Transurethral resection of the prostate (TURP for short) is a minimally invasive urological surgical procedure. It is used to remove abnormal prostate tissue directly via the urethra. The surgeon uses a so-called resectoscope and a wire loop. The procedure does not require an external incision and is considered the "gold standard" of prostate resection with few complications.
Here you will find information and medical specialists in the field of transurethral resection of the prostate / TURP.
TURP is often used to treat
is used. Both diseases lead to an enlargement of the prostate, which in turn can be accompanied by a narrowing (obstruction) of the lower urinary tract.
The main aim of the operation is to alleviate the associated symptoms.
Benign prostate enlargement occurs frequently and usually causes various symptoms © bilderzwerg / Fotolia
TURP can also contribute to a significant increase in the urinary flow rate and a reduction in the amount of residual urine.
However, the volume of the prostate must not exceed 75 milliliters (about 60 to 80 grams) for a TURP. If, for example, the adenoma to be removed is larger, an adenomectomy is performed as an alternative. An adenomectomy is the open surgical removal of an adenoma.
A TURP is always necessary if the prostate enlargement is accompanied by one or more of the following urological findings:
Depending on the case, a TURP can also be performed if the prostate enlargement
In addition, TURP is also used for
applied.
You must discontinue various medications prior to the procedure. These include in particular
Discontinuing anticoagulants such as Marcumar or acetylsalicylic acid (ASA) reduces the risk of bleeding during or after the operation. However, always discuss the discontinuation of these medications and any existing impairments of the coagulation system with your attending physician.
You should stoptaking antidiabetic drugs such as metformin at least 24 to 48 hours before the operation. These drugs increase the risk of so-called lactic acidosis. In lactic acidosis, the pH value in the blood drops due to an accumulation of lactate (lactic acid). This results in acidosis.
Antibiotic prophylaxis is usually carried out before the procedure to reduce the risk of infection. This is particularly important in cases of increased risk of infection such as
The majority of TURP procedures are performed under spinal or peridural (near the spinal cord) anesthesia. The patient undergoing surgery is in the lithotomy position (lying on their back with their legs spread apart). In addition, a bladder fistula catheter (catheter through the abdominal wall into the urinary bladder) is usually inserted.
To remove the diseased tissue, about 4 to 5 milliliters of lubricant are first introduced into the urethra and spread. A continuous irrigation resectoscope is then advanced through the urethra (transurethral) to the prostate.
The tissue to be removed is then removed using a high-frequency snare and continuous irrigation with a saline or saline-free solution. Adenoma tissue, for example, can be distinguished from healthy prostate tissue by its yellowish granular structure.
The high-frequency snare also allows simultaneous sclerotherapy(coagulation) of the vessels injured during the procedure. This results in less (secondary) bleeding.
Experienced surgeons remove around 1 to 1.2 grams per minute. The procedure therefore takes a maximum of around 60 minutes, even for larger adenomas.
After the prostate tissue has been removed, an irrigation 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 possible complications.
Once the catheter has been removed, the doctors place another bladder fistula catheter to drain the bladder. About 48 hours later, the emptying of the bladder (micturition) is checked.
Postoperative bleeding is relatively common after TURP, but this usually stops on its own. In a few cases, this is not the case and the bleeding must be cauterized (coagulated) as part of a repeat procedure.
Other side effects, such as urinary incontinence, may also occur during the healing process.
In addition, so-called retrograde ejaculation can occur. This means that the seminal fluid is expelled into the bladder and not outwards. It then remains in the bladder until the next urination. In this case, the man is infertile, although his sperm production is functioning.
In very rare cases (5 percent), the salt-free flushing solution can enter the body via an injured vein, for example. This can lead to a disturbance of the water-electrolyte balance. This in turn can result in cardiovascular stress and even right heart failure (right heart failure).
A TUR syndrome is present if at least
are present.
Sometimes benign prostate enlargement is treated with an alpha-reductase inhibitor such as finasteride or dutasteride. If you have had this treatment for a month, the risk of bleeding during and after the operation is significantly reduced. You will also generally need fewer transfusions.
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