TURP (Transurethral Resection of the Prostate) — How It Works, Benefits & Recovery — Procedure Guide, Recovery & Risks | MyMedicPlus

Transurethral resection of the prostate (TURP) is the gold-standard surgical treatment for symptomatic benign prostatic hyperplasia (BPH) — the non-malignant enlargement of the prostate gland that progressively narrows the prostatic urethra, causing lower urinary tract symptoms (LUTS) including weak stream, frequency, nocturia, urgency, and incomplete bladder emptying. TURP is an endoscopic procedure performed without any external skin incision: a rigid resectoscope — a specialised instrument combining a telescope, continuous irrigation channel, and an electrosurgical cutting loop — is passed transurethrally into the bladder, positioned within the prostatic urethra, and used to systematically resect (shave) prostatic tissue in sequential chips or fragments until adequate lumenal decompression is achieved. The resected prostate chips are flushed into the bladder and evacuated by irrigation at the end of the procedure. Historically performed with monopolar electrosurgery using glycine irrigation fluid (which carried the risk of TUR syndrome from hyponatraemia caused by absorption of hypotonic irrigation fluid), modern TURP increasingly uses bipolar electrosurgery with normal saline (isotonic) irrigation, eliminating the risk of TUR syndrome and enabling safer, longer resection times in larger prostates. TURP remains the benchmark against which all emerging BPH surgical technologies are compared and continues to be the most commonly performed surgical treatment for BPH worldwide.

TURP is indicated for men with moderate-to-severe LUTS caused by BPH — typically an International Prostate Symptom Score (IPSS) above 15 — that significantly impairs quality of life and has not responded adequately to medical therapy. First-line medical treatment includes alpha-1 adrenergic receptor antagonists (tamsulosin, alfuzosin, silodosin — which relax smooth muscle in the prostate and bladder neck), 5-alpha reductase inhibitors (finasteride, dutasteride — which reduce prostatic size by blocking dihydrotestosterone-mediated growth in prostates over 30-40 mL), or combination therapy. TURP is recommended over ongoing medical therapy when symptoms are severe and bothersome, when complications of BPH have developed — including acute urinary retention (AUR), overflow incontinence, recurrent urinary tract infections, bladder stones, or upper tract obstructive nephropathy — when the patient prefers definitive surgical treatment after informed counselling, or when medical therapy causes intolerable side effects. Prostate malignancy must be excluded before TURP by PSA testing, digital rectal examination, and biopsy if indicated. TURP is most effective for prostate volumes between 30-80 mL; prostates over 80-100 mL may require open simple prostatectomy (Millin procedure) or holmium laser enucleation (HoLEP) for complete obstruction relief.

TURP is performed under spinal or general anaesthesia with the patient positioned with legs in lithotomy. A resectoscope (22-24 Fr outer diameter) is passed through the urethra under direct vision, inspecting the urethra, verumontanum (landmark delineating the distal safe resection limit — resection distal to this causes external sphincter damage and incontinence), bladder neck, and the extent of prostatic enlargement. Irrigation fluid (normal saline for bipolar TURP, 1.5% glycine for monopolar TURP) flows continuously through the resectoscope to maintain a clear operative field and evacuate resected tissue. The cutting loop is advanced, positioned in the prostatic tissue, and the electrical current activated as the loop is drawn back — resecting a controlled volume of prostatic tissue per stroke. Resection proceeds systematically from the bladder neck distally, addressing the lateral lobes, then the anterior commissure and middle lobe, maintaining clear anatomical landmarks throughout. The verumontanum is never resected, protecting the ejaculatory ducts and external urethral sphincter. Each resected fragment (chip) is aspirated into the bladder and at the end of the resection, all chips are evacuated using an Ellik evacuator — a bulb syringe device that creates turbulence in the bladder to collect all tissue fragments for histopathological examination. Haemostasis is achieved by coagulation of bleeding vessels under direct vision using the diathermy loop in coagulation mode. A three-way Foley catheter (20-22 Fr) is inserted and bladder irrigation commenced to prevent clot formation. Total operative time is 30-90 minutes depending on prostate volume.

TURP achieves significant and durable improvement in urinary symptoms in over 85-90% of patients, with IPSS scores improving by a mean of 70-80% from baseline. Maximum urinary flow rate (Qmax) improves from a preoperative mean below 10 mL/s to greater than 15-20 mL/s post-operatively, with post-void residual urine reduced to under 50 mL. These functional improvements are sustained at 5-year follow-up in over 75% of patients, providing long-term relief superior to all currently available medical therapies. Compared to laser alternatives such as holmium laser enucleation (HoLEP) and greenlight laser photoselective vaporisation (PVP), TURP achieves equivalent functional outcomes for prostates under 80 mL with comparable complication profiles, though HoLEP achieves superior outcomes for larger prostates and carries lower reoperation rates at 5-10 years. Bipolar TURP (B-TURP) using saline irrigation achieves equivalent efficacy to monopolar TURP while eliminating TUR syndrome risk, enabling longer resection of larger glands with greater safety in patients with cardiac comorbidity. TURP definitively relieves acute urinary retention caused by BPH in over 95% of cases, restoring normal voiding.

Urinary tract infection occurs in 5-10% and is addressed with targeted post-operative antibiotics based on pre-operative urine culture results. Retrograde ejaculation — semen flowing backward into the bladder at orgasm rather than anterograde due to disruption of the bladder neck smooth muscle mechanism — is the most common permanent effect, occurring in 65-90% of patients; it is not harmful but causes infertility and must be discussed explicitly before consent. Temporary urinary incontinence from bladder irritability or sphincter spasm occurs in 20-30% immediately post-operatively and resolves in the majority within 4-6 weeks with pelvic floor exercises. Permanent stress urinary incontinence from external sphincter injury occurs in 1-2% of TURP procedures and represents the most feared functional complication; it is minimised by precise distal resection limit identification using the verumontanum. Urethral stricture formation — secondary scarring of the urethra — develops in 3-5% of cases at 2-5 years and requires urethral dilation or DVIU. TUR syndrome (monopolar TURP only) — hyponatraemia from absorption of hypotonic glycine irrigation fluid — causing confusion, nausea, bradycardia, and in severe cases cerebral oedema, has been virtually eliminated by bipolar TURP with saline. Haemorrhage requiring blood transfusion occurs in 1-2%.

Continuous bladder irrigation through the three-way catheter continues for 12-48 hours post-operatively until the irrigant runs clear, preventing clot retention and obstruction of the catheter. The catheter is removed after 1-3 days in clinic or ward when urine is clear and the patient demonstrates adequate pain control and mobility. After catheter removal, transient burning, urinary frequency, urgency, and mild haematuria are expected for 2-4 weeks as the resection cavity re-epithelialises and mucosal inflammation resolves. Patients should maintain a high fluid intake of 2-3 litres daily throughout recovery. Constipation and straining at stool must be avoided — laxatives are prescribed where appropriate — as straining raises intraurethral pressure and can precipitate secondary haemorrhage. Heavy lifting, vigorous exercise, cycling, and sexual intercourse are avoided for 4-6 weeks. A return to light office work is possible within 1-2 weeks in most patients. Secondary haemorrhage — fresh bright red bleeding occurring at 7-14 days when the surgical eschar separates — occurs in 2-5% of cases; most settle with conservative management (increased fluid intake, rest, avoiding straining), but some require hospital readmission and catheter replacement. Uroflowmetry and post-void residual assessment at 3 months confirms functional recovery. PSA should be re-checked at 3 months as it typically falls to very low levels after TURP — a rising PSA at this stage warrants assessment for missed or new prostate malignancy.