Transurethral Resection of the Prostate: How TURP Works and What to Expect

Medically Reviewed By Matt Coward, MD, FACS
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Transurethral resection of the prostate (TURP) is the removal of a portion of the prostate gland through the urethra in the penis. It does not involve an incision. TURP relieves symptoms of an enlarged prostate. This procedure typically requires one night in the hospital. This article will describe the details of TURP, including its uses, how it is performed, and how to prepare. It will also discuss recovery and potential complications.

What is TURP?

TURP is an incisionless method of removing part of the prostate gland. The prostate is a walnut-sized gland that makes a component of semen. It is below the bladder. Urine empties from the bladder through the urethra, a tube that extends through the prostate and out through the penis.

“Transurethral” means through the urethra. “Resection” means to cut out.

In this procedure, the surgeon inserts a thin, metal tube with a camera — a resectoscope — into the urethra at the tip of the penis. When the surgeon reaches the prostate, they use an electric current to heat the wire loop on the end of the scope. They move this along the prostate to cut away excess tissue to reduce its size.

Why is TURP performed? 

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TURP is the gold standard surgical therapy for an enlarged prostate.

The medical term for an enlarged prostate is “benign prostatic hyperplasia (BPH).” It is a noncancerous (benign) condition that can occur with age.

When the prostate gland grows to excess, it presses against the urethra and bladder, causing:

According to the American Urological Association (AUA), your urologist may recommend surgery if you have:

TURP reduces the size of the prostate so that urine flows freely.

TURP is also used to drain prostate abscesses.

TURP is not a treatment for prostate cancer. However, a doctor may study a sample of tissue from TURP to determine whether it contains cancer cells.

Laser as a TURP alternative

TURP is one of many transurethral options for small to average size prostate glands causing urinary symptoms.

For people with a large prostate, AUA recommends either open prostate removal surgery or transurethral procedures with lasers to more effectively remove the prostate tissue. These include:

  • holmium laser enucleation of the prostate (HoLEP)
  • thulium laser enucleation of the prostate (ThuLEP)
  • photoselective vaporization of the prostate (PVP), also known as greenlight laser TURP

The AUA also recommends these procedures for patients with a higher chance of bleeding. This includes people on anticoagulants as well as those with a higher chance of bleeding from medical conditions. Laser methods can be safer than conventional TURP for these patients because they result in less blood loss.

Learn about seven treatment options for enlarged prostate here.

Who performs TURP?

A urologist performs TURP. A urologist is a doctor who specializes in diseases and conditions of the urinary tract and the male reproductive organs.

Get tips for finding a TURP surgeon here.

How is TURP performed?

A surgeon will perform the TURP procedure in a hospital or surgery clinic. They will place the person who has an enlarged prostate under general anesthesia.

What to expect on the day of your TURP

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
  • Go to the bathroom to empty your bladder.
  • Change into a hospital gown.
  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
  • Talk with your surgeon about the procedure and what to expect when you wake up.
  • A surgical team member will start an IV and your anesthesia. 
  • The anesthesiologist or nurse anesthetist may place a tube in your windpipe to protect and control breathing during general anesthesia.
  • Your urologist inserts the resectoscope and advances it to the prostate. Electric current heats the wire at the end of the scope. This cuts away the prostate tissue in tiny pieces while also minimizing bleeding.
  • The surgical team will monitor your lung and heart function throughout the procedure and during recovery.
  • You will wake up after surgery with a catheter in your penis. The catheter drains the bladder continuously. Your doctor will remove the catheter within a week after surgery.

What are the side effects, risks, and potential complications?  

As with all surgeries, TURP involves possible complications. Most TURP procedures are successful, but complications can be serious. Complications can develop during surgery or recovery.

General risks of surgery 

The general risks of surgery relate to: 

Risks and side effects of TURP

TURP can cause long-term problems with ejaculation, orgasm, erection, and infertility.

Semen may flow backward into the bladder, a condition termed “retrograde ejaculation,” or “dry orgasm.” Retrograde ejaculation may affect up to 65–75% of males who have undergone TURP, according to the National Health Service (NHS).

Retrograde ejaculation can also make orgasm feel different or less pleasurable. It also reduces fertility.

TURP has variable effects on erectile dysfunction. In a small study involving 264 men who underwent TURP, 5.8% of the 109 men who had good erectile function before TURP reported worsening erectile function afterward. However, of the 136 men who reported mild to moderate erectile dysfunction before surgery, 16.2% reported an improvement afterward. Other research indicates permanent erection problems are rare.

Other potential problems with TURP include:

  • damage to the urethra or bladder
  • transurethral resection (TUR) syndrome, a concerning but uncommon complication
  • scar tissue on the urethra, which makes it harder to urinate and requires additional surgery
  • urinary incontinence, which may subside in the weeks following surgery

Before deciding on TURP, talk with your surgeon about side effects and potential complications.

If you have concerns about sexual function, you may be a candidate for other prostate procedures that preserve sexual function. According to the AUA, these include prostatic urethral lift (PUL) and water vapor thermal therapy (WVTT). PUL involves implantable sutures to widen the urethra. WVTT removes excess prostatic tissue with steam.

Reducing your risk of complications

You can help reduce the chance of certain complications by:

  • following activity, dietary, and lifestyle restrictions and recommendations before surgery and during recovery
  • notifying your doctor immediately of any concerns, such as bleeding, bloody urine, fever, an increase in pain, or a change in urination
  • seeing your doctor as instructed before and after surgery
  • taking your medications exactly as directed
  • telling all members of your care team if you have any allergies

How do I prepare for TURP? 

You can prepare for TURP by:

  • Answering all questions about your medical history and medications: This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins.
  • Getting preoperative testing as directed: Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, electrocardiogram, and blood tests.
  • Not eating or drinking before surgery or as directed: Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents while under anesthesia.
  • Stopping smoking as soon as possible: Even quitting for just a few days can be beneficial and help the healing process.
  • Taking or stopping medications exactly as directed: This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. 

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a TURP procedure? Is this the best option for treating my condition?
  • What is my chance of having ejaculation problems?
  • How long will the surgery take? When can I go home?
  • What restrictions will I have after the surgery? When can I return to work and other activities?
  • How long should I wait to have sex after the surgery?
  • What assistance will I need at home?
  • How long will I need to have a urinary catheter after the surgery?
  • What medications will I need before and after the surgery? How should I take my medications?
  • How will you treat my pain?
  • When should I follow up with you?
  • How should I contact you? (Ask for numbers to call during and after regular hours.)

What can I expect after TURP?

Knowing what to expect can help make your road to recovery after TURP as smooth as possible. 

Recovery time

TURP recovery time depends on the type of anesthesia, your general health, age, and other factors. Full recovery takes 3–4 weeks, according to the National Health Service (NHS).

You will stay in the recovery room after surgery until you are alert, you are breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.

You may stay in the hospital for 1–3 days. However, you will go home the same day if you had an outpatient TURP procedure.

Your catheter will stay in place 1–7 days, according to the NHS. Your urine may look bloody, and your care team will use the catheter to flush out blood and blood clots from the bladder with fluid.

You may have a frequent urge to urinate. You also may have small amounts of blood for up to a month after the doctor removes the catheter. These symptoms should improve steadily over time.  

Will I feel pain?

Pain management is important for healing and a smooth recovery. There will be discomfort after your surgery, including burning during urination. This should go away gradually over several weeks.

Your doctor will give you clear instructions for managing pain. This may include prescription pain medication and acetaminophen (Tylenol). Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after TURP. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • breathing problems, such as shortness of breath
  • a change in alertness
  • chest pain
  • fever
  • inability to have a bowel movement or pass gas
  • leg pain, redness, or swelling, especially in the calf, which may indicate a blood clot
  • little or no urine
  • numbness or tingling in the genitals 
  • pain that is not controlled by your pain medication or a new type of pain
  • unexpected drainage, pus, redness, or swelling of your penis
  • urine that is bloodier than expected or bleeding from your penis

Outlook

TURP can relieve the symptoms of an enlarged prostate. Studies show that about 75 out of 100 people have mild urinary symptoms 9 months after TURP.

TURP may affect erection, but this is not common. The situation may be different for males with erectile dysfunction before surgery, according to the AUA.

However, TURP frequently causes retrograde ejaculation, reduces fertility, and may affect orgasm.

If you have concerns, ask your doctor how TURP might affect your sexual function and how to treat it if it happens.

Summary

TURP is a method of removing prostate gland tissue through the penis via the urethra, without the need for incisions. Doctors perform TURP to relieve symptoms of an enlarged prostate.

Most people stay at least one night in the hospital. It usually takes 3–4 weeks for a full recovery. Serious complications are not common, although there is a chance of dry orgasms, which is an orgasm without ejaculation.

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Medical Reviewer: Matt Coward, MD, FACS
Last Review Date: 2022 Mar 29
View All BPH/Enlarged Prostate Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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