TURP

TURP

Transurethral resection of the Prostate (TURP) is a minimally-invasive surgical procedure that is performed to remove prostate tissue that is obstructing your urinary flow. Many people refer to TURP as the “rooter” procedure because it is analogous to the service that a plumbing professional performs to remove blockages from pipes in your home or building. Just like a rooter procedure, no cuts are made on the outside to access the blockage. During TURP, your urologist utilizes specialized cystoscopic tools to gain entry into the lumen of your urethra and the obstructing prostate tissue is cleared by carefully scraping it from the inside. TURP is by far the most commonly performed surgical procedure performed for benign prostatic hyperplasia (BPH).

Can I use medications for BPH?

Before recommending a TURP, your urologist will generally determine if medications are effective at controlling your bothersome lower urinary tract symptoms. Surgical procedures such as TURP are considered when the medications do not work or if they cause intolerable side effects. You will typically be offered a trial of a medication called an “alpha blocker” such as tamsulosin, which is generally well tolerated in most cases. If these medications are ineffective at relieving your symptoms, the dose of the alpha blocker may be increased or a “5 alpha reductase inhibitor (5-ARI)” - finasteride or dutasteride - will be added. While alpha blockers and 5ARIs work better together than either alone, 5-ARI medications can have significant side effects such as erectile dysfunction, decreased libido, decreased ejaculatory volume, depressive symptoms, breast tenderness and breast tissue growth. Further, the FDA has issued a warning against 5-ARIs stating that they may increase the risk of being diagnosed with high-grade prostate cancer (a more serious form of prostate cancer).[1] While the existence of post-finasteride syndrome (PFS) remains controversial, it is a potential concern from long-term usage of 5ARIs. This syndrome describes a constellation of long-term sexual, psychological, neurological and physical adverse side effects that may persist long after one discontinues use of the 5ARI.

If my medications are controlling my symptoms, do I still need a TURP?

Failure of medical management of BPH is one indication to undergo a surgical procedure such as a TURP. Other indications also exist such as the presence of bladder stones that are present with your BPH (so that they may be removed at the same time), recurrent bleeding from your prostate, recurrent urinary tract infections, recurrent urinary retention (being unable to void at all and needing a catheter to empty your bladder) and obstruction of your ureters (the tubes that connect your kidneys to your bladder) due to impingement from your prostate. TURP may occasionally be performed in patients with prostate cancer - not as an oncologic treatment of the cancer itself but as a way of unobstructing your prostatic urethra and/or ureters in the setting of advanced disease if you have not had or if you are not a candidate for a radical prostatectomy.

Are other non-medication treatment options available aside from TURP?

TURP was first introduced in the 1920’s and remains the gold standard surgical treatment option for BPH by which all others are compared. Over the ensuing decades may technologies have been developed, promising to replace TURP, but none have ever done so and most of these technologies have fallen to the waste basket of urological history, almost never to be spoken about anymore. Some examples are Intraprostatic stents (temporary and permanent), transurethral needle ablation of the prostate (TUNA), and transurethral microwave thermotherapy (TUMT).

A variety of different minimally-invasive treatment options for BPH are currently in use such as green light laser prostatectomy, HoLEP, Urolift ®, Rezum, ® Aquablation and prostate artery embolization. The decision of which procedure to undergo should be made in conjunction with your urologist who knows your full medical and urological history and has also carefully studied your genitourinary system with diagnostic tests such as cystoscopy, blood tests, transrectal ultrasound, prostate MRI, Urocuff and/or urodynamic studies.

Transurethral incision of the prostate is often effective for patients who have bladder neck obstruction causing significant lower urinary tract symptoms but who have very small prostate glands (this diagnosis may be difficult to make with cystoscopy alone). Your urologist may recommend a simple prostatectomy (open, laparoscopic or robotic) if you have an extremely large prostate, if it is difficult to place you in the correct position for TURP (due to lower limb contractures, hip flexion abnormalities, etc), if you have severe urethral stricture disease, if you have very large bladder stones that would be difficult to treat endoscopically or if you have a large bladder diverticulum requiring concomitant repair.

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