Transurethral resection of the prostate (TURP): procedure, recovery and risks

The prostate is a gland about the size of a walnut that sits under the bladder and surrounds the urethra, the tube that carries pee out of the body. It makes the white fluid that mixes with sperm to form semen. When it grows larger, as it often does with age, it can squeeze the urethra and make peeing difficult.

The NHS explains that TURP is done to help you pee more easily. It may be recommended if the prostate has grown large enough to put pressure on the bladder or the urethra. It may also be used when someone has prostate cancer. The NHS says it can help if you need to pee often, feel you still need to pee after going, take a long time to pee or stop and start, or have pee leaking.

Because an enlarged prostate is very common and is not caused by prostate cancer, the NHS stresses that it does not always need treatment. TURP sits near the end of a ladder of options that starts with lifestyle advice and medicines.

The NHS says that if symptoms are not causing many problems, doctors usually recommend lifestyle changes first. These include cutting down on alcohol and caffeine, reducing how much you drink before bed or going out (while drinking enough during the rest of the day), eating enough fibre to prevent constipation, keeping to a healthy weight, waiting a moment after you pee and trying again, and not straining. A doctor or pharmacist can also check whether medicines taken for other conditions are making things worse.

If symptoms are moderate or severe, medicines may be offered. The NHS lists tamsulosin, doxazosin or alfuzosin to help you pee, oxybutynin or tolterodine for needing to pee more often or urgently, and finasteride or dutasteride to help stop the prostate growing in people at high risk of the condition getting worse. Bladder training, pelvic floor exercises and products such as pads can also help with symptoms.

Surgery comes into the picture if medicines have not helped or symptoms are severe. A doctor will usually discuss the choices with you, and NHS England has a decision support tool that the NHS page points to.

TURP is done in hospital. The NHS says you may have a general anaesthetic, where you are asleep, or a spinal anaesthetic, where you are numb from the waist down and will not feel any pain, and a doctor will explain which is best for you.

A long, thin tube containing a camera and other tools is passed into the penis and up to the prostate. The surgeon uses it to remove small pieces of prostate. The operation can take around an hour, depending on how much needs to be removed. The NHS says there is no need for stitches or dressings afterwards.

A catheter is put in to help empty the bladder so you do not have to pee straight after the operation. A small sample of prostate may be sent to a laboratory to check for things such as cancer. After the operation you spend time in the recovery room and receive medicine to help with pain and swelling.

The NHS says that after the operation you might see blood mixed with pee in the catheter bag for a few days, need the catheter flushed, and feel sore in and around the area. When the catheter comes out you may need to pee often for a few days, it might burn and there may be a bit of blood. You might not be able to control your pee at first. These problems should get better as you recover.

If it is painful or difficult to pee when the catheter is removed, the NHS says you may need a new catheter put in before you go home. After you leave hospital, a district nurse can help with the catheter and remove it after a few days.

There is a chance of blood in the pee again 10 to 14 days after the operation. The NHS says this is part of the recovery process, but it also lists specific warning signs described below.

Most people leave hospital between 1 and 4 days after TURP, according to the NHS. You may be able to do your usual activities around 2 to 4 weeks later, although it can take up to 6 weeks to heal fully.

• Drink plenty of fluid for the first few days to reduce the chance of a bladder infection.

• Take pain relief when you need it, and any antibiotics you are given.

• Start pelvic floor exercises as soon as you can to help regain bladder control; the NHS points to a British Association of Urological Surgeons leaflet on these.

• Do not lift very heavy things or do intense exercise for around 6 weeks.

Not everyone has complications, and your doctor should discuss the chances with you beforehand. The NHS lists these among the problems that can happen: still having problems peeing, heavy bleeding during or straight after the operation, difficulty getting or keeping an erection, permanently being unable to control when you pee (urinary incontinence) and always needing a catheter, needing TURP again if the prostate regrows, and problems with fertility.

The fertility point is specific: the NHS says you may have no semen when you ejaculate, although sex will still feel the same. If you plan to have children, raise this before surgery.

There is also a chance that prostate cancer or bladder cancer is found, either during the operation or later when the removed tissue is tested. If that happens, your doctor will talk to you about the next steps.

The NHS advises asking for an urgent GP appointment or getting help from NHS 111 if you have recently had TURP and you have a high temperature or feel hot, cold or shivery, suddenly cannot pee, are bleeding from your penis, have blood in your pee that looks like small blobs of jelly, or your penis is swollen or red (redness can be harder to see on brown and black skin).

If you cannot pee at all, or you feel seriously unwell, do not wait for a routine appointment. Make sure you know which number to call from the ward or your discharge paperwork, and keep it with you for the first few weeks.

The NHS says that if TURP is not right for you there are other options. These include lifestyle measures and medicines, and also procedures that make the prostate smaller or widen the urethra so you can pee more easily. Examples named on the NHS enlarged prostate page include removing or destroying part of the prostate using lasers, an electrical current, steam or a jet of water, holding part of the prostate open with a small implant, and making small cuts in the prostate near the bladder opening.

The NHS says some of these procedures have a shorter recovery time and fewer side effects than TURP, but not all are available on the NHS, and not all are suitable for everyone. The surgeon should explain the options, risks and benefits for your situation. The British Association of Urological Surgeons and Prostate Matters are the organisations the NHS points to for more detail.

On the NHS, TURP is usually arranged after a GP assessment, tests such as a urine sample and PSA blood test, and a specialist urology assessment. The NHS says tests might include a urine flow test, a bladder ultrasound or a cystoscopy.

Some people use private urology services to be seen or treated sooner, or to access newer procedures that are not offered everywhere on the NHS. The underlying assessment is similar either way. Whichever route you choose, ask which procedure is being proposed and why, what the realistic benefits and risks are for you and who you should contact if problems occur after discharge.