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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The path to a TURP procedure begins with a structured diagnostic evaluation. The goal is not merely to confirm that the prostate is large, but to prove that the prostate is the cause of the patient’s symptoms. Many conditions, such as overactive bladder, urethral strictures, or neurogenic bladder, can mimic the symptoms of BPH. Therefore, urologists employ a combination of subjective questionnaires and objective physiological tests to build a case for surgical intervention.
The initial step is the International Prostate Symptom Score (IPSS). This validated questionnaire asks the patient to rate the severity of seven specific urinary symptoms (incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia) and one quality-of-life question. This score stratifies patients into mild, moderate, or severe categories and serves as a baseline to measure the success of future treatments.
The Digital Rectal Examination (DRE) remains a cornerstone of the physical assessment. By inserting a gloved finger into the rectum, the urologist can palpate the posterior surface of the prostate. This exam provides critical data:
Objective proof of obstruction is vital. Uroflowmetry is a simple, non-invasive test where the patient urinates into a specialized funnel connected to a computer. The device measures the volume voided over time.
Post-Void Residual (PVR): Immediately after the flow test, an ultrasound scanner is placed on the lower abdomen to measure how much urine is left in the bladder. High residuals (>100-200 ml) indicate that the bladder is failing to empty, reinforcing the need for decompression via TURP.
While DRE estimates size, Transrectal Ultrasound (TRUS) measures it precisely. An ultrasound probe is placed in the rectum to visualize the prostate.
Blood and urine tests are mandatory to ensure patient safety and rule out other pathologies.
Urinalysis: Checks for infection (nitrites/leukocytes) and blood (hematuria). Surgery cannot proceed in the presence of an active, untreated infection due to the risk of sepsis.
Before the final decision for TURP, many urologists perform a flexible cystoscopy. A thin camera is passed up the urethra into the bladder under local anesthesia. This allows direct visualization of the prostatic urethra.
The surgeon assesses the degree of occlusion (how much the lobes are “kissing” or touching), the presence of a median lobe, and the health of the bladder wall. Signs of chronic obstruction in the bladder include trabeculation (thickened muscle bundles) and diverticula (outpouchings). Seeing these changes confirms that the obstruction is causing structural damage to the bladder, solidifying the indication for TURP.
In complex cases—such as patients with neurological diseases or those with high flow rates but severe symptoms—invasive urodynamics are performed. This involves placing catheters in the bladder and rectum to measure pressures during filling and voiding. This is the only test that can definitively distinguish between bladder outlet obstruction (high pressure, low flow) and detrusor underactivity (low pressure, low flow). This distinction is critical because TURP relieves obstruction but does not strengthen a weak bladder muscle.
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PSA stands for Prostate-Specific Antigen. It is a protein produced by the prostate. High levels can indicate a large prostate (BPH), infection, or prostate cancer. Before doing a TURP, doctors check PSA to ensure there isn’t a hidden cancer that needs to be treated differently.
No, the uroflow test is entirely painless and non-invasive. You urinate into a special toilet or funnel in a private room. The machine measures the speed and amount of your urine stream. You need to arrive with a comfortably full bladder to get an accurate reading.
A cystoscopy allows the surgeon to plan the operation. By looking inside, they can see precisely how the prostate is blocking the channel—whether it’s squeezing from the sides or growing up from the bottom. They also check the bladder for stones or tumors that might need to be removed at the same time as the TURP.
If the ultrasound shows a huge prostate (usually over 80-100 grams), a standard TURP might take too long or cause too much bleeding. In this case, the doctor might recommend a different procedure, such as a laser enucleation (HoLEP) or a robotic simple prostatectomy, which can remove larger amounts of tissue safely.
The digital rectal exam (DRE) may be slightly uncomfortable or cause a momentary urge to urinate, but it should not be painful. It takes only a few seconds. It provides vital information about the texture of the prostate that imaging scans sometimes miss, helping to rule out hard nodules associated with cancer.
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