Written by Mr Jai Seth, BSc(Hons) MBBS MRCS MSc(Urol) MD(Res) FRCS(Urol)
Consultant Urological Surgeon · Medically reviewed:
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). For most men, the bipolar technique means a procedure that is functionally equivalent to traditional TURP in outcome, with a safer fluid-handling profile.
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 typically takes 45 to 90 minutes depending on prostate size.
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 under 90 minutes 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.
- Most men stay one night in hospital. Discharge is once the catheter is out and you have demonstrated that you can pass urine adequately on your own — usually the day after surgery, sometimes two days.
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.
- Some urgency, frequency and occasional leakage for the first weeks can occur. These usually settle as the bladder accommodates to the new pressure landscape; persistent symptoms beyond six weeks should be 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.
- 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 — saline-based irrigation, the modern standard — 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.
- Retreatment rates at 10 years are in the order of 10 to 15 per cent — higher than HoLEP, lower than minimally invasive alternatives like UroLift and 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. The trial illustrates how decisions between TURP and minimally invasive alternatives are increasingly being studied in the specific patient populations where the choice matters most.
Risks and complications
- Common (1 in 10 or more): Retrograde ejaculation — semen passes backwards into the bladder during orgasm rather than externally. The sensation of orgasm is preserved, but visible ejaculation is reduced or absent. This affects most men after TURP 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.
- Less common (1 in 10 to 1 in 50): Urinary tract infection requiring antibiotics. Temporary need to recatheterise after the initial catheter removal — usually because of bladder muscle weakness, not because of incomplete resection. Erectile dysfunction is uncommon and where it occurs is often related to underlying cardiovascular health rather than the surgery itself.
- Rare (less than 1 in 50): Significant bleeding requiring transfusion. Urethral stricture — narrowing of the urethra from healing scar. Bladder neck contracture — scarring at the bladder neck. Urinary incontinence persisting beyond the early recovery — uncommon and usually treatable. TUR syndrome (dilutional hyponatraemia) is largely eliminated by the bipolar saline-irrigation technique.
- Individual risk depends on prostate size, general health, anticoagulant status, and the technical specifics of the operation. Mr Seth will discuss the risk profile relevant to your situation as part of 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
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Private appointments available at Nuffield Health Parkside Hospital, Wimbledon, and other consulting locations across London.
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