TURP - Transurethral Resection of the Prostate
Transurethral Resection of the Prostate (TURP) is a procedure to remove excessive growth of the prostate gland, resulting from Benign Prostatic Hyperplasia (BPH). The prostate gland plays an essential role in the functioning of the male reproductive system, secreting fluid into the urethra during ejaculation. It surrounds the urethra and is located immediately below the neck of the urinary bladder.
What is Benign Prostatic Hyperplasia?
BPH is when the prostate gland enlarges until it squeezes the urethra and eventually prevents the smooth, even flow of urine. It is believed to be caused by hormonal changes as a result of aging and a family history. It's one of the most common diseases of men over 55 and the primary condition treated by urologists. Statistics indicate that nearly 50% of men will develop an enlarged prostate gland by age 50 and 75% of men by age 80. Some symptoms of BPH are frequent urination, especially at night, hesitant and intermittent flow, dribbling, and a feeling the bladder is not emptied. It's important to consult a doctor with these symptoms because untreated BPH can result in damage to the urogenital organs. BPH does not develop into, nor does it indicate a predisposition to prostate cancer. However, it is not curable and the gland will continue to enlarge.
Treatment for BPH
For most men, the first level of treatment is medication to reduce the restriction on the urethra by relaxing the prostate muscles or shrinking the gland. The next level of treatment involves procedures performed in a physician's office using microwave or radio frequency waves to destroy tissue. If symptoms persist, a variety of surgical and non-surgical interventions are available. There are two generalized types of intervention, invasive and minimally-invasive, the difference being whether or not there is an incision.
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What is Transurethral Resection of the Prostate?
Transurethral resection of the prostate (TURP) is an invasive procedure to remove the overgrowth of prostate tissue. Despite the more recent development of less invasive treatments, TURP is still considered the "gold standard" and preferred treatment for BPH. It is performed by a urologist in a hospital under general anesthesia or spinal anesthesia coupled with a sedative. A resectoscope (an instrument much like a cystoscope with the advantages of a microscope, light, irrigation capability, and a wire loop) or a spring action cutting tool, is inserted into the urethra to access the enlarged gland. The electricity generated through the cutting tool removes small pieces of tissue until the urethra is no longer restricted. To control bleeding, the vessels are cauterized by the wire loop and the bladder and urethra are irrigated with a saline solution. A urinary catheter is put in for the purpose of resting the bladder and prostate, keeping the urethra open if swelling develops, and to empty the bladder of blood to avoid clotting. The procedure takes about 90 minutes to two hours.
Commonly, there is a one-night hospital stay for observation and flushing of the catheter. Light bleeding will continue, presented in the urine and when the catheter is flushed out. The catheter will remain in for a few days to a week and must be flushed regularly by the patient after discharge; instructions on how to do this are given while in the hospital.
After discharge, precautions are recommended for the purpose of healing, comfort, and preventing damage to the treated area. Patients will require rest and should drink large quantities of water to flush out the bladder to prevent a urinary tract infection. No straining, lifting or pushing heavy items should occur. A significant improvement in recovery is seen after the catheter has been removed and, while some of the pre-operative symptoms may continue, they will slowly decrease over a period of two to eight weeks. Complete reversal of all prior symptoms may take several months.
Sexual function returns for most men but the doctor may advise against ejaculation for up to two months. While the ability to orgasm is unaffected by TURP, your ejaculate may no longer exit through the penis. This occurs if the valve to the bladder, which controls the direction of semen, is damaged during the procedure.
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The Benefits of TURP
Recent technological advances to reduce the invasive aspect of surgical treatments of BPH offer some very desirable options, such as lasers, microwave, radio waves, and ultrasound. A new and promising laser procedure, GreenLight Laser PVP - photoselective vaporization of the prostate - has been demonstrated to remove prostate gland overgrowths using pulses of light with nearly no bleeding, less catheterization, and a greatly reduced recovery time.
TURP has several advantages over the newer technologies. It's an option for men with other health problems which make the newer procedures inadvisable. If the prostate has grown too large they may not be effective, and some may feel more comfortable with surgery than an unfamiliar technology.
Additional advantages include:
- Visual, hands-on access to the prostate
- Immediate removal of excess tissue
- Can be coupled with other procedures, e.g., removing small bladder stones
- Longevity of use with supportive data on overall efficiency, safety, and success rates
- Traditionally taught in medical schools so doctors have extensive experience
Contact Dr. Samadi to learn more about TURP and other treatments for Benign Prostatic Hyperplasia
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