Bipolar Transurethral Resection of the Prostate (TURP) For Enlarged Prostate (BPH)
Transurethral Resection of the Prostate or TURP is a surgical procedure used to shrink the prostate by physically cutting away areas of excess prostatic cell growth (hyperplasia) in order to improve urinary function in men.
There was a time not too long ago where the Trans-Urethral Resection of the Prostate was the most commonly performed operation in America besides cataract operations. This was before the advent of alpha blockers and 5-alpha reductase inhibitors as medical therapy for benign prostatic hypertrophy (BPH). Now, patients with BPH symptoms that want to be treated, or must be treated due to a complication are usually treated by the surgeons at Urologic Surgeons of Washington in a stepwise fashion.
Scroll down to view operative video
First, medical therapy is introduced. The patient on his own may try herbal remedies such as saw palmetto. Symptoms do usually progress despite medical therapy, and at that point the patient may be offered a second medication or a minimally invasive office treatment such as TUNA or microwave. Some patients will not get adequate relief from an office treatment, recur early, or just want a procedure with a higher success rate and faster results.
Some patients have problems associated with their BPH which require more aggressive obstruction relief such as infections, bladder stones, severe urinary retention or even kidney failure. These patients are typically offered a TURP.
How The TURP Is Performed
The TURP itself has gone through several improvements over the years, brought on in large part by competitive pressure by lasers used for the same purpose such as the Greenlight laser, or Holmium laser (HOLAP). Now, a TURP is done via continuous flow, using bipolar electrical current. This allows the surgeon to use saline as an irrigant rather than water, and this has dramatically increased our ability to offer a bipolar TURP to patients with larger prostates allowing for longer resection times and far fewer complications. A bipolar TURP is the preferred OR procedure of the surgeons at Urologic Surgeons of Washington, with benefits that far outweigh those provided by the various laser vaporization systems currently marketed.
This video below represents an actual TURP procedure – Warning, Content is graphic
A bipolar TURP is typically now done under general anesthesia, lasts an hour to 1.5 hours, and will involve an overnight hospital stay.
TURP Recovery & Aftercare
There is little pain with a TURP. Blood in the urine is to be absolutely expected, and can occur for up to a month in a limited fashion. Although the catheter can be removed the next day, more typical is for the patient to be sent home with the urinary catheter for a few days. Dr. Engel has his patients take out their own catheters the night before seeing him in the office so that urinary retention can be ruled out. Dr. Losee prefers to take out the catheter in the office after filling the bladder with water.
The main reasons one may choose a minimally invasive office procedure is that a bipolar TURP must be done under anesthesia, requires a visit to the internist, has a nearly 100% retrograde ejaculation rate, and carries with it a 1% risk of post-operative incontinence. There are the usual risks of pain, infection of course, and bleeding as mentioned.
Offsetting these risks is a higher success rate (93%) and more immediate relief. The risks of a TURP are not very high, but since they are higher than an office procedure we usually consider it the procedure to turn to when other remedies have failed. Once done, it is extremely effective and patients usually consider their problem solved. It can take up to three months for the bladder to adjust to urinating without obstruction, which leads to less warning time to get to the bathroom after a TURP, but with time this should resolve.
Due to tissue regrowth patients, on average, will enjoy 7 years of relief with a bipolar TURP.