Transurethral resection of the prostate (TURP) is a surgical procedure for men that involves removing part of the prostate gland. It’s used to treat a common condition where the prostate becomes enlarged, causing difficulty with passing urine. This is known as benign prostatic hyperplasia (BPH).
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Before Transurethral resection of the prostate (TURP)
Why it's done
TURP helps reduce urinary symptoms caused by benign prostatic hyperplasia (BPH), including:
. Frequent, urgent need to urinate
. Difficulty starting urination
. Slow (prolonged) urination
. Increased frequency of urination at night
. Stopping and starting again while urinating
. The feeling you can't completely empty your bladder
. Urinary tract infections
TURP might also 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 or an inability to urinate at all
. Bladder stones
. Blood in your urine
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Why has my prostate enlarged?
As men get older, the cells of the prostate begin to swell, which increases the size of the prostate. This is called benign prostatic hyperplasia (BPH), which means extra growth of normal (non-cancerous) cells. This isn’t usually serious, but sometimes the prostate grows so large that it puts pressure on your urethra.
This can make it difficult for you to pass urine and may cause other urinary symptoms such as:
. Not being able to empty your bladder completely, so you may need to go to the toilet more often (referred to as frequency).
. Having a weak urine flow
. Having to strain to pass urine.
Because of the squeeze on your urethra, you may have to use a lot of pressure to pass urine. In the long term, this can damage your bladder and kidneys.
About Iranian Surgery
Iranian surgery is an online medical tourism platform where you can find the best Surgeons in Iran. The price of a transurethral resection of the prostate (TURP) surgery in Iran can vary according to each individual’s case and will be determined by an in-person assessment with the doctor. So if you are looking for the cost of transurethral resection of the prostate (TURP) procedure in Iran, you can contact us and get free consultation from Iranian surgery.
What are the advantages and disadvantages of TURP?
. The operation is widely available across Iran.
. It can improve your flow of urine and the effects of symptoms on your day-to-day life.
. It has a long-lasting effect.
. The prostate tissue that is removed can be checked for signs of cancer, although having an enlarged prostate does not put you at greater risk of getting prostate cancer.
. TURP can be used to treat and remove bladder stones, if present.
. You may need to stay in hospital for a few days after the operation.
. At some point you may need another operation. About 7 or 8 out of 100 men (7 or 8 per cent) will need another operation within 4 years.
. Around 3 out of 100 men (3 per cent) need to have a blood transfusion.
. It may take between four and eight weeks to fully recover from a TURP. Symptoms may take several weeks to improve.
. After the operation, a thin flexible tube (catheter) will be put through your penis to drain urine from the bladder. A small number of men find that they cannot pass urine at all in the hours after their catheter has been removed. If this happens, you will need a new catheter put in – usually for a few days.
How do I get ready for a TURP?
Some things you can expect before the procedure include:
. Your healthcare provider will explain the procedure and you can ask questions.
. You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything isn’t clear.
. Your healthcare provider will review your medical history, and do a physical exam to be sure you’re in good health before you have the procedure. You may also need blood tests and other tests.
. You will be asked not to eat or drink anything for 8 hours before the procedure, generally after midnight.
. Tell your healthcare provider if you are sensitive to or allergic to any medicines, latex, iodine, tape, contrast dyes, or anesthesia.
. Make sure your healthcare provider has a list of all medicines herbs, vitamins, and supplements that you are taking. This includes both prescribed and over-the-counter.
. Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or any other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
. If you smoke, stop as soon as possible to improve recovery and your overall health.
. You may be given a sedative before the procedure to help you relax.
. Your doctor may prescribe an antibiotic to prevent urinary tract infection.
. Arrange transportation because you won't be able to drive yourself home after the procedure that day or generally if you have a catheter in your bladder.
. You might not be able to work or do strenuous activity for up to six weeks after surgery. Ask your doctor how much recovery time you might need.
. Based on your medical condition, your healthcare provider may request other specific preparation.
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Risks and Complications
Risks of TURP can include:
. Temporary difficulty urinating. You might have trouble urinating for a few days after the procedure. Until you can urinate on your own, you will need to have a tube (catheter) inserted into your penis to carry urine out of your bladder.
. Urinary tract infection. This type of infection is a possible complication after any prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place. Some men who have TURP have recurring urinary tract infections.
. Dry orgasm. A common and long-term effect of any type of prostate surgery is the release of semen during ejaculation into the bladder rather than out of the penis. Also known as retrograde ejaculation, dry orgasm isn't harmful and generally doesn't affect sexual pleasure. But it can interfere with your ability to father a child.
. Erectile dysfunction. The risk is very small, but erectile dysfunction can occur after prostate treatments.
. Heavy bleeding. Very rarely, men lose enough blood during TURP to require a blood transfusion. Men with larger prostates appear to be at higher risk of significant blood loss.
. Difficulty holding urine. Rarely, loss of bladder control (incontinence) is a long-term complication of TURP.
. Low sodium in the blood. Rarely, the body absorbs too much of the fluid used to wash the surgery area during TURP. This condition, known as TURP syndrome or transurethral resection (TUR) syndrome, can be life-threatening if untreated. A technique called bipolar TURP eliminates the risk of this condition.
. Need for re-treatment. Some men require follow-up treatment after TURP because symptoms don't improve or they return over time. Sometimes, re-treatment is needed because TURP causes narrowing (stricture) of the urethra or the bladder neck.
During Transurethral resection of the prostate (TURP)
During the procedure
The TURP procedure takes about 60 to 90 minutes to perform. Before surgery you'll be given either general anesthesia — which means you'll be unconscious during the procedure — or spinal anesthesia, which means you'll remain conscious. You might also be given a dose of antibiotics to prevent infection.
Once the anaesthetic has taken effect, your surgeon will feed a thin telescopic tube up through your urethra (the tube in your penis that carries urine out of your body), into your bladder. This gives your surgeon a good view of your prostate. They then insert an electrically heated wire loop, and use it to cut out small pieces from the middle of your prostate. Your surgeon uses suction to remove the pieces of prostate from your bladder. These can be sent to a laboratory for testing if needed.
At the end of the procedure, your surgeon will put a tube (catheter) into your bladder and use a salt water fluid (saline) to flush through any clots, blood and loose tissue.
Alternatives to TURP
Transurethral resection of the prostate (TURP) is only one type of procedure for an enlarged prostate gland. Other options include the following.
. Holmium laser enucleation of the prostate (HoLEP). This uses a high-powered laser to remove part of your prostate.
. Transurethral vaporisation of the prostate (TUVP). This involves use of an electrical current to burn away parts of your prostate.
. Photoselective vaporisation (PVP). This technique uses a particular type of laser, which destroys prostate tissue without leaving any fragments behind. It’s sometimes called ‘Greenlight’ laser surgery.
. Transurethral incision of the prostate (TUIP). This involves your surgeon making small cuts in the neck of your bladder and prostate to widen the bladder opening. It may be an option if your prostate is only slightly enlarged.
. Open prostatectomy. This is surgery to remove part of your prostate through a cut in your abdomen (tummy), instead of going through the urethra. As a more invasive surgery, it’s usually only suggested for a very large prostate.
. Urethral lift implant. This is a less invasive option that may be offered for a smaller prostate. It involves a surgeon inserting a small implant to pull the tissue of the prostate away from the urethra, opening it up. One device approved for this procedure is called UroLift.
. Prostate artery embolisation. This is a procedure to block the blood supply to your prostate gland, causing some of the tissue to die and shrinking your prostate. It’s a less invasive option that might be suitable for some men.
. Rezum steam treatment. This involves using stream treatment to destroy part of your prostate. The steam is delivered to your prostate using an instrument inserted through your urethra.
Your surgeon will talk to you about which treatment is most suitable for you. This will depend on several factors, including how severe your symptoms are, how big your prostate is, whether you have any other health problems and what’s available at your local hospital.
After Transurethral resection of the prostate (TURP)
What to expect afterwards
You might need to stay in hospital for up to three nights after you’ve had a transurethral resection of the prostate (TURP). You’ll need to rest until the effects of the anaesthetic have worn off. You might have some discomfort as the anaesthetic wears off, but you'll be offered pain relief if you need it.
Your catheter will need to stay in place for up to four days. It will drain urine from your bladder into a bag. For the first day or so, you’ll have sterile fluid running through the catheter to wash out your bladder and help flush out blood clots. When your catheter is removed, your nurse will check whether you’re able to pass urine normally. Not all men can straightaway. If you have any problems, you’ll have a new catheter put in for a couple more days.
After your catheter is taken out, you may find you have blood in your urine for a while and it might hurt or burn when you pee. You might need to pee more often too. These symptoms can come and go while you recover, but it will usually get better in a few days and is normally nothing to worry about.
When you’re ready to leave hospital, you’ll need to arrange for someone to drive you home. Before you leave, your doctor or nurse will give you some advice about your recovery and information about follow-up appointments.
Recovering from TURP
It can take several weeks to fully recover from TURP. Normally, any side-effects will settle down by around six weeks. You should be prescribed any medication you need – including painkillers from the hospital to take home with you. You can also take over-the-counter painkillers, such as paracetamol or ibuprofen if you need them.
You may be given instructions to drink more than normal for a day or two. This will help to flush out your bladder and reduce the risk of infection. You may find that you have some blood clots in your urine around 10 to 14 days after your procedure. These are scabs from your prostate healing and coming away. If drinking more doesn’t clear this up, contact your GP.
You’ll usually be advised to do pelvic floor exercises when you get home, to improve your bladder control. Your doctor or nurse at the hospital will explain how to do them and how often.
Most people wait two or three weeks before going back to work, but always follow your surgeon’s advice. If your job is strenuous or involves heavy lifting, you may need to stay off work for longer.
Your doctor is likely to recommend that you:
. Drink plenty of water to flush out the bladder.
. Eat high-fiber foods, to avoid constipation and straining during a bowel movement. Your doctor also might recommend a stool softener.
. Wait to resume taking any blood-thinning medications until your doctor says it's OK.
. Avoid strenuous activity, such as heavy lifting, for four to six weeks or until your doctor says it's OK.
. Hold off on sex for four to six weeks.
. Avoid driving until your catheter is removed and you're no longer taking prescription pain medications.
Contact your doctor if you:
. Are unable to urinate
. Notice bright red blood or an increase in clots in your urine
. Notice that your urine isn't becoming clearer after drinking more fluid and resting for 24 hours.
. Develop a fever above 100.4 degrees F (38C)
TURP operation success rate
TURP typically relieves symptoms quickly. Most men experience a significantly stronger urine flow within a few days. Follow-up treatment to ease symptoms is sometimes needed, particularly after several years have passed.
Studies have shown that TURP can permanently reduce prostate-related problems. Nine months after having TURP, about 75 out of 100 men only have mild symptoms.