Written by Mr Jai Seth, BSc(Hons) MBBS MRCS MSc(Urol) MD(Res) FRCS(Urol)
Consultant Urological Surgeon · Last updated:
In short
- Treats
- An enlarged prostate of moderate size, typically 30 to 80 g
- Who it suits
- Men whose medication has not worked, or with a complication of obstruction
- Anaesthetic and stay
- General or spinal; one to three nights in hospital
- Operating time
- About 45 to 60 minutes; longer for larger prostates
- Back to normal
- Two to four weeks before heavy lifting or strenuous exercise
- Sex afterwards
- Erections and orgasm are usually unaffected; semen is no longer released in about two men in three to three in four
- Where
- Privately at Nuffield Health Parkside, Wimbledon
- Right for you?
- Depends on prostate size, your general health, and how you feel about the change to ejaculation
Mr Seth uses the bipolar variant of TURP, which employs saline irrigation rather than the older glycine. This change, adopted as the modern standard across UK urology, reduces the risk of one of the rarer but more serious historical complications of TURP (dilutional hyponatraemia, sometimes called TUR syndrome).
Who is it suitable for?
- Medication has not adequately controlled urinary symptoms.
- The prostate is of moderate size, typically 30 to 80 grams, though larger or smaller prostates can also be treated with care.
- There is a clear obstructive pattern on urodynamic or flow testing.
- You want a durable, established surgical solution rather than a minimally invasive option.
- There is a complication of BPH driving the decision: recurrent urinary tract infection, recurrent retention requiring catheterisation, bladder stones, or progressive kidney impairment from obstruction.
- TURP is generally not the right answer when symptoms are very mild and not affecting daily life, when the prostate is very large (over 100 grams, where HoLEP is usually preferable), when preserving antegrade ejaculation is a priority (where UroLift or Rezum may be better suited), or where anaesthetic risk is high and medical management remains tolerable.
How does it work?
- TURP is performed under general or spinal anaesthetic. A telescope (resectoscope) is passed up the urethra into the prostate.
- Through this telescope, a thin wire loop carrying bipolar electrical energy is used to cut, vaporise and seal the obstructing prostate tissue in small pieces.
- The pieces are flushed out through the resectoscope at the end of the procedure and sent to the pathology laboratory for examination.
- The body of the prostate, the outer capsule that contains the gland, is left in place. What is removed is the inner adenoma, the part that has grown over time and has been compressing the urethra.
- A catheter is left in the bladder at the end of the procedure to allow drainage while the prostate bed heals.
- The procedure takes about 45 to 60 minutes on average (BAUS leaflet), longer for larger prostates.
What to expect
Before the procedure
- Pre-operative assessment confirms fitness for anaesthesia. This involves routine blood tests, an ECG if indicated, and a discussion of any blood-thinning medication you take.
- Antibiotics are given immediately before surgery to reduce the risk of urinary tract infection.
- Anti-coagulant management. Most blood thinners need to be paused for a period before TURP; the precise plan is individualised. Do not change anticoagulant medication without specific instructions from the surgical team.
- No food for six hours, and no clear fluids for two hours before the anaesthetic, per standard pre-operative fasting guidance.
On the day
- Admission is typically a few hours before the operation. The procedure itself lasts around an hour for most prostates.
- You will wake with a urinary catheter in place, which usually drains pink-tinged irrigation fluid for the first 12 to 24 hours.
- The hospital stay is one to three nights (BAUS); in some units it is a day case. The catheter comes out between one day and a week after surgery, and discharge follows once you have shown you can pass urine adequately on your own.
Recovery and aftercare
- Pink urine for one to two weeks is normal. Drink plenty of water; the urine clears gradually.
- A burning sensation when passing urine for a few days is typical as the prostate bed heals.
- Around one man in five has a further bleed 10 to 14 days after getting home as the scabs in the prostate cavity separate; more fluid usually settles it, and if not the GP may prescribe antibiotics (BAUS). Heavy bleeding, clots or suddenly being unable to pass urine need same-day medical attention.
- Some urgency, frequency and leakage in the first weeks are common. BAUS says overactive-bladder symptoms can take up to three months to settle, whereas flow improves immediately, and pelvic floor exercises help control return. Symptoms persisting beyond that are reviewed.
- Avoid heavy lifting, strenuous exercise, and prolonged driving for two to four weeks.
- Return to sexual activity is usually possible after two to four weeks, when comfort permits.
- Most men need two to three weeks at home before they feel ready for work; BAUS recommends three to four weeks for physically demanding jobs, with no heavy lifting during recovery.
- Follow-up is typically at six weeks, with a flow test and a check of symptom score (IPSS).
Outcomes and evidence
- TURP has been the surgical comparator for benign prostatic obstruction for over fifty years. The bipolar variant, with saline irrigation, is now the standard and produces functional outcomes equivalent to the older monopolar technique, with a substantially reduced risk of TUR syndrome.
- Across published series, the great majority of men experience a meaningful improvement in flow rate and symptom score after TURP. Symptom-score improvements are typically in the order of 60 to 70 per cent from baseline; flow rate improvements are similar.
- BAUS puts the chance of a repeat operation because the prostate regrows at between 1 in 10 and 1 in 50. In a national analysis of 23,123 men, 7.4% had a second TURP within eight years and 14.7% had some further procedure on the prostate, bladder neck or urethra (Madersbacher et al., European Urology 2005); the rate is higher than after HoLEP and lower than after UroLift or Rezum.
- Mr Seth contributed as a co-author to the CO-STAR feasibility trial (Wong K, Kinsella N, Seth J, et al., BMJ Open 2023), which set out a protocol for comparing UroLift and standard TURP ahead of radiotherapy in men with urinary symptoms secondary to prostate enlargement, across the South-West London and North Cumbria NHS catchments.
Risks and complications
- Common (1 in 10 or more): Retrograde ejaculation. Erections and the sensation of orgasm are preserved; what changes is that semen passes backwards into the bladder during orgasm, so visible ejaculation is reduced or absent. This affects between two in three and three in four men after TURP (BAUS) and is permanent. Mild urinary urgency or frequency in the first weeks, which usually settles. Mild bleeding in the urine for one to two weeks. Treatment not relieving all symptoms, in between 1 in 2 and 1 in 10 (BAUS), usually because the bladder muscle rather than the prostate was the main problem.
- Less common (1 in 10 to 1 in 50, BAUS bands): Urinary tract infection requiring antibiotics. Temporary need to recatheterise after the initial catheter removal, usually because of bladder muscle weakness, not incomplete resection. Poor erections in men whose erections were previously normal. Bleeding needing a transfusion or a return to theatre. Urethral stricture, a narrowing from scar tissue, or scarring at the bladder neck. Loss of urinary control, which may be temporary or permanent. A repeat operation later because the prostate regrows. Unsuspected cancer found in the removed tissue, which may need further treatment.
- Rare (1 in 50 to 1 in 250): Irrigation fluid entering the bloodstream and causing confusion or heart problems (TUR syndrome), largely eliminated by the bipolar saline-irrigation technique. Anaesthetic or cardiovascular complications, which depend on your general health; the anaesthetist estimates your individual risk.
- Set against these, most men get good relief of their symptoms (BAUS), roughly nine in ten need no second TURP within eight years (Madersbacher et al., 2005), and the saline-based technique has largely removed the fluid-absorption problem that was TURP's most serious historical complication.
- Your own risk depends on prostate size (larger glands mean a longer resection), your general health (which sets the anaesthetic and cardiovascular risk), whether you take blood thinners and for what reason, and whether the bladder muscle is strong enough to empty once the obstruction is gone. Mr Seth goes through the figures that apply to you at the pre-operative consultation.
How does it compare to alternatives?
HoLEP
Removes the obstructing tissue more completely via laser enucleation. Lower retreatment rate. Suitable for any prostate size including very large glands. Recovery profile similar to TURP.
UroLift
Implant-based, preserves antegrade ejaculation in most men, no tissue removed. Suitable for smaller-to-moderate prostates without a substantial median lobe. Higher retreatment rate than TURP at 5 years.
Rezum
Water-vapour therapy, preserves antegrade ejaculation in most men, outpatient procedure. Suitable for moderate prostates. Effect develops over weeks to months.
Aquablation
High-pressure water jet under ultrasound guidance, a relatively newer technique. Suitable for moderate-to-large prostates.
Mr Seth's published research
See all publications.
Further reading
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Private appointments available at Nuffield Health Parkside Hospital, Wimbledon, and other consulting locations across London.
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