132 - Transurethral resection of the prostate (TURP)

Summary

Transurethral resection of the prostate (TURP) is considered the gold standard surgical treatment for benign prostatic hyperplasia (BPH) throughout the world. In the 1986 National Health Survey, 96% of patients undergoing prostate surgery for BPH had TURP. It was estimated that 350 000 Medicare patients had a TURP that year. During the last 5 years, the number of these procedures performed has decreased to less than 150 000 per year (Medicare data) because of the increasing number of patients managed by watchful waiting, medical therapy, and minimally invasive thermal therapy.

TURP is the treatment of choice in patients with moderate to severe BPH symptoms and significant compromise to their quality of life who fail or are unable to tolerate other forms of management, are in urinary retention thought to be secondary to BPH, have recurrent urinary infection secondary to BPH, have bladder stones secondary to BPH, have renal failure secondary to BPH, or have recurrent bleeding (gross hematuria) secondary to BPH.

Spinal or general anesthesia can be used for the procedure, though the former is the preferred method since it permits closer intraoperative monitoring of the patient and allows for easier postoperative recovery. The patient is placed in dorso-lithotomy position. The urologist uses a specially designed cystoscopic instrument (resectoscope) to perform the procedure under direct vision. The resectoscope has an energy-active (radiofrequency) metal loop that is used to resect the obstructing prostatic tissue into small chips (1/2 to 1 gram).