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Transurethral Resection of the Prostate (TURP) Surgery India

What is Transurethral Resection of the Prostate (TURP)?

Transurethral resection of the prostate, or TURP, is a surgical procedure for removing certain portions of the prostate gland through the urethra.

What is the need for a Transurethral Resection of the Prostate (TURP)?

The prostate gland is a major part of the male reproductive system. It is made of three portions and surrounds the neck of the bladder and the urethra - the tube which expels the urine from the bladder to outside the body through the urethral opening at the tip of the penis. The prostate gland is a small walnut-shaped organ that weighs an average 1 ounce, or around 28 grams. It is a combination of muscle and glandular tissues connected to the urethra through ducts. PSA (prostate-specific antigen) is secreted by the prostate along with a somewhat alkaline fluid which are parts of the semen’s formation.

Benign prostatic hyperplasia (BPH), or benign prostatic enlargement (BPE), is one of the common prostate disorders. This disorder is caused by hormonal changes in the prostate which results in enlarged prostate. PSA levels in BPH are known to be as high as 2 to 3 times the normal levels. Higher PSA levels increase the chances of prostate cancer in men. BPH is seen initially growing in the innermost part. As it causes swelling in the gland, it starts to squeeze the urethra which passes through it. This leads to urinary problems, mainly, difficulty in urinating. BPH in its developed stage tends to form a thick capsule of tissue which blocks the flow of urine from the bladder. This results in incomplete emptying of the bladder and can lead to kidney malfunction or bladder malfunction.

Transurethral resection of the prostate (TURP) is the best-suited treatment for BPH. The term ‘transurethral’ refers to the urethral approach the procedure requires to be performed. The ‘resection’ part indicates to the surgical removal.

How is Transurethral Resection of the Prostate performed?

TURP is performed by using an instrument inserted through the urethra to reach the prostate. There are two other similar types of surgeries, namely:

• Transurethral Incision of the Prostate (TUIP) – It widens the urethra by making small incisions in the bladder neck and in the prostate gland.

• Transurethral Laser Incision of the Prostate (TULIP) – This is an ultra-modern treatment technique that uses a laser beam to melt the affected tissue by generating heat.

TURP is a simple procedure. The surgeon will administer general anesthesia. A cystoscope is inserted to allow the doctor a better look at the bladder tissue. Once the thick tissue capsule is located, the surgeon will insert another device through the urethral opening at the tip of the penis and remove the thickened tissue mass which had blocked the urine.

Once the tissue mass has been completely removed, the doctor will then insert a catheter to remove the urine from the bladder.

What are the symptoms of BPH?

BPH shows these following symptoms:

• Difficulty in starting urinating

• Frequent urination, especially at night

• Urge incontinence

• Slow/dribbling urine flow

• Incomplete emptying of the bladder

• Painful/burning sensation while urinating

How is BPH diagnosed?

The doctor will perform a complete physical examination and the following procedures to determine the development of BPH in a person.
DRE (digital rectal exam) – It is advised for men over 50 to get this test done once a year. This is a physical exam to check the prostate through the wall of the rectum for lumps or hardened areas.

PSA (prostate specific antigen) test – This test is also advised annually for men over 50 years of age. This test helps to measure the levels of this prostate antigen. Cancer, BPH and prostatitis (infection) are known to raise the PSA levels in men.

If the doctor suspects the development of BPH, they will refer you to a urologist for additional tests, such as blood tests and urine tests.

How can I get ready for Transurethral Resection of the Prostate (TURP)?

These are the simple steps that help you to prepare for a TURP surgery:

• Choose an experienced TURP surgeon

• Buy a bulk forming natural laxative

• Wear loose and comfortable clothing on the morning of the surgery

• Request family or friends to help assist you in the hospital

• Take a week off from work

• Sleep sufficiently the night before the surgery

How to take care after Transurethral Resection of the Prostate (TURP)?

The patient wakes up in the recovery room with a catheter and IV line already attached.

Initial recovery is seen within a week. It may cause some amount of discomfort or pain due to the urinary catheter. Expect spastic convulsions of the prostate and bladder.

The doctors usually advise to avoid alcohol and sexual intercourse for at least a few weeks after the surgery. Avoid driving a car for a few weeks and keep the activities around the house to a minimum. Avoid strenuous exercise or lifting weight for at least 3 to 4 weeks. Take care of hygiene and drink plenty of fluids.

Are there any risks associated with Transurethral Resection of the Prostate (TURP)?

Advanced surgical technology has made surgical complications almost negligible for prostate surgeries. These techniques are able to avoid harm to the nerves and injury to the bladder opening.

There are certain other types of risks that are seen in a few cases, such as:

• Incontinence

• Uncontrolled urination

• Leakage of urine

In general, the control over urination recovers within several weeks or a few months. There are rare cases of permanent urinary incontinence. Impotency is also another risk and causes erectile dysfunction. Around 40% to 60% of men are able to achieve erection. Semen is not ejaculated as the prostate gland prevents its production. This is mostly caused in elderly patients and those with other disorders.

Post-surgical risks may include:

• Blood loss

• Urinary tract infection (UTI)

• Unsatisfactory results

How successful is Transurethral Resection of the Prostate (TURP)?

Normally, a TURP patient notices improved flow of urine after the catheter is removed. The exact condition of each patient will determine the specific success rate and recovery period. These will include the patient’s age and overall state of health.

There may be slightly discomforting symptoms seen following the surgery, such as bladder spasms, hematuria, painful urination and problems with urinating. The doctor will advise you on the measures to take and remove these symptoms effectively.

Complete recovery after a TURP may often take up to a year and most patients are satisfied with the results.

What are the alternative treatments for BPH?

Conventional surgeries for treating BPH in a person include:

• Interstitial Coagulation – In this, a laser beam device is inserted through the urethra using a catheter. It generates heat to destroy the targeted thickened tissue mass.

• Transurethral Needle Ablation (TUNA) – This technique requires using radio waves to destroy the enlarged prostate.

• Transurethral electro-vaporization – A modified version of TURP, it uses a device which emits electric waves to destroy the enlarged tissue cells.

• Photoselective Vaporization of the Prostate (PVP) – A strong laser beam is used to vaporize the enlarged tissue in a short procedure.

• Transurethral Incision of the Prostate (TUIP) – This procedure involves making a small incision in the bladder and the sphincter muscles to release tension.

• Transurethral Microwave Thermotherapy (TUMT) – This procedure shrinks the enlarged prostate using heat generated by microwave energy through a device inserted in the urethral opening in the penis. This is a short outpatient procedure.

• Water Induced Thermotherapy (WIT) – This procedure requires using a closed-loop catheter system. It maintains a constant temperature in the hot water.

• Balloon Dilation – This procedure involves using a catheter to insert a small surgical balloon through the urethra till the blockage. The balloon is inflated to widen the urinary channel. This technique provides relief for a few years at least.

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