Transurethral Resection of th... Health Article

Definition

Transurethral resection of the prostate (TURP) is a surgical procedure by which portions of the prostate gland are removed through the urethra.

Purpose

The prostate is a gland that is part of the male reproductive system. It consists of three lobes, and surrounds the neck of the bladder and urethra (tube that channels urine from the bladder to the outside through the tip of the penis). The prostate weighs approximately one ounce (28 g), and is walnut-shaped. It is partly muscular and partly glandular, with ducts opening into the urethra. It secretes an antigen called prostate-specific antigen (PSA), and a slightly alkaline fluid that forms part of the seminal fluid (semen) that carries sperm.

A common prostate disorder is called benign prostatic hyperplasia (BPH) or benign prostatic enlargement (BPE). BPH is due to hormonal changes in the prostate, and is characterized by the enlargement or overgrowth of the gland as a result of an increase in the number of its constituent cells. BPH can raise PSA levels two to three times higher than normal. Men with increased PSA levels have a higher chance of developing prostate cancer. BPH usually affects the innermost part of the prostate first, and enlargement frequently results in a gradual squeezing of the urethra at the point where it runs through the prostate. The squeezing sometimes causes urinary problems, such as difficulty urinating. BPH may progress to the point of generating a dense capsule that blocks the flow of urine from the bladder, resulting in the inability to completely empty the bladder. Eventually, this could lead to bladder and kidney malfunction.

Transurethral resection of the prostate (TURP) is the treatment of choice for BPH, and the most common surgery performed for the condition. "Transurethral" refers to the procedure being performed through the urethra. "Resection " refers to surgical removal.

Demographics

Prostate disease usually occurs in men over age 40. BPH eventually develops in approximately 80% of all men. Prostate cancer occurs in one out of 10 men. In the United States, more than 30,000 men die of prostate cancer each year.

Description

TURP is a type of transurethral surgery that does not involve an external incision. The surgeon reaches the prostate by inserting an instrument through the urethra. In addition to TURP, two other types of transurethral surgery are commonly performed, transurethral incision of the prostate (TUIP), and transurethral laser incision of the prostate (TULIP). The TUIP procedure widens the urethra by making small cuts in the bladder neck (where the urethra and bladder meet), and in the prostate gland itself. In TULIP, a laser beam directed through the urethra melts the tissue.

The actual TURP procedure is simple. It is performed under general or local anesthesia. After an IV is inserted, the surgeon first examines the patient with a cystoscope, an instrument that allows him or her to see inside the bladder. The surgeon then inserts a device up the urethra via the penis opening, and removes the excess capsule material that has been restricting the flow of urine. The density of the normal prostate differs from that of the restricting capsule, making it relatively easy for the surgeon to tell exactly how much to remove. After excising the capsule material, the surgeon inserts a catheter into the bladder through the urethra for the subsequent withdrawal of urine.

Diagnosis/Preparation

BPH symptoms include:

• increase in urination frequency, and the need to urinate during the night
• difficulty starting urine flow
• a slow, interrupted flow and dribbling after urinating
• sudden, strong urges to pass urine
• a sensation that the bladder is not completely empty
• pain or burning during urination

In evaluating the prostate gland for BPH, the physician usually performs a complete physical examination as well as the following procedures:

• Digital rectal examination (DRE). Recommended annually for men over the age of 50, the DRE is an examination performed by a physician who feels the prostate through the wall of the rectum. Hard or lumpy areas may indicate the presence of cancer.
• Prostate-specific antigen (PSA) test. Also recommended annually for men over the age of 50, the PSA test measures the levels of prostate-specific antigen secreted by the prostate. It is normal to observe small quantities of PSA in the blood. PSA levels vary with age, and tend to increase gradually in men over age 60. They also tend to rise as a result of infection (prostatitis), BPH, or cancer.

If the results of the DRE and PSA tests are indicative of a significant prostate disorder, the examining

physician usually refers the patient to a urologist, a physician who specializes in diseases of the urinary tract and male reproductive system. The urologist performs additional tests, including blood and urine studies, to establish a diagnosis.

To prepare for TURP, patients should:

• Select an experienced TURP surgeon to perform the procedure.
• Purchase a mild natural bulk-forming laxative.
• Wear loose clothing on the morning of surgery.
• Ask friends or family to be available for assistance after surgery.
• Schedule a week off from work.
• Get sufficient sleep on the night before surgery.