TURP is a surgical procedure for BPH

What is TURP

TURP stand for TransUrethral Resection of the Prostate which is a surgical procedure to reduce the size of an enlarged prostate gland.

The prostate gland is located below the bladder and around the urethra. It is part of the male reproductive system.

However, the prostate gland is prone to enlargement as the man gets older. The reason for this enlargement is not known but, is believed to be associated with changing hormone levels.

The balance of your hormones changes as you age and it is believed these changes cause the prostate gland to grow.

But, an enlarged prostate gland could also be a BPH.

Normally, the prostate gland is roughly the size of a chestnut and weighs as little as 30 grams.

Benign Prostatic Hyperplasia (BPH)

Also known as prostate gland enlargement, benign prostatic hyperplasia is quite a common condition as men get older.

The severity of benign prostatic hyperplasia symptoms varies widely. But, these symptoms will worsen over time. The common signs and symptoms of benign prostatic hyperplasia include:

• Frequent or urgent need to urinate
• Increased frequency of urination at night (nocturia)
• Difficulty starting urination (urinary hesitancy)
• Weak urine stream or a stream that stops and starts
• Dribbling at the end of urination
• Inability to completely empty the bladder

Although an enlarged prostate gland is not normally reported to cause pin or discomfort. I believe that it does.

While I experience almost constant pain in my genitals, I cannot be certain that it is being caused by the enlarged prostate.

However, I have had a BPH diagnosed and been prescribed both Tamsulosin and Mirabegron to try to treat the condition.

Diagnosing Benign Prostatic Hyperplasia (BPH)

If you suspect that you have Benign Prostatic Hyperplasia, there are some fairly simple diagnostic tests.

• Digital Rectal Exam (Rubber Glove)
• Urine Test
• PSA Blood Test

The initial check for an enlarged prostate is quick and simple, albeit a little awkward. This diagnostic test involves your GP os urologist donning a rubber glove and inserting a digit (finger) into your rectum.

The urine test does not confirm BPH. Rather it rules out other conditions or UTIs (Urinary Tract Infections)

The PSA Blood Test might sound exotic. But, from the patient’s perspective, it is a simple blood test. The blood will be tested for the presence of PSA (Prostate-Specific Antigen)

PSA is a protein produced by the prostate gland. High levels of the protein may indicate a cancerous or malignant tumour.

As I recall, there was a fourth possible test. A biopsy taken from the prostate gland would be tested for malignancy.

However, I was advised that this was only carried out in exceptional circumstances. Because the act of taking the biopsy could cause the prostate tissue to become malignant.

The function of the Prostate Gland

The one and only function of the prostate gland is to power the ejaculation at the male climax. Sperm released from the testicles is combined with fluid in the prostate gland.

The prostate gland is surrounded by a capsule of connective tissue comprising many smooth muscle fibres.

At the point of climax, these smooth muscles contract suddenly, to eject the semen forcefully along the urethra and out from the penis.

Prostatectomy Alternatives

It was after enquiring about the practicality of prostate removal that I was informed about TURP.

I have multiple sclerosis and I am advancing in years. I have near-constant pain which I suspect is coming from the prostate gland. So, I figured that I probably no longer need this reproductive accessory.

I am quite sedentary these days, My sons are all adults and have families of their own. My tubes were tied by a vasectomy many years ago so, my prostate gland in redundant.

However, I had been relating all of these facts to the practice nurse at our local health centre when she told me about a procedure called TURP.

You will see what is involved with TURP in a moment and some of the alternatives are just variation on the resectoscope involving lasers.

However, prostatic urethral lift (PUL) implants are an interesting alternative. Implants hold the prostate gland away from the urethra preventing any blockage allowing urine to flow freely.

When TURP should be considered

If you are having persistent problems with your waterworks, TURP should be a consideration.

Symptoms that may improve after TURP:

• problems starting to urinate (urinary hesitancy)
• a weak urine flow or stopping and starting 
• having to strain to pass urine 
• a frequent need to urinate 
• waking up frequently during the night to urinate (nocturia)
• a sudden urge to urinate 
• being unable to empty your bladder fully

I think that I have or have had all of these symptoms which is why I am considering TURP.

But, my worst symptom by far, is the constant pain.

The TURP Procedure

This is a surgical procedure that will require anaesthesia. You may be put to sleep with a general anaesthetic or you might be given spinal anaesthesia.

You will be placed on your back on an operating table and your feet will be in stirrups.

The procedure is carried out with a resectoscope. If you are unfortunate enough the have had an endoscopy you will have an idea of what a resectoscope is like.

The resectoscope is fed into the urethra, which passes through the prostate gland. This allows access to the inside of the prostate gland from whence the surgery will be performed.

Your resectoscope will be fitted with a camera and a loop of wire for cutting. The wire loop is heated by an electric current to facilitate the cutting procedure.

This allows your surgeon to cut away parts of the prostate gland (resectioning) that have been causing your problems.

The debris from the operation passes into the bladder from where it will be flushed later.

After the operation, a catheter will be inserted into the bladder and water will be pumped in to flush out the debris from the operation.

The catheter will be left in place as it will be needed during recovery from the surgery.

Recovery from transurethral resection of the prostate

You are likely to be kept in hospital for at least a couple of days after the TURP procedure. The catheter will still be in place and is likely to stay that way until you are discharged from the hospital.

As well as post-surgery swelling, you may have blood in your urine. This is not unexpected but, you need to keep an eye on it.

If the blood resembles ketchup, this is wrong and you should report this to your doctor.

You may have continued pain when urinating. This could take six or eight weeks to settle down. If you notice blood clots in your urine, you should report it.

Risk Factors of TURP

All surgical procedure carry a certain element of risk and the TURP procedure is no different.

• Temporary difficulty urinating. There is likely to be swelling of the prostate and urethra for several days after the procedure
• Urinary Tract Infection. While the catheter remains in place, there is an increased risk of UTI.
• Dry orgasm. When the semen ejected by orgasm enters the bladder rather than exiting vis the penis. Also called retrograde ejaculation. It is not hafmful and should not diminish the joy of sex.
• Erectile dysfunction is quite a rare side-effect of TURP
• Difficulty holding urine. Not often, incontinence can be a long-term side-effect of TURP.
• Need for a second treatment. Very rarely the prostate gland will continue to grow and will require further resectioning.

Preparing for the TURP Procedure

Your health specialist will advise you on the preparatory steps you should take.

• You must be in good general health
• You must not be allergic to anaesthetic drugs
• If you smoke you must stop.
• You will be asked not to eat or drink for eight hours prior to surgery.

References

Transurethral resection of the prostate NHS
Transurethral resection of the prostate (TURP) Mayo Clinic
What is a transurethral resection of the prostate (TURP)? John Hopkins Medicine
How does the prostate work? NCBI

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