What are the indications for a TURP?
The prostate sits around the urethra as it leaves the bladder. When it enlarges, it can squeeze the waterpipe and obstruct the flow of urine. A TURP may be recommended when bothersome symptoms are not controlled by medication, including:
- A weak or slow urine stream, hesitancy or straining
- A feeling of not emptying the bladder fully
- Getting up frequently at night to pass urine
- Inability to pass urine at all (retention) needing a catheter
- Recurrent infections, bladder stones or bleeding caused by the enlargement
What are the alternatives?
- Watchful waiting — Monitoring symptoms, which can be stable for long periods.
- Medication — Tablets such as tamsulosin or alfuzosin to ease urine flow, or finasteride/dutasteride to shrink the gland.
- Other techniques — UroLift™, Rezūm™ steam, Laser (HoLEP or GreenLight), Aquablation® or prostate artery embolisation.
- Long-term catheter — Reserved for those unfit or unwilling to consider surgery.
What happens before surgery?
You will be asked to attend for a pre-operative assessment approximately 2-3 weeks before surgery, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain drugs should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.
On the day of surgery you should avoid eating for six hours before, and drink only clear fluids within two hours of the procedure. You will be given a gown and compression stockings to wear, your consent will be confirmed, and an anaesthetist will discuss whether a general anaesthetic (asleep) or a spinal anaesthetic (numb from the waist down) suits you best, and how your pain will be managed afterwards.
What does the procedure involve?
- Performed under general or spinal anaesthetic under antibiotic cover.
- A telescope is passed along the urethra — there are no cuts in the skin.
- The central, obstructing part of the prostate is removed using a heated diathermy loop.
- The fragments are flushed out and sent to the laboratory for analysis.
- Bleeding points are sealed and a catheter is placed to irrigate and drain the bladder.
- The operation usually takes 45–60 minutes; most men stay overnight although the procedure can be performed as a daycase.
What are the side-effects?
- Temporary burning, bleeding, frequency and urgency (almost all patients).
- Semen passing backwards into the bladder (retrograde ejaculation) (70-100%).
- Symptoms not fully relieved by surgery (up to 30%).
- Weaker erections in men with previously normal function (5-10%).
- Bleeding needing transfusion or a return to theatre (1-2%).
- Regrowth of the prostate needing repeat treatment, or a urethral narrowing (up to 10%).
What happens after surgery?
The catheter is removed once the urine is clear, usually within a day to a week. It is normal to pass blood, tissue and clots for the first few days, after which you will experience discomfort, urgency and frequency for a few weeks. You may even notice occasional involuntary leakage of urine. This is quite normal and part of the healing process. During your recovery you should drink plenty of fluid, perform pelvic floor exercises to reduce any leakage, and avoid straining or heavy lifting for at least 4 weeks. The tissue removed during surgery is routinely analysed in the laboratory to check for any unexpected findings. The results will be reviewed with you at a follow-up appointment approximately 6–8 weeks after your procedure.
Patient information leaflet
Read the British Association of Urological Surgeons (BAUS) leaflet: Transurethral resection of the prostate (TURP).
View the BAUS leaflet
Patient information video
Watch the animated video: Transurethral resection of the prostate (TURP)
Watch the video