After a person reaches the age of 40 years old, cells in the prostate gland can sometimes begin to multiply. This growth can lead to enlargement of the gland, causing it to squeeze the urethra, often interfering with urination.
This condition is known as benign prostatic hyperplasia (BPH) or benign prostatic enlargement (BPE). It is not related to cancer and is usually harmless, though it can cause unpleasant symptoms.
The prostate is a walnut-sized reproductive gland responsible for producing some of the fluid components of semen. The fluid combines with sperm from the testicles when it enters the urethra during ejaculation.
The most common surgery for BPH is called transurethral resection of the prostate or TURP. During the procedure, surgeons remove the excess prostate tissue through the urethra.
According to the American Urological Association, transurethral resection of the prostate or TURP is the most common type of surgery used to treat BPH. Every year, doctors perform it on around 150,000 American men.
Surgeons perform most TURP procedures when the patient is under general anesthesia and unconscious or asleep.
Alternatively, they use spinal anesthesia, where a needle is placed in the spine to stop any sensation below the waist.
How does the procedure work?
After anesthesia, a surgeon will insert a tool called a resectoscope into the urethra. In some cases, a separate device will be used to flush sterile fluid through the surgical site.
Once the surgeon has positioned the resectoscope, they will use it to cut away abnormal prostate tissues and seal broken blood vessels.
Finally, the surgeon will insert a long plastic tube called a catheter into the urethra and flush destroyed prostate tissues into the bladder where they are excreted through urine.
Most TURP surgeries take between 1 and 2 hours and require several hours recovery under continuous monitoring.
The catheter is usually kept in place for 2 to 3 days after TURP surgeries and removed when the bladder has been completely flushed.
Initially, the urethra and surrounding area will be inflamed, and it will be difficult to urinate. The catheter and flushing process can also be uncomfortable and cause bladder cramping.
The urethra, penis, and lower abdominal area will be tender, red, and swollen for a few weeks after surgery, which can interfere with urination. Most people also feel very weak and tire easily for several weeks.
Common side effects of TURP surgeries include:
- difficulty completely emptying the bladder
- urinary incontinence or leakage
- urinary urgency or the sudden urge to urinate
- discomfort during urination
- small dribbles or clots of blood in the urine, for up to 6 weeks
The minor side effects associated with TURP surgeries usually go away as the urethra and prostate tissues become less inflamed, usually within a few weeks.
Though TURP surgeries may or may not be associated with erectile difficulty in some people, they can decrease the volume of semen produced during ejaculation.
As with any medical procedure, especially those involving anesthesia, the surgery for BPH is associated with some medical complications.
Possible but rare risks associated with TURP procedures include:
- excessive bleeding
- urinary tract infections
- retrograde ejaculation, where semen flows backward into the bladder during ejaculation
- chronic urinary problems, especially incontinence
- prostate regrowth or scarring, with about 10 percent of men requiring further surgery within 5 years
- impotence or erectile dysfunction
- a split stream of urine caused by urethral narrowing
- chronic prostatitis or inflammation of the prostate
- allergic or abnormal reaction to anesthesia
In rare cases, post-TURP syndrome occurs. This is where too much of the fluid used for surgical flushing is absorbed by the body, leading to major electrolyte, fluid, and blood volume imbalances.
Early signs of post-TURP syndrome include:
- abdominal pain
- tightness in the chest
Signs of severe post-TURP syndrome include:
- difficulty breathing
- blurred vision
Though rare, post-TURP syndrome can be fatal if it is not treated early enough.
It is usually safe to return to basic everyday activities 1 to 2 weeks after TURP procedures, and safe to return to strenuous activities after 1 to 2 months.
There are several ways to reduce the risk of complications after TURP surgery.
Common tips include:
- staying hydrated
- eating a healthful, balanced diet
- avoiding sexual intercourse for between 1 and 2 months
- avoiding heavy lifting for 1 to 2 months
- limiting exercises that put a strain on the groin or lower abdominal area
- avoiding stimulants, such as caffeine, alcohol, and nicotine
- limiting the use of over-the-counter medications that can cause dehydration, such as decongestants and anti-histamines
Most people begin to feel better and have an improved urine flow within 4 to 6 weeks after TURP surgery.
Overall, the risk of serious complications after TURP surgery is quite low. But as with all surgeries, there are some potential health risks associated with the procedure that require medical attention and intervention.
Reasons to seek medical attention after TURP surgery include:
- bleeding from the urethra, outer prostate, or penis
- inflammation and pain in the urethra, prostate, or penis lasting longer than 2 weeks or worsening
- reduced urine flow or urinary symptoms, such as incontinence or urinary urgency 6 weeks post-surgery
- blood in the urine that is severe or lasts longer than 4 to 6 weeks
- severe clots of blood in urine or urine that is entirely red
- weakness and fatigue that does not improve after 4 weeks
- impotence or erectile dysfunction
- difficulty ejaculating
- dizziness, shortness of breath, or confusion
- severe or intensifying abdominal pain or discomfort
Though TURP remains the commonly performed BPH surgery, several other procedures are available to treat BPH that may be more appropriate for some people or carry a lower risk of complications.
Transutheral incision of the prostate (TUIP)
The TUIP procedure is used in cases where the prostate is fairly small, but urethral constriction is severe.
During TUIP procedures, the surgeon will insert a cystoscope into the urethra and widen the urethra by making tiny cuts in the prostate, and the area where the urethra connects to the bladder.
The TUIP procedure usually relieves urethral pressure immediately, making urination easier.
As with TURP, TUIP surgery takes a few hours, requires a few days of hospitalization, and insertion of a catheter.
Many of the side effects, complications, and risks associated with TUIP are similar to those of TURP.
Laser prostatectomy (HoLEP and PVP)
Laser prostatectomy techniques include holmium laser enucleation of prostate (HoLEP) or photoselective vaporization (PVP).
These procedures are similar to TURP except they use a laser to destroy or vaporize prostate tissues instead of cutting them away with an electrical wire.
Because there is less cutting involved, there are fewer side effects associated with HoLEP surgeries than with traditional TURP surgeries, and less risk of serious complications.
Many HoLEP surgeries also only require one night of hospitalization and catheter use.
Prostatic urethral lifts
In minor cases of BPH, prostatic devices may be inserted into the prostate that helps lift it away from the urethra, reducing urethral pressure and constriction.
Transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT)
A fairly new procedure, TUNA uses fine needles to deliver low-frequency radio waves to target prostate tissues and destroy them. During TUNA procedures the urethra is protected from the radio waves with a shield.
During the TUMT procedure, a urologist inserts a catheter with an attached microwave generator through the urethra and into the prostate. It is then used to heat and destroy prostate tissues.
Both TUNA and TUMT are procedures that can be done in an outpatient setting, such as a clinic, and have short recovery times.
But while the procedures have been shown to be better at reducing BPH symptoms than medications alone, they are not considered as good as TURP or TUIP surgeries.
In severe cases of BPH — usually those that do not respond to any other type of treatment — the prostate may be partially or entirely removed.
Open prostatectomies are associated with a higher rate of side effects and risk of complications. As a consequence, they require longer hospital stays and rehabilitation than most procedures used to treat BPH.