What is Prostate Surgery for BPH (TURP)?
Transurethral Resection of the Prostate (TURP) is an endoscopic surgical procedure performed to treat lower urinary tract symptoms caused by Benign Prostatic Hyperplasia (BPH)—a non-cancerous enlargement of the prostate gland in aging men.
During TURP, a specialized instrument called a resectoscope is passed through the urethra without any external skin incisions. An energized wire loop trims away obstructing prostate tissue layer by layer, immediately clearing the urinary channel.
Who Needs TURP Surgery?
TURP is recommended for men with symptomatic BPH unresponsive to medications.
Key clinical indicators include:
- Acute or chronic urinary retention.
- Recurrent urinary tract infections due to incomplete bladder emptying.
- Recurrent blood in urine (hematuria) from prostatic vessels.
- Bladder stones caused by chronic urine stasis.
- Severe urinary hesitancy, weak stream, nocturia, and urgency affecting quality of life.
Types of BPH Surgery
- Monopolar TURP (m-TURP): Traditional technique using monopolar electrocautery and non-conductive irrigation fluid.
- Bipolar TURP (b-TURP): Advanced technique using bipolar energy and normal saline irrigation, reducing TUR syndrome risks.
- Laser Prostatectomy / HoLEP: High-precision laser enucleation ideal for very large prostates with minimal bleeding.
Benefits of TURP Surgery
- Immediate relief from urinary obstruction and restored urine flow.
- Long-lasting symptom improvement with low retreatment rates.
- Completely incisionless procedure performed via the natural urethra.
- Tissue retrieval for pathological confirmation.
- Protection of long-term bladder and kidney health.
What to Expect Before Surgery?
- Diagnostic Workup: Serum PSA, urine culture, uroflowmetry, and residual urine ultrasound.
- Medication Adjustment: Stopping blood thinners 5 to 7 days prior under medical guidance.
- Fasting: Strict NPO fasting for 8 hours prior to surgery.
Complete Procedure
The surgical process generally follows these steps:
- Administration of spinal or general anesthesia.
- Inserting the resectoscope through the tip of the penis into the urethra.
- Initiating continuous fluid irrigation for high-definition visualization.
- Trimming obstructing prostatic tissue into small slices using monopolar/bipolar loop or laser.
- Flushing tissue chips out of the bladder for biopsy analysis.
- Inserting a 3-way catheter for continuous bladder irrigation (CBI).
What to Expect During Surgery?
Surgery takes 40 to 90 minutes. Patients experience no pain under spinal or general anesthesia while vitals are continuously monitored.
Monopolar TURP vs Bipolar TURP / HoLEP
| Feature | Monopolar TURP | Bipolar TURP | Laser Prostatectomy (HoLEP) |
|---|---|---|---|
| Irrigation Fluid | Glycine / Sorbitol | Normal Saline (0.9%) | Normal Saline (0.9%) |
| Bleeding Risk | Moderate | Low | Minimal |
| Prostate Size | Up to 60-80 cc | Up to 100 cc | Any size (Ideal >80 cc) |
| Hospital Stay | 3 - 4 Days | 2 - 3 Days | 1 - 2 Days |
Success Rate and Safety
TURP has a success rate exceeding 85% to 90%, providing dramatic improvements in urinary flow rates and symptom scores.
TURP Surgery Cost Estimate
| Type of Procedure | Estimated Cost Range (INR) |
|---|---|
| Monopolar TURP (Standard) | ₹1,00,000 - ₹1,80,000 |
| Bipolar TURP (Advanced) | ₹1,50,000 - ₹2,50,000 |
| Laser Prostatectomy (HoLEP) | ₹2,20,000 - ₹3,80,000 |
Disclaimer: Final costs depend on room category, prostate size, and technology used.
Recovery Guide & Post-Operative Care
Recovery Timeline
- Day 1-3: Catheter in place with continuous irrigation; urine clears from red to pink.
- Week 1-2: Catheter removed before discharge; mild burning/urgency is normal.
- Week 3-6: Urinary stream strengthens; return to desk work.
- Week 6-8: Full internal healing; resumption of exercise and heavy lifting.
Post-Op Precautions & Care
- Hydration: Drink 2.5 to 3 liters of water daily.
- Prevent Straining: Eat high-fiber foods to prevent constipation.
- Avoid Heavy Lifting: Refrain from heavy lifting (> 5 kg) for 4 to 6 weeks.
Frequently Asked Questions
How long is the catheter needed after TURP?⌄
The urinary catheter is typically kept for 1 to 3 days to drain urine and flush out any small blood clots.
What is retrograde ejaculation?⌄
Retrograde ejaculation ('dry orgasm') is when semen enters the bladder during ejaculation. It is harmless, occurs in 65%-75% of TURP patients, but causes male infertility.
Will TURP affect erectile function?⌄
Permanent erectile dysfunction after TURP is rare (2%-5%) because the nerves controlling erections lie outside the prostate.
When can I return to work?⌄
Most patients can return to desk jobs within 1 to 2 weeks after catheter removal.
Is incontinence common after TURP?⌄
Permanent incontinence is rare (< 2%). Temporary urgency or light leakage resolves as muscles heal.