Transurethral Resection of the Prostate (TURP) is a common surgical intervention used to treat symptoms resulting from benign prostatic hyperplasia (BPH), the non-cancerous enlargement of the prostate gland. The procedure involves inserting a specialized instrument called a resectoscope through the urethra to trim away excess prostate tissue that is blocking urine flow. TURP is highly effective at relieving urinary symptoms like frequency and poor stream. However, as with any surgery, TURP carries a range of potential outcomes and complications that patients should understand.
Retrograde Ejaculation: The Most Common Outcome
The most frequent functional change following a TURP procedure is retrograde ejaculation, which affects a significant majority of patients. This occurs because the procedure often involves resection of tissue near the bladder neck, which contains the internal urethral sphincter muscle. This muscle is responsible for closing off the entrance to the bladder during ejaculation, ensuring that semen travels forward through the urethra.
When the bladder neck is widened or damaged during tissue removal, the sphincter mechanism no longer closes properly. Instead of being expelled, semen flows backward into the bladder during orgasm, resulting in a “dry orgasm.”
Studies suggest that the incidence of retrograde ejaculation affects approximately 65% to 90% of men who undergo the traditional TURP procedure. While this outcome is not physically dangerous and does not typically affect the sensation of orgasm or the ability to achieve an erection, it is a permanent anatomical change. For patients concerned with fertility, the backward flow of semen into the bladder makes natural conception impossible. The ejaculate mixes with urine and is passed out later during urination, which is the defining characteristic of this change.
Acute Surgical and Urinary Risks
Complications that occur immediately during or shortly after TURP are primarily related to bleeding and infection at the surgical site. Some bleeding is expected as the prostate is a highly vascular organ, though modern techniques have reduced the risk of excessive blood loss. Significant hemorrhage requiring a blood transfusion is uncommon, occurring in roughly 8% of cases.
In the immediate recovery phase, patients are at risk for a urinary tract infection (UTI) due to the instrumentation of the urinary tract. The reported rate of UTI development ranges between 1.7% and 8.2% of patients and often requires antibiotic treatment.
Temporary urinary issues are common as the bladder adjusts to the removal of the obstruction and the surgical site heals. These short-term irritative symptoms can include urinary frequency, urgency, and dysuria (a burning sensation during urination). Transient urge incontinence, where a sudden urge to urinate leads to leakage, may affect up to 40% of patients in the early weeks following surgery. These symptoms usually resolve spontaneously as swelling subsides, typically improving within two to three weeks.
Addressing Serious and Chronic Complications
Beyond the common and temporary issues, a few serious or chronic complications are possible, though they are rare. TURP syndrome is a unique risk associated with the procedure.
This syndrome occurs when the body absorbs too much of the non-electrolytic irrigation fluid used to wash the surgical site. Excessive fluid absorption leads to dilutional hyponatremia (low blood sodium), which can affect the brain and heart.
Though rare, occurring in less than 1% of cases, symptoms like confusion, nausea, vomiting, and visual disturbances require immediate medical intervention. The use of newer bipolar TURP technology has decreased the incidence of this complication by allowing the use of saline-based irrigation fluid.
Less common long-term structural issues can develop, specifically urethral strictures and bladder neck contracture. These conditions involve the formation of scar tissue that narrows the urethra or the bladder opening, potentially causing a recurrence of obstructive urinary symptoms. Urethral strictures are reported in 2.2% to 9.8% of patients, and bladder neck contracture occurs in 0.3% to 9.2% of cases, often requiring additional procedures. Long-term, severe stress incontinence (the inability to control urine flow with physical exertion) is a very rare outcome, typically affecting less than 0.5% of patients.