Transurethral Resection of Prostate

Introduction

Transurethral resection of the prostate, almost always shortened to TURP, is one of the longest-established and most studied operations in urology. It is used to relieve urinary problems caused by an enlarged prostate — specifically when medications have not provided enough relief, or when the enlargement has begun to cause complications such as repeated infections, bladder stones, or sudden inability to pass urine.

If you are reading this, you have likely already been told that your prostate is enlarged and that surgery is being considered, or has been recommended. This guide explains what TURP is, how it compares with newer laser options, what happens before, during, and after the operation, and what life tends to look like in the weeks and months that follow. The aim is to give you enough background to have a clearer, more confident conversation with your urologist about the choice that fits your situation.

What Is TURP?

TURP stands for transurethral resection of the prostate. The name describes the route and the action:

• Transurethral — the surgeon works through the urethra, the natural tube that carries urine from the bladder out of the body. There is no cut on the skin.
• Resection — pieces of tissue are removed.
• Prostate — the walnut-sized gland that sits just below the bladder and wraps around the urethra in men.

In a healthy prostate, the gland is small enough that urine flows out of the bladder freely. With age, the prostate often grows. This condition is called benign prostatic hyperplasia (BPH). It is not cancer. But as the gland enlarges, it can squeeze the urethra and make it harder to empty the bladder. TURP works by removing the inner portion of the prostate that is pressing on the urethra, widening the channel so urine can flow more easily.

TURP has been performed for more than half a century. For many decades it was considered the surgical reference standard for moderate-to-large prostates causing significant urinary symptoms. Major urological societies, including the American Urological Association (AUA) and the European Association of Urology (EAU), continue to list TURP as a recommended surgical option, alongside several newer laser-based techniques that are now also considered first-line in their respective situations.

Why Is TURP Performed?

TURP is performed to relieve obstruction at the bladder outlet caused by an enlarged prostate. Doctors typically consider it when one or more of the following is true:

• Bothersome lower urinary tract symptoms that have not improved enough with medication. These include a weak or interrupted urine stream, straining to urinate, frequent urination during the day, waking multiple times at night to urinate (nocturia), urgency, a sense of incomplete emptying, and dribbling at the end of urination.
• Acute urinary retention — a sudden inability to pass urine that has required catheterisation, especially if attempts to remove the catheter have failed.
• Recurrent urinary tract infections related to incomplete bladder emptying.
• Bladder stones forming because urine is not emptying fully.
• Repeated episodes of blood in the urine (haematuria) clearly coming from the enlarged prostate.
• Damage to the bladder or kidneys caused by long-standing obstruction — for example, a very thickened bladder wall, a stretched bladder that no longer contracts well, or back-pressure on the kidneys.
• Intolerance of medication — some men cannot take, or do not wish to remain long-term on, the drugs commonly used for BPH.

Surgery is generally not the first step. Most men with mild or moderate symptoms are treated initially with lifestyle changes and medication. TURP enters the conversation when those measures are not enough, or when complications have already developed.

Who Is a Candidate?

Several factors influence whether TURP is a reasonable option for a given person:

• Prostate size. TURP is generally well suited to small and moderately enlarged prostates — typically those up to around 80–100 millilitres in volume, though this threshold varies between surgeons and institutions. For very large prostates, alternatives such as holmium laser enucleation (HoLEP) or open/simple prostatectomy are often preferred.
• Overall fitness for anaesthesia. TURP requires either spinal or general anaesthesia. Your fitness for one of these is assessed before surgery.
• Bleeding risk. Men who take blood-thinning medication, or who have bleeding disorders, need careful planning. Some laser techniques have a lower bleeding profile and may be preferred in higher-risk cases.
• The shape of the prostate. A large “middle lobe” protruding into the bladder, for example, may influence the choice of technique.
• Other urinary tract problems. Bladder stones, urethral strictures, or suspected cancer may require additional steps or change the surgical plan.

The decision about whether TURP, a laser alternative, or another approach is the best fit is a clinical one. It is made by your urologist after reviewing your symptoms, your investigations, your other health conditions, and your preferences.

Alternatives to TURP

TURP is one of several established options for treating an enlarged prostate that is causing significant urinary symptoms. A meaningful discussion of alternatives is important because, for many men, more than one option is reasonable.

Continued medical therapy

The two main classes of drugs used for BPH are alpha-blockers (such as tamsulosin, alfuzosin, silodosin), which relax muscle in the prostate and bladder neck, and 5-alpha reductase inhibitors (finasteride, dutasteride), which slowly shrink the prostate over months. These can be used alone or in combination. They work well for many men with mild-to-moderate symptoms but may not be enough if obstruction is severe or complications have developed.

Laser surgery

Several laser techniques are now widely used:

• Holmium Laser Enucleation of the Prostate (HoLEP). The inner prostate tissue is separated from the outer capsule and removed in larger pieces. HoLEP is effective across a wide range of prostate sizes, including very large glands, and is increasingly considered a reference standard alongside TURP. Major guidelines describe HoLEP as size-independent.
• Thulium Laser Enucleation (ThuLEP). Similar principle to HoLEP, using a different laser wavelength.
• GreenLight (Photoselective Vaporisation, PVP). The laser vaporises prostate tissue rather than cutting it. Often chosen for men on blood thinners because of its lower bleeding profile.

Laser techniques can offer shorter catheter times, shorter hospital stays, and less bleeding than monopolar TURP. They require specific equipment and surgical training, and not every centre offers every technique.

Minimally invasive office-based treatments

Newer techniques such as prostatic urethral lift (UroLift) and water vapour therapy (Rezum) are options for selected men, particularly those with smaller prostates who want to preserve ejaculatory function. Their availability and suitability vary.

Open or laparoscopic simple prostatectomy

For very large prostates that are not well suited to TURP, the inner prostate tissue can be removed through an abdominal incision or through laparoscopic or robotic surgery. This is a bigger operation with a longer recovery, but it is sometimes the most appropriate choice.

Long-term catheterisation

For men who are not fit for surgery, a long-term indwelling or intermittent catheter is sometimes used. It is not a preferred long-term solution but can be the right choice in particular circumstances.

It is worth noting that TURP is for benign enlargement, not for prostate cancer. If cancer is suspected or confirmed, a different set of treatments — including radical prostatectomy, radiotherapy, or active surveillance — is considered, and these are addressed in separate articles.

Surgical Approaches and Variations

Within TURP itself, there are two main electrical techniques. The choice between them depends on the equipment available, the surgeon’s training, and patient factors.

Monopolar TURP

This is the traditional technique. Electrical current passes from a small wire loop on the resectoscope (the instrument inserted through the urethra), through the prostate tissue, and out through a pad placed on the patient’s skin. A non-conductive fluid such as glycine is used to flush the area and keep the view clear.

Monopolar TURP has decades of evidence behind it. Its main limitation is that the irrigation fluid is not saline, and if too much is absorbed into the bloodstream during surgery, it can cause a rare but serious complication called TUR syndrome (a fluid and electrolyte imbalance). This risk rises with longer operating times and larger prostates.

Bipolar TURP

In bipolar TURP, the electrical circuit is completed at the tip of the instrument itself, so no skin pad is needed. Importantly, normal saline can be used as the irrigation fluid, which essentially removes the risk of TUR syndrome. Bleeding tends to be similar or slightly less than with monopolar TURP, and slightly longer operations on slightly larger prostates can be performed safely.

Major guidelines, including those from the AUA and EAU, regard bipolar TURP as offering at least equivalent symptom relief to monopolar TURP with a better safety profile, and many centres now use bipolar systems as standard. Both techniques remain accepted options.

How TURP compares to laser enucleation in practice

Symptom improvement with TURP and with enucleation techniques such as HoLEP is broadly comparable in studies. Laser techniques typically offer shorter catheterisation and hospital stay, and a lower transfusion rate. TURP offers the advantage of long-term outcome data and wide surgical familiarity. Discussing the comparative profile with your urologist, in the context of your prostate size and overall health, is the best way to weigh these options.

Preparing for TURP

Once a decision to proceed with TURP has been made, you will go through several preparatory steps over the weeks before surgery.

Pre-operative assessment

Your urologist will confirm the diagnosis and the suitability of TURP based on:

• Symptom assessment, often using a standardised questionnaire such as the International Prostate Symptom Score (IPSS).
• Digital rectal examination (DRE) to estimate prostate size and feel for any irregularities.
• PSA blood test, partly to help screen for prostate cancer and partly because PSA roughly correlates with prostate size.
• Urinalysis and urine culture to identify any infection that must be treated before surgery.
• Ultrasound of the kidneys, bladder, and prostate, to measure prostate volume and check for stones, residual urine, or upper tract changes.
• Uroflowmetry and post-void residual measurement to assess how strongly and completely you empty your bladder.
• Cystoscopy (a thin camera passed into the bladder), in selected cases, to inspect the urethra, prostate, and bladder directly.
• Urodynamic testing in selected complex cases where bladder function is in question.

Medication review

Tell your team about everything you take, including over-the-counter medicines and supplements. Particular attention is paid to:

• Blood-thinning medication (aspirin, clopidogrel, warfarin, apixaban, rivaroxaban, dabigatran). The surgical team will give specific instructions on when to stop, switch, or continue these. Do not stop any blood thinner on your own.
• Diabetes medication, which may need adjustment around the fasting period.
• Herbal supplements, some of which can increase bleeding.

Anaesthetic review

You will meet an anaesthetist before surgery. TURP is usually performed under spinal anaesthesia (numbing from the waist down while you remain awake or lightly sedated) or general anaesthesia. The choice depends on your health, the expected duration, and your preference.

Practical preparation

• You will be asked not to eat or drink for several hours before surgery.
• Arrange transport home for after discharge; you will not be able to drive.
• Plan for a quieter few weeks at home with no heavy lifting or strenuous activity.
• If you live alone, having someone to help for the first few days can be useful.

What Happens During TURP

The operation typically takes 60 to 90 minutes, depending on the size of the prostate and the technique used. From your perspective, the experience usually unfolds like this:

1. You arrive at the hospital, change, and are taken to the operating area. An intravenous line is placed.
2. The anaesthetist gives spinal or general anaesthesia. With a spinal, you will not feel anything from the waist down. With a general, you will be asleep.
3. You are positioned with your legs supported and apart so the surgeon can access the urethra.
4. The surgeon passes the resectoscope — a thin metal instrument with a light, a camera, and a working channel — through the urethra and into the prostatic area. There is no cut on the skin.
5. Using a small electrical loop (monopolar or bipolar), the surgeon trims away the inner prostate tissue piece by piece, widening the channel for urine.
6. The removed tissue chips are flushed out of the bladder and collected. Some or all of this tissue is sent to the laboratory to confirm it is benign.
7. Bleeding points are sealed (cauterised).
8. A three-way urinary catheter is placed at the end of the operation. This catheter has three channels: one to drain urine, one to inflate the balloon that holds the catheter in place, and one to run sterile fluid into the bladder. This continuous bladder irrigation flushes out blood and small clots in the first day or so.

You wake up (or, if you had a spinal, are taken to recovery) with the catheter already in place. Mild discomfort, a sense of urgency, or bladder spasm in the first hours is common and is managed with medication.

Recovery and Healing

In hospital

Most men stay in hospital for one to three days. During this time:

• The continuous bladder irrigation is gradually reduced and then stopped as the urine clears from bright red to pink to pale yellow.
• The catheter is typically removed once the urine is clear enough, usually after one to three days.
• You will be encouraged to drink plenty of water to keep the urine dilute.
• You may be given antibiotics, painkillers, and sometimes medication to reduce bladder spasms.
• Once you are passing urine well after catheter removal, you will be discharged.

It is not unusual for a small number of men to find passing urine difficult immediately after the catheter is removed, because of bladder weakness or swelling. If this happens, the catheter may be replaced for a short period and removed again later.

The first few weeks at home

Expect the following in the first one to six weeks:

• Some blood in the urine is common and may come and go for several weeks. It often increases briefly around the second or third week as scabs separate from the healing prostate bed. Drinking more water helps. Heavy bleeding or clots that block urine flow are not normal and need medical attention.
• Urinary urgency, frequency, and a burning sensation when urinating are common in the early weeks. These usually settle as the area heals.
• Some leakage or stress incontinence can occur and almost always improves with time and pelvic floor exercises.
• Avoid heavy lifting, straining, and vigorous exercise for about four to six weeks to reduce the risk of bleeding.
• Avoid long drives and prolonged sitting in the first one to two weeks.
• Constipation should be avoided, as straining can trigger bleeding. A high-fibre diet and adequate fluids help; a mild laxative may be advised.
• Sexual activity is typically avoided for about four weeks, then gradually resumed.

Follow-up

You will usually be seen for a check-up within the first few weeks after surgery. Repeat assessments of urine flow, symptom scores, and PSA may be done over the following months. The lab report on the tissue removed during surgery will also be reviewed.

Risks and Complications

TURP is a well-established procedure with a strong safety record, but no surgery is without risk. Understanding the possible complications helps you recognise problems early and discuss prevention with your team.

Common and expected effects

• Blood in the urine for days to weeks.
• Burning, urgency, and frequency in the early weeks.
• Retrograde ejaculation (see below) — very common.

More significant complications

• Bleeding requiring transfusion. Uncommon with modern technique, more likely with very large prostates or in men on blood thinners.
• Urinary tract infection. Treated with antibiotics. Persistent infections may require further investigation.
• Urinary retention after catheter removal, usually temporary.
• Urinary incontinence. Some early leakage is common; persistent incontinence beyond a few months is uncommon. Pelvic floor exercises help recovery.
• Urethral stricture — scarring that narrows the urethra. Can develop weeks to months after surgery and may need a small additional procedure.
• Bladder neck contracture — scarring at the bladder outlet, also treatable.
• TUR syndrome — a rare fluid and electrolyte imbalance, essentially eliminated by the use of bipolar systems with saline irrigation.
• Anaesthetic complications, deep vein thrombosis, and chest infections, as with any operation.

Effect on sexual function

This is one of the most important issues for many men, and worth discussing in detail with your urologist.

• Retrograde ejaculation — semen passes backwards into the bladder during orgasm rather than out through the penis — happens in the large majority of men after TURP. Orgasm itself is still felt, but ejaculation may be reduced or absent. This is harmless to health but is a permanent change. It does affect fertility, which is relevant for any man hoping to conceive after surgery.
• Erectile function is usually preserved. Some studies suggest a small risk of new or worsened erectile difficulty after TURP, while others show no significant change.
• Orgasm can feel different but is generally maintained.

Need for re-treatment

TURP gives durable relief for most men, but prostate tissue can regrow slowly over many years, and a small proportion of men require a further procedure later in life.

Life After TURP

For most men who have had significant symptoms, life after TURP is noticeably easier. Long-term studies show substantial improvement in urinary flow, symptom scores, and quality-of-life measures, and the improvement tends to be lasting. Common changes that men describe include:

• A stronger and steadier urine stream.
• Fewer trips to the toilet during the day and at night.
• Less urgency and less sense of incomplete emptying.
• Freedom from a catheter, in those who had been catheter-dependent before surgery.

A few practical points are worth keeping in mind for the years ahead:

• Prostate cancer screening still applies. TURP removes the inner part of the prostate, but the outer rim, where most prostate cancers begin, remains. PSA testing and clinical review are still appropriate based on your age and risk.
• PSA usually drops after TURP. Your urologist will discuss what your new baseline looks like and how to interpret future values.
• Hydration and bladder habits. Drinking adequately during the day, limiting fluids in the evening, and reducing caffeine and alcohol can all help urinary comfort.
• Pelvic floor exercises support continence and can be useful long-term.
• Other conditions matter. Diabetes, obesity, and certain medications can affect bladder function. Managing these supports the longer-term benefit of surgery.

Frequently Asked Questions

How long does TURP take?

The operation itself usually takes 60 to 90 minutes. Larger prostates take longer, and the total time at the hospital, including preparation and recovery, is several hours.

Will I be awake during the surgery?

That depends on the anaesthetic. Under spinal anaesthesia, you are numb from the waist down and may be awake or lightly sedated. Under general anaesthesia, you are fully asleep. The anaesthetist will discuss what is most appropriate for you.

How long will I have a catheter?

Usually one to three days. The catheter is removed once the urine has cleared sufficiently. A small number of men need the catheter for a little longer.

How soon can I go back to work?

Light desk-based work is often possible within one to two weeks, depending on how you feel. Physically demanding work usually needs four to six weeks. Your surgeon will give specific advice.

Will TURP affect my ability to have sex?

Erections are usually preserved. The most common change is retrograde ejaculation, where semen goes into the bladder instead of out through the penis. Orgasm still occurs, but visible ejaculation is reduced or absent. This change is permanent in most cases and does affect fertility.

Is TURP a cure?

TURP gives long-lasting relief for most men. Because some prostate tissue is left behind and can regrow slowly, a small number of men may need a further procedure many years later.

How is TURP different from laser surgery?

TURP uses an electrical loop to cut prostate tissue. Laser techniques use light energy to either vaporise or enucleate tissue. Symptom outcomes are broadly similar. Laser options often involve shorter catheterisation and less bleeding, especially helpful for men on blood thinners or with very large prostates. Your urologist can advise which option suits your situation.

Does TURP treat prostate cancer?

No. TURP is for benign enlargement. The tissue removed is sent to the laboratory, and occasionally early cancer is found incidentally, but TURP is not a treatment for prostate cancer. Cancer is treated with different approaches.

Is some blood in the urine normal afterwards?

Yes, intermittent light bleeding for several weeks is common and tends to settle on its own, especially with good fluid intake. Heavy bleeding, clots blocking urine flow, fever, or sudden inability to urinate are not normal and require medical attention.

Can TURP be repeated?

Yes, if symptoms return many years later because of regrowth, a repeat TURP or another procedure can be considered.

Conclusion

Transurethral resection of the prostate is a well-established surgical option for men whose lives are being affected by an enlarged prostate, particularly when medication is no longer enough or when complications have set in. Both monopolar and bipolar TURP can give durable symptom relief, and bipolar systems have largely removed the older concern of fluid-related complications. Laser alternatives such as HoLEP and GreenLight now sit alongside TURP as accepted choices, with the right fit depending on prostate size, bleeding risk, available expertise, and personal preference.

Whichever route is recommended, the most important step is an unhurried conversation with your urologist about what the operation involves for you, what the recovery is likely to look like, and what changes — including the very common change in ejaculation — you should be prepared for. With clear expectations and good follow-up, most men come through TURP with substantially improved urinary comfort and a meaningful improvement in day-to-day quality of life.