Transurethral resection of prostate adenoma (TURP)
When is this procedure indicated?
Transurethral resection of prostate adenoma (TURP) is the surgical treatment of benign prostatic hyperplasia (BPH) with cervical-urethral obstruction and consequent dysuric symptoms during emptying and/or filling indicated in patients with prostate volume between 30 and 80 ml.
How is it performed?
Transurethral resection of prostate adenoma (TURP) is performed under peripheral or general anesthesia according to the judgment of the anesthesiologist. This surgery is used to remove the inner portion of the prostate (the so-called prostate adenoma) while leaving the outer prostate capsule in place. An endoscopic instrument (resector) is introduced to resect, under direct vision, the adenomatous tissue obstructing the urethra, just below the bladder, into small frustules by means of electrical energy. These frustules are then externally aspirated and sent to Pathology for histological examination. The procedure is completed with careful hemostasis, and a 3-way bladder catheter is left in place with continuous bladder flushing, for between 2-3 days in the absence of complications.
Hospitalization has variable duration generally conditioned by the days of permanence of the bladder catheter, usually from 2 to 3 days. Once the catheter is removed, resumption of spontaneous urination may be characterized by the presence of bloody urine and the need to urinate frequently (usually this picture improves considerably during the first post-operative month).
- Transient dysuric symptoms (burning on urination).
- Transient stress urinary incontinence. Present when abdominal pressure increases, such as during a coughing fit or when lifting weights.
- Acute urinary retention at bladder catheter removal.
- Post-operative fever for urinary tract infection.
The most common long-term complication in patients undergoing this type of surgery is retrograde ejaculation. This condition, which occurs in about 90% of cases, consists in disappearance of seminal fluid discharge during orgasm, while maintaining orgasmic sensitivity and erectile function. Seminal fluid collected in the bladder is subsequently expelled with the first urination. The rest of the long-term complications are rare and essentially represented by:
- Stenosis of the urethra or bladder neck with need for re-intervention;
- Definitive urinary incontinence.