Transurethral Resection of the Prostate (TURP) Surgery

Transurethral Resection of the Prostate gland or TURP is a surgical procedure that removes a section of the prostate gland. This surgery is carried out to treat the urinary problems that arise from an enlarged prostate gland.

Anatomy and Physiology of Prostate Gland

The prostate gland is a part of a male's reproductive system, situated just in front of the rectum and below the urinary bladder. Its anatomy and physiology are as follows:

1. The prostate gland is around the size of a chestnut and is conical in shape.
2. This gland produces semen (the male ejaculatory fluid that contains sperm and other bodily fluids). The semen carries the sperm into the female vagina during sexual intercourse.
3. When the prostate gland enlarges, it causes various problems and exerts pressure on the bladder and urethra below it.
4. The enlarged prostate gland is Benign Prostatic Hypertrophy (BPH).

Benign Prostatic Hypertrophy (BPH) caused due to enlarged prostate can be treated with TURP Surgery. The bladder and urethra, which are located just below the prostate gland, are put under pressure as the prostate gland enlarges, which leads to symptoms like straining during urination and an urge to urinate. While the exact cause of prostate gland enlargement is unknown, factors related to ageing and testicular changes may have a role to play.

The right candidates for the TURP surgery are the males who are having an enlarged prostate gland beyond a considerable size having symptoms like

1. Urgency to urinate
2. Difficulty in starting to urinate
3. Weak flow of urine
4. Straining during urinating
5. Having an urge to urinate with increased frequency, especially during the night.

Men with blocked urinary outflow due to BPH or enlarged prostate may benefit from TURP. As an alternative to more invasive robotic or open BPH surgeries, TURP surgery can be performed on older, chronically ill males.

TURP surgery is a prostate resection procedure conducted using a device known as a resectoscope. The resectoscope is a thin metal tube containing light, a camera, and a loop of wire. The procedure takes about 60 to 90 minutes to complete depending on various factors which include the patient's age, the patient's medical condition and the complexity of the case. The steps involved in the TURP procedure are as follows:

1. The patient will be asked to lie down on his back and be given IV lines for receiving fluids and medicines during the procedure.
2. Once the patient is in the set position, the anaesthesiologist will give general anaesthesia (the patient will be unconscious during the procedure) or spinal anaesthesia (the patient will be awake during the procedure) as decided.
3. The surgical site is then cleaned with spirit and betadine and draped with an aseptic cloth to prepare the surgeon.
4. The patient's blood pressure, pulse, and respiratory rate are measured throughout the procedure.
5. The scope is inserted into the patient's penis and is passed along the urethra till it reaches the prostate gland. This means that there will be no cuts or incisions on the skin to reach the prostate gland.
6. The wire loop is then heated with an electric current to the tip nearest to the prostate gland.
7. The section of the prostate gland is then cut and removed using this heat.
8. A thin tube known as a catheter is inserted into the urethra.
9. Fluid is pumped through this tube into the urinary bladder to flush away the pieces of the resected prostate gland.
10. Depending on the extent of the prostate enlargement, the prostate gland is cut as required. Based on the patient's condition and the stage of prostate enlargement, the surgeon decides the size of the prostate gland that needs to be cut.
11. The scope and other instruments will then be removed, but the catheter will be left in place for a few days until the patient is able to urinate normally.

The doctor/surgeon will discuss and prepare the patient for the surgery.

Before TURP surgery

Before undergoing the TURP procedure, the following things would be done:

1. The surgeon will prescribe all the basic tests that need to be conducted before the surgery. The tests, along with a general examination, will help decide if the patient is physically fit for the surgery.
2. A doctor will be told to examine if the patient is physically fit for the surgery. The doctor will ask about the patient's medical history and based on the results of all the tests, provide the patient with a fitness certificate.
3. Based on this certificate, the surgeon will fix a date for the surgery.
4. The type of anaesthesia (General or Spinal) will depend on the surgeon and the anesthesiologist. This is decided after considering the patient's medical history and current health status.
5. The patient should inform the surgeon if he/ she is under certain medicines like blood thinners (warfarin, clopidogrel) or painkillers (aspirin, ibuprofen, and naproxen). To avoid complications, the patient may stop taking these medicines at least 2 weeks before the surgery. 
6. The surgeon may also prescribe certain antibiotics to prevent infections like UTIs and secondary infections.
7. The patient will be told to fast for at least 6 hours before surgery. This means the patient cannot eat or drink anything from 6 hours before the TURP surgery.
8. The patient should get his or her queries, if any, solved by the surgeon.

On the day of TURP surgery

On getting admitted, the patient will need to sign a few forms, including consent for the surgery, any untoward complications during the surgery, and consent to perform emergency care during the surgery in case of any complications. Other steps would be followed as follows:

1. The family members are also asked to sign the form to provide their consent as well.
2. Before operating, the patient will be told to remove his clothes, jewels, dentures, and any other items he dons.
3. The pubic hair will be shaved by the nursing staff, and the surgical site will be prepped for surgery.
4. The healthcare providers monitor the patient’s vitals throughout the surgery.
5. Once the surgery is performed, the patient is taken to a recovery room. Here the patient is monitored until his health condition becomes stable. 

After the surgery, the patient will be shifted to the recovery room for observation. There are certain things that the doctor or the healthcare staff will take care of and also guide the patient or the attendants to follow:

The recovery process at the hospital

1. A urinary catheter attached will be attached for residual urine that needs to be removed.
2. The surgeon will monitor for post-surgical complications, wearing off of anaesthesia effects and the vitals.
3. The surgeon will put the patient on antibiotics for infection and pain relievers for pain.
4. The patient may observe blood in his urine for 24 to 48 hours after the surgery, which is normal.
5. The catheter is left in place for this duration to allow the swelling to reduce and until the patient becomes able to urinate on his own.
6. The patient may experience pain or irritation while urinating or a constant urgency or increased frequency of urination after the surgery. This usually subsides within 6 to 8 weeks of the surgery.
7. If the patient's condition is stable, then the doctor will discharge the patient within a few days.

Recovery process/expectation after hospital discharge

1. Instructions provided by the doctor must follow at home.
2. The patient must:
   1. Drink plenty of water to flush the urinary bladder.
   2. Eat high-fibre foods to improve bowel movement and avoid constipation.
   3. Resume the medications that were stopped before surgery, only after checking with the doctor.
   4. Avoid lifting heavy weights and strenuous activity for at least 6 weeks after surgery.
   5. Not involve in sexual intercourse for about 6 weeks after surgery.
   6. Not drive till the catheter is removed and the pain medicines have been stopped.

First follow-up appointment

1. The first follow-up is usually within 1 to 2 weeks.
2. During the follow-up, the doctor may recommend the patient undergo some tests to check for recovery and any complications if present.
3. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area.
4. The patient will also be informed regarding future visits to examine if the implant is in place and functioning properly.

TURP surgery apart from being a gold standard for treating enlarged prostate has the following benefits:

1. Less painful as it is a minimally invasive surgery
2. It involves minimal bleeding
3. Very fewer chances of complications
4. Requires less operating time
5. It does not intermingle with sexual function
6. Fast recovery

Despite the TURP's high success rate, some of the possible risks and complications associated with the TURP surgery include:

1. Inability to ejaculate during masturbation or sexual intercourse
2. Loss of bladder control (involuntary peeing)
3. Erectile dysfunction: inability to get the penis erected
4. Difficulty while passing urine
5. Urinary tract infections

When is consultation with the doctor needed?

The patient must consult the doctor if he experiences:

1. Inability to urinate
2. Bloody urine
3. Clots in the urine
4. Turbid or cloudy urine despite drinking enough fluids
5. Fever with chills

Prostate surgery is a very common surgery that helps ease most urinary complaints that a male may experience due to prostate enlargement. With this surgery of prostate resection, the pressure on the urinary bladder is reduced significantly.

If the TURP surgery is delayed, then an individual may experience a worsening of the symptoms, including:

1. Sudden inability to urinate
2. Recurrent urinary tract infections (UTIs)
3. Urinary stones
4. Kidney damage
5. Bloody urine

The cost of TURP surgery ranges from ₹80,000 to ₹2,00,000. The cost varies based on some of the following factors:

1. Age of the patient
2. Type of the procedure done
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.