T.U.R.P. Surgery

A transurethral resection of the prostate (TURP) is a surgical procedure that removes portions of the prostate gland through the penis. A TURP requires no external incision.

The surgeon reaches the prostate by inserting an instrument through the urethra (the narrow channel through which urine passes from the bladder out of the body). This instrument, called a resectoscope, is about 12 inches long and one-half inch in diameter. It contains a light, valves that control irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels. It's inserted through the penis and the wire loop is guided by the surgeon so it can remove the obstructing tissue one piece at a time. The pieces of tissue are carried by fluid into the bladder and flushed out at the end of the procedure.

The prostate gland is about the size of a walnut and surrounds the neck of a man's bladder and urethra—the tube that carries urine from the bladder. It's partly muscular and partly glandular, with ducts opening into the prostatic portion of the urethra. It's made up of three lobes, a central lobe with one lobe on each side.

As part of the male reproductive system, the prostate gland's primary function is to secrete a slightly alkaline fluid that forms part of the seminal fluid (semen), a fluid that carries sperm. During male climax (orgasm), the muscular glands of the prostate help to propel the prostate fluid, in addition to sperm that was produced in the testicles, into the urethra. The semen then travels through the tip of the penis during ejaculation.

Researchers don't know all the functions of the prostate gland. However, the prostate gland plays an important role in both sexual and urinary function. It's common for the prostate gland to become enlarged as a man ages, and it's also likely for a man to encounter some type of prostate problem in his lifetime.

Many common problems are associated with the prostate gland. These problems may occur in men of all ages and include:

• Benign prostatic hyperplasia (BPH). An age-related enlargement of the prostate that isn't malignant. BPH is the most common noncancerous prostate problem, occurring in most men by the time they reach their 50s. Symptoms are slow, interrupted, or weak urinary stream; urgency with leaking or dribbling; and frequent urination, especially at night. Although it isn't cancer, BPH symptoms are often similar to those of prostate cancer.
• Prostatism. This involves decreased urinary force due to obstruction of flow through the prostate gland. The most common cause of prostatism is BPH.
• Prostatitis. Prostatitis is inflammation or infection of the prostate gland characterized by discomfort, pain, frequent or infrequent urination, and sometimes fever.
• Prostatalgia. This involves pain in the prostate gland, also called prostatodynia. It's frequently a symptom of prostatitis.

Cancer of the prostate is a common and serious health concern. According to the American Cancer Society, prostate cancer is the most common form of cancer in men older than age 50, and the third leading cause of death from cancer.

There are different ways to achieve the goal of removing the prostate gland. Methods of performing prostatectomy include:

• Surgical removal includes a radical prostatectomy (RP), with either a retropubic or perineal approach. This is used to treat cancer. Radical prostatectomy is the removal of the entire prostate gland. Nerve-sparing surgical removal is important to preserve as much function as possible.
• Transurethral resection of the prostate, or TURP, which also involves removal of part of the prostate gland, is an approach performed through the penis with an endoscope (small, flexible tube with a light and a lens on the end).
• Cryosurgery is a less invasive procedure than surgical removal of the prostate gland. Treatment is administered using probe-like needles that are inserted in the skin between the scrotum and anus. The urologist can also use microwaves.
• Laparoscopic surgery, done manually or by robot, is another method of removal of the prostate gland.

TURP is generally done to relieve symptoms due to prostate enlargement, often due to BPH. When the prostate gland is enlarged, the gland can press against the urethra and interfere with or obstruct the passage of urine out of the body. BPH is a condition in which the prostate gland may become quite enlarged and cause problems with urination. Symptoms may include:

• Problems with getting a urine stream started
• Having to urinate more frequently at night
• Having an urgent need to urinate
• Dribbling after you finish urinating

These symptoms can create problems such as retaining urine in the bladder, which can contribute to bladder infections or formation of stones in the bladder.

BPH can also raise prostate-specific antigen (PSA) levels two to three times higher than the normal level. An increased PSA level doesn't always indicate cancer, but the higher the PSA level, the higher the chance for having cancer. A TURP may be done in men who can't tolerate a radical prostatectomy due to their age or overall health status.

Specific treatment for BPH will be determined by your doctor based on:

• our age, overall health, and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Eventually, BPH symptoms usually require some kind of treatment. When the gland is just mildly enlarged, treatment may not be needed, as research has shown that some of the symptoms of BPH can clear up without treatment in some mild cases. This decision can only be made by your doctor after careful evaluation of your individual condition. Regular checkups are important, however, to watch for developing problems.

Sometimes a TURP is done to treat symptoms only, not to cure the disease. For example, if you're unable to urinate because of cancer, but radical prostatectomy isn't an option for you, you may need a TURP.

There may be other reasons for your doctor to recommend a TURP.

As with any surgical procedure, certain complications can occur. Some possible complications may include:

• Blood in the urine after surgery
• Painful or difficult urination
• Possibility of infection
• Retrograde ejaculation (when ejaculation occurs in the bladder and not the penis)
• Bleeding
• Infection

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Some things you can expect before the procedure include:

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You'll be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something isn't clear.
• In addition to a complete medical history, your doctor may perform a physical examination to ensure you're in good health before you undergo the procedure. You may also undergo blood tests and other diagnostic tests.
• You'll be asked to fast for eight hours before the procedure, generally after midnight.
• Notify your doctor if you're sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general.)
• Notify your doctor of all medications (prescribed and over the counter) and herbal supplements that you're taking.
• Notify your doctor if you have a history of bleeding disorders or if you're taking any anticoagulant (blood-thinning) medications, aspirin, or any other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• If you smoke, you should stop smoking as soon as possible prior to the procedure, in order to improve your chances for a successful recovery from surgery and to improve your overall health status.
• You may receive a sedative prior to the procedure to help you relax.

Based on your medical condition, your doctor may request other specific preparation.