Transurethral resection of the prostate (TURP)

Transurethral resection of the prostate (TURP) is a kind of surgery done to correct prostate enlargement. It is a surgery of the prostate gland in men. The prostate is a male reproductive organ. It is cone-shaped with five lobes and produces fluid that keeps the sperm healthy. BPH is a condition of the prostate. It commonly affects the older age group. It is done to treat urinary problems caused by the prostate enlargement. 

BPH causes an increase in the size of the prostate leading to symptoms like increased frequency to urinate at night, urge of urination, and inability to empty the bladder. The excess prostate tissue is removed by using a special tool that uses a current or laser. It is an effective treatment for large prostate enlargements.  

Technique:

TURP is used to treat large BPH. A resectoscope, a special instrument, is used in this procedure. This is inserted through the penis and the urethra to reach the prostate. Using the instrument the excess prostate is scraped or removed. This extra tissue removal relieves the pressure of the prostate on the bladder thus reducing the symptoms. 

Indications:

TUIP is indicated in mild BPH. It is done to reduce the symptoms of BPH like increased frequency of urination, urge of urination, difficulty in starting to urinate, prolonged urination, increased frequency of nighttime peeing, discontinuous flow of pee, inability to empty the bladder, and frequent urinary tract infections. 

Additional disease conditions where TUIP is indicated are kidney or bladder damage, stones in the bladder, and blood in the urine. 

Advantages:

TURP has many advantages.

• It is a faster procedure
• It causes much better relief of urinary symptoms than other procedures. 
• It is advantageous over other procedures for kidney stones and bladder issues
• It is an advised procedure for larger BPH

Before the procedure:

Before TURP, it is important to understand the importance of the procedure by discussing it with the healthcare provider (HCP). Complete details regarding the medical, surgical, allergic, and medication history should be given to the HCP. Diet will be restricted and a list of medications to be stopped and another list of medicines to be used before the procedure will be given. One has to undergo certain blood tests to understand the current medical condition.

 Certain advanced imaging studies like MRI or CT is also carried out to evaluate the extent of the disease. TUIP will be done on an empty stomach under anesthesia. Hence it is necessary to refrain from eating anything 8-12 hours before the procedure. Inform the healthcare provider of any previous allergies to anesthesia. 

During the procedure:

TURP is done under general anesthesia or it may be done under spinal anesthesia. Spinal anesthesia blocks the sensation and pain from below the waist. Local anesthesia will be given through the urethra and the prostate by a gel or an injection. 

A special instrument called the resectoscope is used in this procedure. It has a lens or a camera, a cutting edge, and a few valves. It is inserted in the penis and sent from the penis tip till it reaches the prostate. Using the ends of the instrument, prostate tissue is trimmed or scraped from the inner surface of the gland. This removes the excess prostate tissue and thus relieves pressure on the bladder. 

The resectoscope releases fluid through the valves. This fluid releases the scraped tissue along with the fluid. A hollow tube called the catheter is placed in the bladder to drain the urine. It is also used for repeated flushing of the bladder and urethra with a sterile solution to prevent clots. TURP takes about an hour. 

After the procedure:

After the procedure, the individual is monitored till the vitals stabilize. Medications are given to reduce pain and ward off infection. Based on their recovery status, one has to stay in the hospital for 1-2 days. About 1-3 days after the procedure, the catheter is removed. One can resume normal activities in 3 days but should avoid strenuous activities for at least two weeks after the procedure. One can have sex about four weeks after the procedure. Pelvic floor exercises should be started to increase control over the pelvis area. 

Instructions:

• Consume plenty liquids to flush the trimmed tissue through urine 
• Eat a lot of fibre-rich foods to prevent straining while pooping 
• Postpone blood-thinner medications for a few days 
• Do not drive till the catheter is removed. 

Effectiveness:

TURP is effective for large prostate enlargement and reduces the signs and symptoms of BPH for almost 15 years. 

Side effects:

Some side effects are the presence of blood in the urine for a few days after the procedure. Frequent urge to urinate, burning sensation at the tip of the penis, and at the end of urination are some of the side effects. 

Risks and complications:

Certain risks associated with the surgery include recurrent urinary tract infections due to catheter placement, erection difficulties in those who did not have it prior, dry orgasm causing retrograde movement of semen into the bladder rather than through the penis, severe bleeding during the procedure needing a blood transfusion, loss of control over the bladder, recurrence of the symptoms needing another treatment, and the development of TURP syndrome due to loss of excess sodium loss during the procedure. 

Conclusion:

TURP is an effective procedure for benign prostate hypertrophy. It is done by scraping excess tissue using a special instrument called a resectoscope. It relieves the symptoms of BPH and improves the quality of life. 

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