits of the procedure and discuss their options with their doctor before making an informed decision.

Failure to treat BPH with TURP or other treatment options can lead to a variety of urinary and general problems that can have a significant impact on the patient's quality of life and overall health. It is essential to consult a doctor to evaluate your treatment options and determine the best plan to manage the condition effectively.