How Is Transurethral Resection of the Prostate Done?

Before the procedure

• Several days before the procedure, your doctor may recommend that you stop taking medications that increase the risk of bleeding, including:
  • Blood thinners such as warfarin or clopidogrel 
  • Nonprescription pain relievers such as aspirin, ibuprofen Motrin IB, or naproxen sodium 
• You will be asked to sign a consent form that permits the doctor to do the procedure.
• You will be asked not to eat or drink anything for 8 hours before the procedure, generally after midnight.
• An antibiotic may be prescribed to prevent urinary tract infections.

During the procedure

• You will be asked to empty your bladder and then lie down on your back. 
• The procedure is done under either general anesthesia (completely unconscious) or spinal anesthesia (conscious but cannot feel pain).
• An instrument called a resectoscope (12 inches long and 0.5 inches in diameter) with a lighted camera and valves is inserted using a visual obturator through the tip of the penis into the urethra and extended into the prostate area.
• The resectoscope helps the doctor visualize and trim away excess prostate tissue that are responsible for blocking urine flow.
• The resectoscope contains an electrical wire loop that helps cut the tissue and seal blood vessels. The wire loop is guided by the surgeon to remove the tissue blocking the urethra one piece at a time. The pieces of tissue are carried by irrigating fluid into the bladder and then flushed out at the end of the procedure.

After the procedure

• You will likely have to stay in the hospital for 1-3 days before you can go home.
• A urinary catheter will be left in place for at least 24-48 hours due to the swelling that blocks urine flow. The catheter is generally left until swelling decreases and you are able to urinate on your own.
• Severe pain is rare, but you may experience some discomfort and bladder spasms from the catheter.
• Arrange transportation because you will not be able to drive yourself home after the procedure that day.
• Before going home, the catheter will be removed to check if you can pass urine.
• Most men need approximately 3-4 weeks for complete recovery. Meanwhile, you will be asked to not perform heavy work or strenuous activity or lift any heavy objects for up to 6 weeks after surgery.
• Your doctor may also recommend the following precautionary measures:
  • Drink plenty of water to flush out your bladder and prevent the risk of a urinary tract infection.
  • Eat high-fiber foods to avoid constipation and straining during a bowel movement. 
  • Resume taking any blood-thinning medications after confirming with your doctor.
  • Avoid strenuous activity such as heavy lifting for 4-6 weeks or until your doctor says so.
  • Hold off on sexual activity for 46 weeks.
  • Avoid driving until the catheter is removed and you are no longer taking prescription pain medications.
  • Perform pelvic floor exercises to help improve bladder control.

Transurethral resection of the prostate (TURP) is considered a safe option for men who have moderate to severe urinary problems that do not respond well to medications. 

TURP is the most effective treatment option for an enlarged prostate, which can press against the urethra and interfere with or block the passage of urine from the body.

TURP cannot cure the condition, but helps reduce urinary symptoms caused by benign prostatic hyperplasia, including:

• Frequent or urgent need to urinate
• Difficulty initiating urination
• Prolonged urination
• Nocturia (increased frequency of urination at night)
• Stopping and starting again while urinating
• Feeling of being unable to empty the bladder
• Urinary tract infections

Additionally, TURP may be done to treat or prevent complications due to blocked urine flow, such as:

• Recurring urinary tract infections
• Kidney or bladder damage
• Inability to control urination (urinary incontinence)
• Inability to urinate 
• Bladder stones
• Hematuria (blood in the urine)
• Obstructive nephropathy
• Episodes of urinary retention 
• Prostate abscess
• Difficulty with clean intermittent catheterization
• Obstructive azoospermia

• Temporary difficulty passing urine: It is very common to face trouble urinating for a few days after the procedure. 
• Urinary tract infection: Infection is a possible complication after any prostate procedure, which is likely to occur the longer a catheter is in place. 
• Dry orgasms: This condition is called retrograde ejaculation (when ejaculation goes into the bladder and not out the penis). It is not harmful and does not affect sexual pleasure, but may interfere with fertility.
• Erectile dysfunction: Although rare, erectile dysfunction may occur after a prostate procedure.
• Heavy bleeding: This is a very rare complication of TURP, wherein a significant amount of blood is lost, requiring a blood transfusion. 
• Difficulty holding urine or painful urination: Loss of bladder control (incontinence) is a long-term complication of TURP.
• Electrolyte abnormalities: Rarely, the body absorbs too much of the fluid used to clean the surgery area during TURP, causing a condition called “TURP syndrome or transurethral resection syndrome,” which can be life-threatening if left untreated.
• Need for follow-up: In some cases, a follow-up treatment after TURP is required because symptoms do not improve or return (relapse) over time or in cases where TURP causes narrowing (stricture) of the urethra or the bladder neck.

While you are recovering, you should contact your doctor if you:

• Have difficulty or severe pain when urinating
• Notice bright red blood or an increase in the passage of clots in urine
• Notice that your urine is not clear despite drinking enough fluid and resting for 24 hours
• Develop a fever above 100.4 F (38 C)