TURP: Specialists & Treatment Information

TURP is frequently used to treat

• benign prostatic hyperplasia or
• a benign tumor (prostate adenoma)

. Both conditions lead to an enlargement of the prostate, which in turn can result in a narrowing (obstruction) of the lower urinary tract.

The primary goal of the surgery is to relieve the associated symptoms.

In addition, a TURP can contribute to a significant increase in urinary flow rate and a reduction in residual urine volume.

However, for a TURP to be performed, the prostate volume must not exceed 75 milliliters (approximately 60 to 80 grams). If, for example, the adenoma to be removed is larger, a procedure known as an adenomectomy is performed instead. An adenomectomy is the open surgical removal of an adenoma.

A TURP is definitely necessary if the enlarged prostate is accompanied by one or more of the following urological findings:

• regularly recurring urinary retention (recurrent ischuria)
• recurrent urinary tract infections
• blood in the urine visible to the naked eye that cannot be treated with conservative measures (recurrent gross hematuria)
• bladder stones (uroliths)
• the urinary tract narrowing causes significant dilation of the upper urinary tract
• Impaired kidney function
• Residual urine volume exceeding 100 milliliters or an increase in residual urine despite medical treatment

Depending on the case, a TURP may also be performed if the enlarged prostate

• has led to symptomatic urinary outflow from the urethra,
• is accompanied by a sac-like protrusion of the bladder wall (bladder diverticulum), or
• conservative treatment has not produced the desired results.

In addition, a TURP is also performed in cases of

• chronic bacterial inflammation of the prostate (bacterial prostatitis),
• a prostate abscess, as well as
• palliative treatment for prostate cancer (prostate carcinoma)

.

You must stop taking various medications prior to the procedure. These include, in particular,

• anticoagulants and
• antidiabetic medications (medications used to treat diabetes mellitus).

Discontinuing anticoagulants such as Marcumar or acetylsalicylic acid (ASA) reduces the risk of bleeding during or after surgery. However, you should always discuss discontinuing these medications—as well as any existing coagulation disorders—with your treating physician.

You should stop taking antidiabetic medications such as metformin at least 24 to 48 hours before the procedure. These medications increase the risk of a condition known as lactic acidosis. In lactic acidosis, the pH level in the blood drops due to a buildup of lactate (lactic acid). This leads to acidosis.

To reduce the risk of infection, prophylactic antibiotics are usually administered before the procedure. This is particularly important in cases of increased risk of infection, such as with

• metabolic disorders (diabetes mellitus),
• drug-induced suppression of the immune system (immunosuppression),
• existing bladder stones, or
• repeat surgeries.

The majority of TURP procedures are performed under spinal or epidural (near the spinal cord) anesthesia. The patient undergoing surgery is positioned in the lithotomy position (supine with legs spread apart). In addition, a bladder fistula catheter (a catheter inserted through the abdominal wall into the bladder) is usually placed.

To remove the diseased tissue, approximately 4 to 5 milliliters of lubricant is first introduced into the urethra and spread. A continuous-irrigation resectoscope is then advanced through the urethra (transurethrally) to the prostate.

Under continuous irrigation with a saline or saline-free solution, the tissue to be removed is finally excised using a high-frequency loop. Adenoma tissue can be distinguished from healthy prostate tissue, for example, by its yellowish, granular structure.

The high-frequency loop also allows for simultaneous ablation (coagulation) of the blood vessels damaged during the procedure. This results in less (postoperative) bleeding.

Experienced surgeons remove approximately 1 to 1.2 grams per minute. The procedure therefore takes no more than about 60 minutes, even in cases of larger adenomas.

After the prostate tissue has been removed, a drainage catheter is inserted through the urethra. This allows the bladder to be continuously flushed with a physiological saline solution for 12 to 24 hours after the procedure. This reduces the risk of potential complications.

After the catheter is removed, the doctors insert a urinary fistula catheter to drain the bladder. About 48 hours later, bladder emptying (micturition) is monitored.

Postoperative bleeding occurs relatively frequently after a TURP, but it usually stops on its own. In a few cases, this is not the case, and the bleeding must be coagulated during a follow-up procedure.

As healing progresses, other side effects may also occur, such as urinary incontinence.

In addition, a condition known as retrograde ejaculation may occur. In this condition, semen is ejaculated into the bladder rather than outward. It then remains in the bladder until the next urination. In this case, the man is infertile, even though his sperm production is functioning normally.

In very rare cases (5 percent), the salt-free irrigation solution may enter the body, for example, through a damaged vein. This can lead to an imbalance in the body’s water and electrolyte levels. This, in turn, can place a strain on the cardiovascular system, potentially leading to right-sided heart failure (right ventricular insufficiency).

TUR syndrome is present when there is at least

• a low heart rate (bradycardia),
• high blood pressure (hypertension),
• low blood pressure (hypotension),
• reduced urine output (oliguria), and
• at least one neurological symptom, such as visual disturbances, nausea and vomiting, headache, fatigue, restlessness, or altered consciousness

are present.

Sometimes, benign prostatic hyperplasia is treated with an alpha-reductase inhibitor such as finasteride or dutasteride. If this treatment was completed at least one month prior to surgery, the risk of bleeding during and after the procedure is significantly reduced. In addition, you will generally require fewer blood transfusions.