Understanding the Prostate
The prostate is a small gland that forms part of the male urinary and reproductive system. Located just below the bladder and surrounding the urethra, it produces fluid that nourishes and protects sperm.
As men age, the prostate commonly enlarges, a condition known as Benign Prostatic Hyperplasia (BPH). Although non-cancerous, an enlarged prostate can compress the urethra and interfere with normal urinary flow.
Common symptoms include:
- Frequent urination
- Difficulty starting urination
- A weak or interrupted urine stream
- Waking at night to pass urine (nocturia)
- A feeling of incomplete bladder emptying
- Urgency or leakage of urine
If left untreated, significant prostate enlargement may lead to urinary retention, recurrent urinary tract infections, bladder stones, bladder damage, or, in severe cases, kidney impairment.
When is Surgery Recommended?
Many men experience significant improvement with medication, including alpha-blockers or 5-alpha reductase inhibitors.
Surgery may be recommended when:
- Symptoms remain bothersome despite medication
- You are unable to empty your bladder properly
- You experience recurrent urinary retention
- Bladder stones have developed
- Recurrent urinary tract infections occur
- There is evidence of bladder or kidney damage caused by obstruction
Your urologist will recommend the most appropriate procedure based on the size of your prostate, your symptoms, and your overall health.
Surgical Treatment Options
Several procedures are available to relieve obstruction caused by an enlarged prostate, including:
- Transurethral Resection of the Prostate (TURP) – the traditional “gold standard” treatment for many men.
- Transurethral Laser Enucleation of the Prostate (TULEP/HoLEP, where appropriate) – a minimally invasive procedure particularly suited to larger prostates.
- Open or robotic simple prostatectomy for selected patients with very large prostates (less commonly required).
If bladder stones are present, they can often be treated during the same operation.
What Happens During a TURP?
A TURP is performed without any external incisions.
Using a specialised telescope inserted through the urethra, your urologist removes the enlarged prostate tissue that is obstructing the flow of urine.
The procedure is commonly performed under spinal or general anaesthetic.
During your hospital stay:
- Antibiotics may be administered to reduce the risk of infection.
- A urinary catheter is placed at the end of the procedure.
- Continuous bladder irrigation is used to prevent blood clots from blocking the catheter.
- Most patients remain in hospital for 1-3 days, depending on their recovery.
As with any prostate surgery, some bleeding during and shortly after the procedure is expected. Blood transfusions are rarely required.
Recovery After Surgery
Most men notice a significant improvement in urinary flow once healing is complete.
During the first few weeks, it is normal to experience:
- Mild burning when passing urine
- Increased urinary frequency or urgency
- Small amounts of blood in the urine
- Temporary discomfort around the bladder or urethra
These symptoms usually improve gradually as the prostate heals.
To support recovery:
- Drink plenty of water unless otherwise advised.
- Avoid heavy lifting and strenuous exercise for several weeks.
- Take prescribed medications as directed.
- Attend your scheduled follow-up appointments.
Possible Risks and Complications
TURP is a safe and well-established procedure, but as with any surgery, complications can occur.
These may include:
- Bleeding
- Urinary tract infection
- Temporary difficulty passing urine requiring reinsertion of a catheter
- Epididymitis (infection or inflammation of the epididymis)
- Temporary urinary urgency or frequency during healing
- Narrowing of the urethra or bladder neck (less common)
- Urinary incontinence (uncommon)
- Erectile dysfunction (uncommon)
Your urologist will discuss these risks with you before surgery.
Sexual Function After TURP
One of the most common long-term effects of TURP is retrograde ejaculation.
This means semen passes backwards into the bladder during orgasm rather than exiting through the penis. Although this does not affect sexual pleasure or the ability to achieve an erection in most men, it can reduce fertility.
If you are planning to have children in the future, discuss this with your urologist before surgery.
Laboratory Analysis
The prostate tissue removed during surgery is routinely sent for laboratory analysis (histology).
Although TURP is performed to treat benign enlargement of the prostate, this examination occasionally identifies previously undiagnosed prostate cancer. If any unexpected findings are present, your urologist will discuss the results and any further treatment or investigations that may be be required.
Follow-Up Care
A follow-up appointment will be arranged to monitor your recovery and assess your urinary function.
Depending on your individual circumstances, this may include:
- Urine flow testing
- Ultrasound assessment of bladder emptying
- PSA monitoring where appropriate
- Ongoing review of your urinary symptoms
Your urologist will ensure your recovery is progressing as expected and advise you on any further treatment if required.
