What is a TURP?
A TURP is an endoscopic procedure in which the urinary channel through the prostate is enlarged by removing obstructing prostate tissue adjacent to the portion of the urethra, which passes through the gland. The urethral lining is removed with the prostate tissue but regenerates within 6-8 weeks. This procedure is performed with the patient under anesthesia in the hospital operating room. All of the removed prostate tissue is sent to the pathologist for analysis and to look for malignancy. After the procedure, a catheter is left in place to allow proper healing. It is usually removed in 1-2 days.
There are generally two types of TURPs performed:
- Traditional TURP: a scope is inserted into the urinary channel within the prostate where the obstructing prostatic tissue is removed with an electric cutting instrument.
- LASER TURP: a scope is inserted through the urinary channel up into the prostate where the obstructing prostatic tissue is removed (ablated) with a LASER. There are several types of lasers that are effective for this like Green Light and Thulium.
Both procedures are well established with an overall 80% rate of improvement in urinary symptoms.
What is the purpose of TURP?
As men age, many will experience increasing problems urinating. In the majority of instances, this is due to progressive enlargement of the prostate, which is a small gland that resides beneath the bladder and through which the urinary channel passes. Over 75% of men will eventually experience symptoms of prostate enlargement which include slowing of the urinary stream, urinary frequency, hesitancy, and occasional urinary leakage. While many men will benefit from medical therapy to improve their symptoms, some men, however, require interventional therapy such as TURP, which affords excellent long-term improvement in male urinary tract voiding symptoms.
What are common symptoms following my TURP?
As mentioned above, after the procedure while the patient is still asleep, a catheter will be placed through the urinary channel into the bladder. Men who undergo the traditional TURP are admitted to the hospital for 1 to 2 days following the operation for observation and irrigation of the catheter to prevent problems from possible bleeding after surgery.
If the LASER TURP is performed, most men can expect to go home the same day with a catheter in place. Since there appears to be less bleeding from this procedure, patients generally do not require hospitalization and their catheters are often removed the next day at home or in the office.
Patients who have a catheter often report mild discomfort in the region of the urinary tract or genitalia, as well as occasional strong urges to urinate, even though the catheter is draining. It is also quite common for a patient to experience cramping and burning in the lower abdomen and genitalia when he is active or when having a bowel movement. These symptoms are caused by bladder contracting strongly around the catheter. These spasms generally last 1-2 minutes and will then resolve spontaneously. During these episodes, it is also common to have a small amount of urine or blood leak around the catheter.
It is also common to have some degree of bleeding for several days after a TURP. This bleeding may turn the urine cherry-colored, burgundy, or even brown. Most bleeding will resolve within the first 1-2 weeks though it is possible to have occasional bleeding up to 1 month after a TURP depending on the patient’s activity level.
Once the catheter is removed, most men report that they are voiding with a much better stream and less hesitancy than before the operation. The patient may have some discomfort and burning with urination, but this will improve within the first 1-2 weeks.
After TURP it is common to have some bladder instability and many men will note some degree of urinary frequency and urgency, which at times may cause mild leakage. These symptoms will gradually improve over 4 to 6 weeks.
Many men will report transient urinary leakage following removal of their Foley catheter. Initially, this often is due to bladder spasms occurring following the surgery. This leakage occurs in conjunction with a sudden need to urinate that can’t be controlled. The second type of leakage is stress incontinence, which is a small amount of leakage that occurs with cough, sneeze, or position changes. Typically, both of these types of leakage will improve as the patient further heals from surgery, but these symptoms may continue for up to 3 months following your surgery. Your doctor may have advice on medication to help with these episodes of leakage.
When should I seek advice from my physician?
A patient should contact their physician if they run a temperature of 101 degrees or greater. Signs of trouble from the catheter would include increasing sensations of bladder fullness and needing to urinate along with a lack of drainage of urine through the catheter into the drainage bag. Excessively bloody urine would also be an indication to call. While this may be a subjective determination, signs of heavy bleeding include the passage of clots through the catheter into the bag or obstruction of the catheter.
After the catheter is removed, signs of trouble would include signs of inability to completely empty the bladder. This would include feeling the need to void, but unable to void for over 6 hours or voiding small volumes (1 to 2 tablespoons) every 10-15 minutes. If you feel that either of these symptoms is occurring, then contact your physician for further instructions.