Transurethral resection of the prostate (commonly known as a TURP, plural TURPs, and rarely as a transurethral prostatic resection, TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. It has been the standard treatment for BPH for many years, but recently alternative, minimally invasive techniques have become available. This procedure is done with spinal or general anaesthetic. A triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. The outcome is considered excellent for 80–90% of BPH patients. The procedure carries minimal risk for erectile dysfunction, moderate risk for bleeding, and a large risk for retrograde ejaculation.

Indications

BPH is normally initially treated medically through alpha antagonists such as tamsulosin, or 5-alpha-reductase inhibitors such as finasteride and dutasteride. If medical treatment does not reduce a patient's urinary symptoms, a TURP may be considered following a careful examination of the prostate or bladder through a cystoscope. If TURP is contraindicated, a urologist may consider a simple prostatectomy, in and out catheters, or a supra-pubic catheter to help a patient void urine effectively. As the medical management of BPH improves, the number of TURPs has been decreasing.

Types of TURP

Traditionally, a cystoscope (a "resectoscope") has been used to perform TURP. The scope is passed through the urethra to the prostate where surrounding prostate tissue can then be excised. There are two types of modalities: A 2019 Cochrane review of 59 studies including 8924 men with BPH urinary symptoms found that bipolar and monopolar TURP probably result in comparable improvements in urinary symptoms, as well as in similar erectile function, incidence of urinary incontinence and need for retreatment. Bipolar surgery likely reduces the risk of TUR syndrome and the need for blood transfusion. Another transurethral method utilizes laser energy to remove tissue. With laser prostate surgery a fiber optic cable pushed through the urethra is used to transmit lasers such as holmium-Nd:YAG high-powered "red" or potassium titanyl phosphate (KTP) "green" to vaporize the adenoma. More recently the KTP laser has been supplanted by a higher power laser source based on a lithium triborate crystal, though it is still commonly referred to as a "Greenlight" or KTP procedure. The specific advantages of utilizing laser energy rather than a traditional electrosurgical TURP is a decrease in the relative blood loss, elimination of the risk of post-TURP hyponatremia (TUR syndrome), the ability to treat larger glands, as well as treating patients who are actively being treated with anticoagulation therapy for unrelated diagnosis. A further transurethal method utilizes a robotically-controlled waterjet to remove prostate tissue. Visualization is provided by a combination of cystoscope and transrectal ultrasound methods. This procedure claims risk reduction advantages as a result of being heat free.

Risks

Because of bleeding risks associated with the procedure, TURP is not considered safe for many patients with cardiac problems. Postoperative complications include:

Acute complications

Chronic complications

In most cases, urinary incontinence and erectile dysfunction resolve on their own within 6 to 12 months post-TURP. Therefore, many doctors will postpone invasive treatment until a year after the surgery. Additionally, transurethral resection of the prostate is associated with a low risk of mortality.

Research

The UNBLOCS trial compared using TURP to the thulium laser transurethral vaporesection of the prostate (ThuVARP). Both methods led to similar improvements, number of complications and lengths of hospital stay. Both were effective as treatment but TURP resulted in a better urinary flow rate.