Understanding TURP Surgery for Enlarged Prostate

Do you find yourself waking several times a night to pass urine, or struggling with a weak stream despite feeling a constant urge to go? These are common frustrations for men living with an enlarged prostate, particularly as they get older. When lifestyle adjustments and medication are no longer enough, surgery may offer a way to regain comfort and confidence in everyday life.

Transurethral resection of the prostate (TURP) is one of the most established procedures used to treat moderate to severe urinary symptoms caused by benign prostatic hyperplasia (BPH). In this article, we take a closer look at what TURP involves, as well as what you can expect from treatment. Read on to learn more.

What Is Transurethral Resection of the Prostate (TURP)?

TURP is a minimally invasive procedure in which a urologist removes excess prostate tissue that is narrowing the urethra and causing symptoms of benign prostatic hyperplasia (BPH). Rather than removing the entire prostate, the urologist trims away excess prostate tissue that is pressing on the urethra and restricting urine flow.

The procedure is carried out transurethrally, meaning the surgeon accesses the prostate through the urethra without making any external incisions. A resectoscope—an instrument with a light, a camera and an electrical loop—is then inserted through the urethra. Using this loop, the surgeon carefully removes small portions of overgrown prostate tissue, creating a wider channel for urine to pass through more freely.

Situations Where TURP May Be Recommended

For many men, mild prostate enlargement can be managed with lifestyle adjustments or medication. However, when symptoms become more persistent or begin to interfere with daily activities, surgical treatment may offer more lasting relief.

Your urologist may recommend TURP if you experience:

• Little or no improvement with medication for BPH
• Moderate to severe lower urinary tract symptoms, such as difficulty starting urination, a weak stream, frequent or urgent urination or waking multiple times at night (nocturia)
• Complications linked to prostate enlargement, including recurrent urinary tract infections, bladder stones, persistent urinary retention or signs of kidney impairment

For those in their sixties and seventies in particular, TURP remains an effective and lasting option for managing these issues and preventing further complications.

How Do I Get Ready for a TURP?

Proper preparation plays an important role in ensuring a smooth procedure and recovery. Your urologist will provide specific instructions, but preparation usually includes the following:

• Reviewing Medications: Some medicines, especially blood thinners such as aspirin, warfarin or clopidogrel, may need to be stopped several days before surgery to reduce the risk of bleeding. Always follow your doctor's guidance on when to stop or adjust any medication.
• Pre-operative Assessments: You may undergo tests such as blood and urine tests, an electrocardiogram (ECG) and a chest X-ray. These help confirm that you are medically fit for the operation.
• Fasting Before Surgery: You will usually be asked not to eat or drink for several hours before the procedure, often starting from midnight the night before, depending on your scheduled surgery time.

What Happens During TURP?

TURP is performed under either general anaesthesia, where you are fully asleep, or spinal anaesthesia, which numbs the lower half of your body while you remain awake. The choice depends on your medical history, preferences and your surgeon’s recommendation.

Once the anaesthetic has taken effect, the resectoscope is gently inserted through the urethra. A sterile fluid is used to flush the area, allowing clear visibility throughout the procedure. The surgeon then uses the electrical loop to carefully shave away excess prostate tissue that is obstructing urine flow. The removed tissue is collected and typically sent for laboratory analysis, while any bleeding is controlled using cautery.

At the end of the procedure, a temporary urinary catheter is placed to allow urine to drain freely and to flush out any small blood clots. The surgery usually takes between 60 and 90 minutes.

What Happens After TURP?

After the operation, you will be taken to a recovery area for monitoring. It is normal to notice blood-tinged urine initially, particularly while the catheter is in place.

Post-operative care includes:

• Bladder Irrigation: The bladder may be continuously rinsed with a fluid for 24 hours to prevent blood clots.
• Catheter Removal: Once the urine is clear of significant bleeding and you can pass urine easily, the catheter will be removed, usually one to three days after the operation.
• Monitoring: Nursing staff will monitor your progress, and most patients are discharged shortly afterwards if urination is satisfactory.

Recovery After TURP

Recovery is gradual, but most patients can go home within one to three days. Your healthcare team will guide you on the following:

• Rest: Prioritise rest for the first two weeks. Avoid strenuous exercise, heavy lifting or any activity that strains the abdominal muscles.
• Driving: Refrain from driving for two to four weeks, particularly if you are still taking strong pain medication.
• Hydration: Drink plenty of water to help flush the bladder and reduce the risk of blood clots.
• Sexual Activity: Avoid sexual intercourse for four to six weeks to allow adequate healing. A common change after TURP is retrograde ejaculation, where semen flows into the bladder rather than out of the body. This is not harmful but may affect fertility.

Urinary symptoms typically continue to improve over the following weeks to months as swelling settles and healing takes place. Regular follow-up with your urologist is important, as TURP relieves the blockage but does not remove the prostate entirely.

What Are the Possible Complications?

Although TURP is a procedure with a strong safety record, like all surgery, it carries some risks. These will be discussed in detail with you before treatment. Common risks and side effects include:

• Temporary Haematuria (Blood in Urine): This is expected for several weeks after the catheter is removed.
• Retrograde Ejaculation: This is a very common side effect, where the bladder neck muscles are opened, allowing semen to flow backwards into the bladder during orgasm.
• Incontinence: Mild, temporary stress incontinence (leaking urine when coughing or sneezing) can occur but usually improves over time. Severe, permanent incontinence is rare.
• Erectile Dysfunction (ED): While less common than retrograde ejaculation, some men report temporary or permanent changes in erectile function.
• Infection: Urinary tract infections are possible and usually treated with antibiotics.
• Need for Re-treatment: While TURP is highly effective and durable, a small percentage of men may require further prostate enlargement treatment years later if the prostate tissue regrows.

Taking the Next Step Towards Symptom Relief

Living with ongoing urinary symptoms can be frustrating and disruptive, but effective treatment options are available. Whether you are exploring medication, minimally invasive therapies or surgery, understanding your choices empowers you to make informed decisions about your health.

If prostate symptoms are affecting your quality of life, a consultation with a urologist is the first step towards lasting relief. Contact us to arrange an appointment and receive personalised advice on the most suitable treatment for you.