Transurethral Prostate Resection: Treatment, Effects & Risks

Transurethral prostate resection is the name given to a surgical procedure in urology. It involves the removal of diseased tissue from the male prostate gland.

What is transurethral prostate resection?

Transurethral prostate resection is the name given to a surgical procedure performed in urology. It involves the removal of diseased tissue from the male prostate gland. Transurethral prostate resection (TURP) is a urological surgical method. During the procedure, the surgeon removes prostate tissue that has undergone pathological changes from the male prostate gland without making an external incision through the urethra. The method is also called prostate resection, transurethral resection of the prostate or transurethral prostatectomy. It is one of the minimally invasive surgical procedures. This means that a resectoscope, a special endoscope, is used and the pathological tissue is removed with a wire snare. The foundation for performing transurethral prostate resection was laid in 1879 by the German urologist Maximilian Nitze (1848-1906) with the introduction of cystoscopes with electric illumination. Later, he also created surgical cystoscopes as well as cauterization when ablating tumors of the urinary bladder. Among the predecessors of transurethral prostate resection was the transurethral punch resection of the prostate gland, developed in 1909. In 1926, Max Stern mixed the punching instrument with a cystoscope and a wire loop. In this way, the prototype of the resectoscope was created. After Joseph McCarthy made some improvements in 1931, the medical instrument became known as the Stern-McCarthy resectoscope.

Function, effect, and objectives

In medicine, a distinction is made between transurethral prostatic resection as well as transurethral urinary bladder resection (TURB). TURB is used to treat superficial bladder cancers, while TURP removes obstructions that prevent urine from flowing through the prostate gland. In this procedure, the physician removes only the inner prostate portion that goes toward the urethra. The organ capsule, outer prostate tissue, urethral sphincter and seminal mound, on the other hand, are largely spared. Transurethral prostate resection is now one of the proven standard procedures for removing obstructions to outflow due to prostate enlargement. Transurethral prostate resection is performed for benign hyperplasia of the prostate gland. The method is considered particularly suitable when the volume of glandular tissue is less than 100 milliliters. The most common indications include recurrent urinary tract infections, repeated urinary retention, urinary stones (uroliths), significant dilatation of the upper urinary tract, and macrohematuria that cannot be effectively treated with medication. Relative indications include acquired or previously congenital diverticula of the urinary bladder, residual urine greater than 100 milliliters after bladder emptying, or allergy to conservative treatment. TURP always takes place in benign enlargement of the prostate only when the administration of drugs for treatment is not sufficient. Before a transurethral prostate resection is performed, the patient must temporarily discontinue certain medications to counteract complications. These are blood-thinning drugs such as Marcumar or acetylsalicylic acid (ASA) and antidiabetic drugs such as metformin. These drugs increase the risk of bleeding or metabolic acidosis. In addition, a urinary tract infection must be ruled out in advance. The anesthesia of the patient during a TURP usually takes the form of a peridural or spinal anesthesia. If necessary, intubation anesthesia may also be used. At the beginning of the transurethral prostate resection, the surgeon inserts a permanent irrigation resectoscope into the prostate via the urethra. During the removal of the tissue, continuous irrigation takes place. The tissue is removed with the help of a high-frequency current loop. Furthermore, the snare precisely obliterates the injured vessels. Transurethral resection of the prostate can be performed both monopolar and bipolar.The monopolar method uses a saline-free solution, while the bipolar method uses a physiological saline solution as the irrigation solution. The safety profile of bipolar transurethral prostate resection is considered more favorable because the risk of bleeding is reduced. Following TURP, the patient’s bladder is permanently irrigated. This is to counteract possible complications. After about 48 hours, a bladder emptying check takes place. In most cases, transurethral prostate resection leads to success. Patients’ symptoms improve noticeably. For example, the amount of residual urine is significantly reduced after the procedure.

Risks, side effects, and hazards

There are a number of complications that can occur during TURP. First and foremost, these include postoperative bleeding. However, these usually regulate themselves. If this is not the case, surgical post-coagulation must take place. A late complication is urinary incontinence, which results from scarring of the urethra or muscular damage. Also in the realm of possibility are retrograde ejaculations, in which the semen is pushed toward the urinary bladder, and TUR syndrome. TUR stands for hypotonic hyperdration. This refers to a disturbance of the water-electrolyte balance in which the water content in the body increases abnormally. TUR syndrome is characterized by high blood pressure, circulatory problems, chest pain and decreased urine output. It may also present with headache, nausea, vomiting, visual disturbances, fatigue, impaired consciousness, and confusion. However, TUR syndrome rarely occurs in modern times. Other conceivable complications include erectile dysfunction. There are also some contraindications to TURP. For example, if there is an exceptionally large adenoma whose volume exceeds 75 milliliters, it is better to perform an adenomectomy instead of transurethral prostate resection. The same applies to urinary bladder stones, urinary bladder diverticula and complex diseases of the urethra that require surgery. Other possible contraindications include acute or chronic urinary tract infections and blood clotting disorders.