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Transurethral Resection of the Prostate (TURP) Procedure

Transurethral Resection of the Prostate (TURP) is a minimally invasive surgical procedure commonly used to treat benign prostatic hyperplasia (BPH), a condition characterized by the enlargement of the prostate gland. TURP aims to relieve urinary symptoms by removing excess prostate tissue that is obstructing urine flow. Here’s a detailed overview of the TURP procedure:

Indications

TURP is typically recommended for men who experience moderate to severe urinary symptoms related to BPH that have not responded adequately to medication or other less invasive treatments. Symptoms may include:

• Frequent urination
• Urgency to urinate
• Difficulty starting or stopping urination
• Weak or interrupted urine flow
• Nocturia (frequent nighttime urination)

Procedure Overview

1. Preoperative Preparation:
   • Medical Evaluation: A thorough medical history and physical examination, including a digital rectal exam (DRE) and possibly urine tests and imaging studies.
   • Medications: Patients may be advised to stop certain medications, such as blood thinners, prior to surgery.
   • Informed Consent: Discuss the procedure, potential risks, and benefits with the healthcare provider and obtain informed consent.
2. Anesthesia:
   • TURP is typically performed under spinal or general anesthesia. Spinal anesthesia numbs the lower half of the body, allowing for a more rapid recovery and less postoperative discomfort.
3. Procedure Steps:
   • Preparation: The patient is positioned comfortably, usually lying on their back.
   • Insertion of the Resectoscope: A resectoscope (a specialized instrument that combines a light, camera, and surgical tools) is inserted through the urethra and into the prostate gland.
   • Resection of Prostate Tissue: Using a wire loop attached to the resectoscope, the surgeon removes small pieces of excess prostate tissue. This is done by cutting and cauterizing tissue to control bleeding.
   • Continuous Irrigation: A saline solution is continuously irrigated through the resectoscope to clear the surgical field of blood and tissue fragments, ensuring clear visibility.
   • Complete Resection: The surgeon carefully removes enough tissue to relieve the obstruction while preserving surrounding structures as much as possible.
4. Completion and Recovery:
   • Removal of the Resectoscope: Once the necessary tissue has been removed, the resectoscope is withdrawn, and the procedure is complete.
   • Placement of a Catheter: A urinary catheter is typically placed in the bladder to drain urine and allow healing. This catheter may remain in place for a few days post-surgery.
   • Monitoring: Patients are monitored in a recovery area for a few hours before being transferred to a hospital room or discharged home.

Recovery

• Hospital Stay: Many patients can go home the same day as the procedure, but some may require a brief hospital stay, especially if complications arise.
• Postoperative Care: Patients will be given instructions on catheter care, fluid intake, and signs of potential complications (e.g., excessive bleeding, infection).
• Urinary Symptoms: Initially, patients may experience urinary urgency, frequency, and mild discomfort as they adjust to the changes. These symptoms usually improve over time.
• Follow-Up: A follow-up appointment is typically scheduled within a few weeks to monitor recovery and assess urinary function.

Risks and Complications

While TURP is generally considered safe, it does carry some risks, including:

• Bleeding: Some blood loss is expected; however, significant bleeding may require additional treatment.
• Infection: As with any surgical procedure, there is a risk of urinary tract infections (UTIs).
• Erectile Dysfunction: Some patients may experience erectile dysfunction after surgery, although this risk is generally lower with TURP compared to more invasive prostate surgeries.
• Retrograde Ejaculation: The condition in which semen enters the bladder instead of exiting through the penis during ejaculation, which is common after TURP.
• Urinary Incontinence: Some patients may experience temporary urinary incontinence that usually improves over time.

Conclusion

Transurethral Resection of the Prostate (TURP) is a widely performed and effective procedure for managing BPH symptoms. By removing obstructive prostate tissue, TURP can significantly improve urinary flow and quality of life for patients. A thorough discussion with a healthcare provider about the potential benefits, risks, and expected outcomes is essential for anyone considering this treatment.