Transurethral electroresection of a hypertrophied prostate (TURP) is an endoscopic procedure used in the case of prostate hyperplasia. It is a minimally invasive method, considered the gold standard in the treatment of prostate hyperplasia. When can you use TURP and how is it done?
Transurethral electroresection of a hypertrophied prostate (TURP)involves inserting a resectoscope through the urethra into the bladder. Then, in this way, with the help of a loop, we perform electroresection, cutting the prostate gland from the inside and leaving its capsule.
Dr. Przemysław Dudek, a urology specialist at the SCM clinic in Krakow, emphasizes that this is not a radical removal of the prostate gland.
- It is the removal of the adenoma, i.e. the glandular part that has grown over the prostate. The patient treated with this method should be aware that he still needs urological monitoring for the risk of prostate cancer. Some men forget about it, thinking that this type of surgery deprives them of their prostate. This is not true. The prostate capsule remains and it may be at risk of developing cancer, explains the SCM clinic expert.
Indications for TURP
There are several basic complications of benign prostatic hyperplasia that qualify the patient for surgery:
- urinary retention - a patient with such an emergency symptom has a catheter or a cystostomy, which consists in inserting the catheter into the bladder, not through the urethra, but percutaneously over the pubic symphysis
- haematuria - a very disturbing symptom that may be associated with an enlarged prostate gland and should always prompt the patient to see a urologist
- urolithiasis - stones may appear in the bladder
- bladder diverticula - an oversized prostate obstructs the urine stream. The urine stream tries to bypass it, causing bladder muscle overgrowth and the formation of diverticula. Bladder diverticula are baggy protrusions of the bladder epithelium extending beyond the bladder. The quality of such a bladder as a reservoir for urine and an organ that then displaces this urine is very low
- bilateral hydronephrosis - usually occursagainst urinary retention
The size of the prostate gland is not a problem that may cause a patient. There are men who have very large prostate glands and do not require surgery, but there is also a group of patients who, despite the small size of the prostate, should be operated on. It is very individual.
As Dr. Przemysław Dudek, Ph.D. explains, when choosing an operating method, the basic criterion is the size of the prostate gland.
- The smaller the prostate gland, the milder the operating methods. The commonly recognized limit is 80 ml. Below this gland volume, we should use transurethral methods, above rather open surgical or laparoscopic methods. Although thanks to the development of technology, especially laser methods, these boundaries in medicine are constantly changing. The golden, minimally invasive standard of treatment is transurethral electroresection of the prostate, or TURP for short, explains the urologist.
TURP mileage
The procedure is performed under anesthesia, the type of which is selected by the anaesthesiologist. After surgery, a catheter is inserted and removed the next day.
The device itself for the treatment consists of the optics and the working part. Usually it is mono- or bipolar.
Bipolar does not require a special fluid that washes the bladder during the procedure. Its advantage is that it causes a much lower risk of overhydration syndrome (the so-called water poisoning).
On the other hand, the procedure performed with the use of a monopolar device requires the use of specially prepared fluids, which, when absorbed through open vessels, may unfortunately cause overhydration syndrome. Therefore, when using this type of device, the treatment should last up to an hour.
When using bipolar equipment, this procedure can take a little longer and is safer.
Complications TURP
Possible complications of transurethral resection of benign prostatic hyperplasia are very rare (less than 1%).
These include postoperative complications in the form of damage to the sphincter. They cause later urinary incontinence or impotence disorders.
There may also be intraoperative complications, such as bleeding, bladder perforation, damage to the ureters, which may require emergency intraoperative intervention, the need to open the abdomen and bladder and repair such damage.
Urethral stricture, which mimics prostatic regrowth, may also be a distant complication. It is related to the technique of the procedure itself, i.e. the carrying outinstrument through the urethra.
Occasionally, this urethra can be invisibly damaged by electric current or thermal energy, or by mechanical trauma, which can lead to narrowing of the urethra.
Dr. Przemysław Dudek, MD, adds that you should remember about the possibility of retrograde ejaculation after the procedure, which is especially important for young men.
- The technique of this treatment may result in retrograde ejaculation and this concerns about 80% of men. During intercourse, semen does not flow through the urethra, but flows into the bladder and is excreted with the first portion of urine. Young men who wish to preserve the ability to procreate still have this chance, but it is a bit more complicated.
Convalescence after TURP
After removing the catheter, the patient can leave the hospital.
As part of your recovery, you should lead a more careful lifestyle for several days.
The operated person should not carry heavy loads, and cannot bathe in hot water for about 7-14 days.
At first you may be surprised by the width of the urine stream, the frequency of urination, which is greater, but within a few weeks these symptoms disappear.
Contraindications to TURP
Squeezing for such procedures is mainly anesthetic.
The patient must not have any infection, and blood coagulation disorders should be compensated.
Before the procedure, check the capacity of the patient's bladder, for example if he or she does not have elevated PSA, which could be a sign of prostate cancer.
Cancer in itself is not a contraindication to this procedure. However, its occurrence should qualify the patient to other methods of treatment - radical removal of the prostate gland, and not only the electroresection itself.
Our expert
Przemysław Dudek, MD, PhD - urology specialist from SCM clinic in Krakow (www.scmkrakow.pl) In 1996 he graduated from the Medical Academy in Warsaw. After passing the European urology exam, he was awarded the FEBU (Fellow European Board of Urology) title. He actively participates in the scientific congresses of the Polish Urological Society, as well as the European Society of Urology and numerous regional societies and medical associations. He is interested in oncological urology and the treatment of urolithiasis, with particular emphasis on minimally invasive methods: endourological treatment of urolithiasis both in the upper and lower urinary tract and laparoscopic removal of ureteral kidney tumors, bladder and prostate gland. InThe doctor's interests also include endoscopic and laparoscopic treatment of prostatic hyperplasia, treatment of bladder diverticula and urinary tract defects in adults. Since 2012, he has been working at the Urology and Urology Oncology Clinic at the University Hospital in Krakow (headed by Professor Piotr Chłosta). Currently, he is the Deputy Head of the Clinic.