Men can experience a condition called benign prostatic hyperplasia (BPH) as they age. This is where the prostate gland increases in size and puts pressure on the tube that carries urine from the bladder to the outside of the body (urethra).

Your doctor may suggest an operation called a transurethral resection of the prostate (TURP) to remove part of the prostate and restore urine flow by reducing pressure on the urethra and the bladder.

Most men aged over 50 ⁽¹⁾ will suffer from BPH at some time in their lives, with incidence increasing with age. BPH is NOT prostate cancer.

BPH can cause the following:

• The need to urinate frequently or urgently, even at night
• Difficulty or straining during urination and a feeling that you have not emptied your bladder fully
• Weak or intermittent urine flow and urine leakage or dribbling

The prostate is the size of a walnut, but in BPH it can grow to the size of a small orange, pressing on the urethra and bladder and blocking or restricting urine flow.

When should I consider a TURP?

About 40,000 ⁽²⁾ TURP operations are performed annually in the UK, but not every man with BPH requires one.

You may be advised to have a TURP if the following have happened:

• You have tried alpha-blocker drug treatments and they have failed
• Your urethra is so blocked that you are getting frequent bladder infections
• You are getting bladder stones because your bladder does not empty fully
• You develop a condition called acute urinary retention, which means you cannot urinate at all and kidney damage may result

Nine out of 10 men say their symptoms are improved three years after the TURP, compared with only four out of 10 men who did not have the operation ⁽³⁾.

What does the TURP operation involve?

You will be given either a general anaesthetic or an epidural, where an anaesthetic is injected into the fluid around your spine to block sensation in the lower half of your body.

If you have an epidural you will be awake during the TURP, but will not be able to see what is happening.

The TURP takes about an hour. A surgeon inserts a thin, metal instrument called a resectoscope into your penis and up through the urethra. The surgeon can look down the resectoscope to examine the prostate.

Attached to the resectoscope is an electrically-heated wire loop (or laser), which the doctor uses to remove the part of your prostate causing the problem.

A sterile solution flushes removed tissue down the resectoscope, some of which may be sent off to be analysed.

The surgeon will lastly insert a catheter into your urethra, so fluid can be flushed in and out of your bladder to clear away pieces of prostate tissue, blood clots and urine.

What happens afterwards?

Once the anaesthetic wears off, your urethra and penis may feel sore.

The catheter can also make you feel you need to go to the toilet, but this should not last long. The catheter will remain in place for two or three days and will keep flushing out your bladder until your urine starts to run clear.

If there is a lot more blood than normal in your urine and it does not clear up after 24 hours, you may need a transfusion and further surgery to stop the bleeding.

Once the catheter is removed you can start to urinate normally. For the first day it may sting when you urinate, and you may feel a strong urge to urinate or go more frequently.

When can I go home?

You may have to stay in hospital for about two to three days ⁽⁴⁾ following your TURP, depending on how quickly you recover.

Recovery dos and don'ts:

• Do drink around two litres of fluids a day to flush out your bladder and reduce the chance of infection
• Don't drink tea, coffee and fizzy drinks for a month or so after you go home, as they may irritate your bladder
• Don't drive for a week after the operation or take part in sports for at least a month
• Don't perform strenuous activities, such as heavy lifting, for six weeks
• Don't have sex until six weeks after the TURP

It can take days or weeks to return to normal. You may also still see some blood in your urine for up to two weeks after your operation, but this will stop.

What is TURP syndrome?

TURP syndrome can happen to about one in 150 men and mainly affects patients whose operations go on for over an hour. It is easily treated, but it can make you feel confused, dizzy or nauseous.

TURP syndrome is caused by your body absorbing the fluid used to flush out bits of prostate removed during surgery, upsetting the salt balance of your blood. It can be harmful to men who have existing heart or kidney problems.

Other TURP complications include:

• Retrograde ejaculation (dry orgasm) affects seven out of 10 men ⁽⁶⁾. Some or all of the prostate fluid goes backwards into the bladder instead of forwards through the urethra. It will not affect enjoyment of sex, but it does mean your fertility could be reduced
• You could develop a urinary infection, but this can be treated with antibiotics ⁽⁵⁾
• About one in 20 men ⁽⁶⁾ may also have problems passing urine because of scar formation around the opening of the bladder. This can be treated with another operation
• Around one in 100 men ⁽⁶⁾ may need another TURP because their prostate continues to grow
• While the nerves that control erections may be damaged during a TURP, there is no strong evidence that TURP causes erectile dysfunction

Despite these complications, three quarters of men ⁽⁷⁾ who undergo a TURP say that their toilet habits are better than before the operation.

Infolinks:

• The Continence Foundation
• The Prostate Cancer Centre
• The Prostate Cancer Charity