TRANSURETHRAL PROSTATECTOMY (TURP)

What is a TURP?

As the prostate enlarges, it gradually squeezes the urethra tighter, eventually allowing only a small opening for the urine to pass through.This condition is known as Benign prostatic hyperplasia. A Transurethral Prostatectomy (TURP) is a surgical procedure that widens the urethral channel by removing prostate tissue from the middle of the gland. The process could be likened to removing the core of an apple, leaving behind the surrounding pulp and skin.

What is Benign Prostatic Hyperplasia (BPH) ?

Benign prostatic hyperplasia (BPH) is a histological condition that is encountered in most aging men. "Prostatism" has traditionally been used to describe a variety of symptoms attributable to BPH.

Symptoms of BHP
consist of the irritative symptoms of dysuria, frequency, urgency and nocturia, and the obstructive voiding symptoms of slow stream, hesitancy, intermittency, straining to void, sense of incomplete emptying, terminal and postvoid dribbling

what causes BHP?
Aging and androgen remain the only established etiologic factors for BPH.

BPH Treatment Options

• * Watchful waiting: A strategy of management in which the patient is monitored but receives no active treatment.
  * Alpha blocker therapy: Treatment using alpha-1-adrenergic receptor blockers that inhibit contraction of prostatic smooth muscle.
  * Finasteride therapy: Treatment using finasteride, an enzyme inhibitor that lowers prostatic androgen levels and can result in some decrease of prostate size.
  * Balloon dilation: A catheter with a balloon at the end is inserted through the urethra and into the prostatic urethra. The balloon is then inflated to stretch the urethra where narrowed by the prostate.
  * Transurethral incision of the prostate (TUIP): An endoscopic surgical procedure in which patients with smaller prostates (<30 g) have an instrument inserted through the urethra to make one or two cuts in the prostate and reduce the constriction on the urethra.
  * Transurethral resection of the prostate (TURP): Surgical removal of the prostate's inner portion by endoscopic approach through the urethra. This is the most common active treatment.
  * Open prostatectomy: Surgical removal of the prostate via an incision in the lower abdomen. It usually requires a longer hospital stay

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Prostatectomy

Prostatectomy is the surgical removal of the prostate.

Procedures

TURP
Transurethral resection of the prostate is the gold standard treatment and most common surgical procedure for benign prostatic hyperplasia (BPH). TURP is performed using spinal or general anesthesia. A special kind of cystoscope (tubelike instrument) is inserted into the penis through the urethra to reach the prostate gland.

A special cutting instrument is inserted through the cystoscope to remove the prostate gland piece by piece. Blood vessels are cauterized (using heat to stop the bleeding) with electric current during the surgery.

A Foley catheter (artificial tube to remove urine from the body) is placed to help drain the bladder after surgery. The urine will initially appear very bloody, but will clear with time.

A bladder irrigation solution may be attached to the catheter to continuously flush the catheter, thus keeping it from becoming clogged with blood or tissue. The bleeding will gradually decrease, and the catheter will be removed within 1-3 days. You will remain in the hospital for 1 to 5 days.

However, it is difficult to remove a large prostate using TURP.

To perform an open prostatectomy (sometimes called suprapubic or retropubic prostatectomy), an incision is made in the lower abdomen between the umbilicus (belly-button) and the penis through which the prostate gland is removed. This is a much more involved procedure and usually requires a longer hospitalization and recovery period.

A radical prostatectomy can be performed to remove the cancer from the prostate and from nearby areas where the cancer has spread. This type of surgery may help prevent further spread of the cancer

NEWER TECHNIQUES
Transurethral laser incision of the prostate (TULIP) and visual laser ablation (VLAP) are two newer procedures that use lasers to cut out or destroy the prostate tissue. These procedures are similar to the transurethral incision of the prostate (TUIP). Laser is being evaluated for use in removal of prostatic tissue because of the ability to easily control bleeding and decrease the amount of time required for healing.

Indications:

• Prostate removal may be recommended for:
  -- inability to completely empty the bladder (urinary retention)
  -- recurrent bleeding from the prostate
  -- bladder stones (calculi) with prostate enlargement
  -- extremely slow urination
  -- stage A and B prostate cancer
  -- increased pressure on the ureters and kidneys (hydronephrosis) from urinary retention
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• Prostate surgery is not recommended for men who have:
  # blood clotting disorders
  # bladder disease (neurogenic bladder)

Risks:

• Risks for any anesthesia are:
  > reactions to medications
  > problems breathing
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• Risks for any surgery are:
  > bleeding
  > infection
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• Additional risks include:
  > problems with urine control (incontinence)
  > difficulty achieving and maintaining an erection (impotence)
  > loss of sperm fertility (infertility)
  > passing the semen into the bladder instead of out through the urethra (retrograde ejaculation)
  > urethral stricture (tightening of the urinary outlet)

Expectations after surgery:

TURP is typically successful at removing the symptoms of an enlarged prostate, although some sources report that within 10 years, about 20% of the people will require another surgery to remove additional prostate tissue.