Transurethral resection of the prostate (TURP) is a common surgical procedure used to treat benign prostatic hyperplasia (BPH), a condition where the prostate gland enlarges and obstructs urine flow. The procedure involves inserting an instrument through the urethra to remove excess prostate tissue. While TURP is effective at relieving urinary symptoms, it is an invasive surgery that carries specific risks and complications. Understanding these complications is important for patients considering the procedure.
Acute and Life-Threatening Risks
The most severe complications occur during the operation or immediately afterward, requiring urgent medical intervention. Transurethral Resection of the Prostate Syndrome (TURP Syndrome) is a rare but serious event resulting from the body absorbing too much of the non-conductive fluid used to irrigate the surgical site. This absorption can lead to a dangerous dilution of the blood’s sodium level, known as hyponatremia. Symptoms include confusion, seizures, and even coma, though the risk is significantly lower with modern bipolar TURP techniques.
Severe hemorrhage is another immediate risk, as the prostate gland is highly vascular. Significant blood loss can occasionally occur, sometimes requiring a blood transfusion. This risk is higher in patients with larger prostates or longer surgical times. Bladder or prostatic capsule perforation, an accidental tear, is also possible. Small tears are typically managed by extending the time the urinary catheter remains in place.
Common Short-Term Recovery Issues
The immediate post-operative period involves several common issues as the surgical site heals. Hematuria, or blood in the urine, is virtually universal and is a normal part of recovery as the prostate bed coagulates and sloughs off tissue. Gross blood usually stops within the first three weeks following the procedure. A secondary, often mild, bleeding episode can occur around 7 to 13 days after surgery, corresponding to the time when the initial surgical scab separates from the wound.
The post-operative urinary catheter and the procedure itself increase the risk of infection. Symptomatic urinary tract infections (UTIs) are reported in approximately 15% to 19% of patients. Risk factors include the duration of catheterization and a history of catheter use prior to surgery. Post-operative dysuria (pain or burning during urination) is common and typically resolves within a few weeks as inflammation subsides.
Temporary inability to urinate, or urinary retention, affects up to 20% of men shortly after the catheter is removed. This is often due to swelling of the prostate bed or bladder muscle weakness. Recatheterization may be necessary in these cases. The short-term retention usually resolves spontaneously as healing continues.
Delayed and Permanent Functional Changes
The most common long-term functional change is retrograde ejaculation, where semen travels backward into the bladder during orgasm instead of exiting the penis. This occurs because surgical removal of tissue near the bladder neck permanently damages the sphincter mechanism that normally closes during ejaculation. The rate of retrograde ejaculation is high, affecting a significant majority of patients (60% to 90%). While this causes a “dry orgasm” and results in infertility, it does not typically reduce the sensation of sexual pleasure or the ability to achieve an erection.
Urinary incontinence is a major concern, though permanent incontinence is rare, occurring in less than 0.5% of patients. The most frequent type of long-term leakage is stress urinary incontinence (SUI), which is the involuntary loss of urine during physical exertion like coughing or lifting. This is usually caused by injury to the external sphincter muscle. Urge urinary incontinence, characterized by a sudden, intense need to urinate, is more common immediately post-operatively, affecting 30% to 40% of patients temporarily, but it often improves as the bladder recovers.
Scar tissue formation can lead to urethral stricture or bladder neck contracture, resulting in the return of obstructive urinary symptoms. Urethral stricture is a narrowing within the urethra, while a bladder neck contracture is a narrowing at the junction of the bladder and the prostate. The incidence of these late complications ranges from 2.2% to 9.8% for urethral strictures and 0.3% to 9.2% for bladder neck contracture, and they may require a subsequent endoscopic procedure.
Erectile function is preserved after TURP. Studies suggest the procedure does not adversely affect long-term erectile ability. Some patients may experience a temporary decrease in erectile function in the first few months post-surgery, but this usually recovers within six months. Erectile function can even improve in some instances, potentially due to the relief of anxiety and stress related to pre-operative urinary symptoms. The risk of developing new, persistent erectile dysfunction is low, around 10%.