Rigi10™ Malleable Penile Prosthesis
Also Known As
Prostate resection, transurethral prostatic resection, TURP procedure, endoscopic prostatectomy
Definition
Transurethral resection of the prostate (TURP) is a minimally invasive surgical procedure where a section of the prostate gland is removed to alleviate urinary symptoms caused by benign prostatic hyperplasia (BPH), also known as an enlarged prostate.¹ It is performed by inserting a specialized instrument called a resectoscope through the urethra, eliminating the need for external incisions. The resectoscope is equipped with an electrically activated wire loop that cuts away obstructing prostate tissue and seals blood vessels to minimize bleeding.¹ The primary purpose of TURP is to improve urine flow, reduce lower urinary tract symptoms (LUTS) such as frequent urination, urgency, and weak stream, and enhance the patient’s quality of life when medical therapies have failed or are not suitable.¹ It has long been considered the gold standard for treating bladder outlet obstruction due to BPH, though newer techniques are also available.¹
Clinical Context
TURP is clinically indicated for patients experiencing moderate to severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) who have not responded adequately to medical management or prefer surgical intervention.¹ It is also used in cases of complications arising from BPH, such as recurrent urinary retention, recurrent urinary tract infections, recurrent gross hematuria, bladder stones, or renal insufficiency due to bladder outlet obstruction.¹ Patient selection criteria typically involve a thorough evaluation including a detailed medical history, physical examination (including a digital rectal exam), urinalysis, and often uroflowmetry and post-void residual volume measurement to assess the severity of obstruction and bladder function.¹ The American Urological Association (AUA) guidelines recommend an evaluation of prostate size and shape before surgery, which can be done via cystoscopy, transrectal ultrasound, CT, or MRI.¹
The surgical procedure is usually performed under general or spinal anesthesia. The surgeon inserts a resectoscope through the urethra to the prostate. Using the wire loop, prostatic tissue is removed piece by piece, creating a wider channel for urine to flow. Irrigation fluid is used throughout the procedure to maintain a clear view and flush away resected tissue and blood clots.¹ Both monopolar and bipolar TURP techniques exist, with bipolar TURP allowing the use of saline irrigation, which reduces the risk of TUR syndrome (dilutional hyponatremia).¹
Expected outcomes are generally favorable, with a significant improvement in urinary symptoms and flow rates reported by a majority of patients. Approximately 90% of patients indicate resolution or significant improvement in their urinary symptoms after TURP, with an average reported degree of improvement of 85%.¹ Urinary flow rates typically increase substantially, and bladder instability often decreases. Recovery involves a short hospital stay, typically with a urinary catheter in place for a day or two. Full recovery and return to normal activities may take several weeks. Potential complications include bleeding, infection, retrograde ejaculation (common), erectile dysfunction (rare), urinary incontinence (rare and often temporary), urethral strictures, and TUR syndrome (rare with modern techniques, especially bipolar TURP).¹