By Pratik Desai MD
A TURP stands for, TransUrethral Resection of the Prostate.This is a surgical procedure done under anesthesia where a telescope is inserted into the urethra then advanced into the bladder. There is an element in that scope that is then used to shave down or resect the blocking tissue of the prostate. Once the resection is done the chips that are shaved off the prostate are then soaked, and any bleeding is cauterized with the instrument. This procedure has been done for many decades in a similar fashion. There have been advances in this technique: such as the use of bipolar energy, and the reduction in some surgical risks, however, there are some invasive and permanent changes that may happen after this procedure. Those mainly are sexual in nature which includes the reduction in the amount of ejaculation that may come out, a reduction in the intensity of an orgasm, and potentially reducing some of the pleasure of the sexual experience. Some of the other risks of this procedure are bleeding, and the need of an overnight stay in the hospital with a catheter, the potential for scar tissue formation in the urethra or in the area of the bladder resection. There may also be a need for repeat procedures in the future if there is regrowth of tissue or an incomplete resection. Another risk includes urinary leakage which can happen in a very small percentage of men.
While a TURP has been done for a long time and has been the cornerstone of our therapy for an enlarged prostate, in the last decade our available treatment options that overlap or replace a TURP have grown by three to five fold. We have no less than half a dozen good procedures that may replace a TURP for certain patients. Those range from minimally invasive office procedures like a UroLift or Rezum, and may involve minimally invasive vascular procedures like a Prostate Artery Embolization (PAE). In some cases this may include a robotic Aquablation, and in very large prostates it may involve a holmium laser enucleation of the prostate. A discussion after a full evaluation by the doctor can help one choose the option that is best with a specific emphasis on getting a good outcome with the least invasive procedure, and reduction in side effects.