Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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Transurethral Resection of the Prostate, or TURP, is considered the standard surgery for treating benign prostatic hyperplasia (BPH). For many years, it has been the main procedure that new, less invasive treatments are compared to. TURP is a precise endoscopic surgery that relieves bladder outlet obstruction by removing the prostate tissue that blocks the urethra. Unlike open prostatectomy, which requires an abdominal incision to remove the whole gland (usually for very large prostates or cancer), TURP removes tissue through the urinary passage without external cuts.
TURP is more than just a surgical technique; it changes how the lower urinary tract works. The prostate sits like a collar around the upper part of the urethra. In BPH, the transition zone of the prostate grows because of an increase in cell number. This growth forms lumps that squeeze the urethra, making it harder for the bladder to push urine out. TURP solves this problem by removing the tissue causing the blockage, widening the passage, and lowering resistance. This helps the bladder empty more easily, protects the kidneys, and relieves symptoms like trouble urinating and frequent urination.
In the modern urological landscape, TURP has evolved. The traditional monopolar TURP, which uses glycine irrigation, has been supplanted or replaced in many centers by bipolar TURP. This technological advancement uses saline irrigation, significantly improving safety by reducing the risk of electrolyte imbalances. Despite the advent of laser therapies and steam injections, TURP remains the definitive “re-boring” of the prostate, offering immediate and durable anatomical results that many pharmacological or less invasive thermal therapies strive to emulate.
To see why TURP is needed, it helps to understand what happens in the prostate. Benign prostatic hyperplasia is not just a simple enlargement; it is an active process where more and more cells build up. This happens because the balance between cell growth and cell death is disrupted. Hormones like dihydrotestosterone (DHT) and growth factors such as EGF and IGF cause the cells in the prostate’s transition zone to multiply.
This process is called hyperplasia, which means the number of cells increases, not just that the cells get bigger. This is important because TURP removes most of these extra cells. However, it does not remove the outer capsule of the prostate or the peripheral zone, so the remaining tissue can still grow back slowly over time.
From a healing perspective, BPH happens when the body loses control over cell growth in the prostate. The supporting cells act more like they did before birth, causing new tissue to form. During TURP, the surgeon removes this overgrown tissue down to the capsule. After surgery, the area heals as new cells from the bladder neck, urethra, and prostate ducts move in to cover the raw surface. This process stops bleeding and shows how well the urinary tract can repair itself after surgery.
TURP uses electrosurgery. The surgeon inserts a resectoscope, which has a wire loop, into the bladder. An electric current runs through the loop. In monopolar TURP, the current travels from the loop through the patient to a grounding pad. This creates heat that cuts tissue, vaporizes water in the cells, and seals blood vessels to control bleeding.
In bipolar TURP, the electric current stays between two electrodes at the tip of the loop. This setup allows the surgery to use normal saline as the fluid. Using saline is much safer because it avoids the risk of low sodium levels that can happen if the body absorbs too much glycine or sorbitol, which are used in the older method.
The definition of a successful TURP is achieving a “wide-open” prostatic fossa. This is often described visually by surgeons as creating a channel that resembles the view of a cathedral arch. The goal is to remove all adenomatous tissue that impinges on the urethral lumen, leaving only the compressed fibers of the true prostatic capsule. This capsule acts as a boundary; breaching it can lead to fluid extravasation and injury to the surrounding nerves, which are essential for erectile function. Therefore, the procedure is a delicate balance of aggressive tissue removal to ensure flow and careful preservation of the peripheral anatomy.
TURP is indicated for men with moderate to severe lower urinary tract symptoms (LUTS) secondary to BPH who have failed medical therapy or who have developed complications of obstruction. These complications include:
Choosing who should have TURP requires careful consideration. TURP works for many men, but not all. Very large prostates (over 80-100 grams) may be better treated with a simple prostatectomy or laser enucleation to avoid long surgeries and bleeding. On the other hand, men with small prostates causing blockage might do better with a simple incision (TUIP). Most men with BPH fall in between, making TURP the best option for them.
BPH is very common in older men around the world, and TURP is still one of the most common surgeries performed. As the population ages, more men need this procedure. TURP is important because it helps maintain quality of life and prevents problems like long-term catheter use and kidney failure.
Although newer treatments have become available, TURP is still the main standard for comparison. Most clinical trials use TURP as the control group, showing how well it works and how much doctors trust its results. TURP lasts longer than many less invasive treatments, often giving relief for 10 to 15 years or more. This makes it a cost-effective choice for long-term care.
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TURP stands for Transurethral Resection of the Prostate. Transurethral means the surgery is performed through the urethra (the urine tube), requiring no external cuts. Resection means the cutting away or removal of tissue. The prostate refers to the gland being treated.
No, TURP is not the removal of the entire prostate. It involves removing only the inner core of the prostate that is growing and blocking the flow of urine. The outer shell, or capsule, of the prostate is left intact. This is different from a radical prostatectomy for cancer, where the whole gland is removed.
In older methods (monopolar TURP), non-conductive fluids like glycine were used, which could be absorbed by the body and cause dangerous drops in sodium levels. Modern bipolar TURP allows the use of saline (salt water), which is compatible with the body’s chemistry. This significantly reduces the risk of TUR syndrome, making the surgery safer and allowing surgeons to operate for more extended periods if necessary.
Since the outer part of the prostate is left behind, the tissue can regrow over time. However, this process is very slow. Most patients experience significant symptom relief for 15 years or longer. Retreatment is possible, but it is not an everyday necessity in the short- to medium-term.
By removing the blockage at the prostate, TURP lowers the pressure the bladder has to generate to empty. This relieves the workload on the bladder muscle. Over time, a thickened, struggling bladder can regain some elasticity and function, reducing symptoms like urgency and frequency, though this bladder healing can take several months.
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