Transurethral Resection of the Prostate (TURP): Techniques, Steps, and Tips

Indications and Pre-Procedure Considerations

TURP is appropriate for patients with moderate-to-severe lower urinary tract symptoms (LUTS) and those who have developed acute urinary retention or other BPH-related complications 1
The American Urological Association recommends that patients who have developed complications of BPH are best treated surgically 1
Discontinuation of anticoagulants before TURP is recommended to reduce the significant risk of bleeding complications 2

Insert a resectoscope through the urethra under direct vision 1
Use an electrified loop to systematically resect prostatic tissue in strips 1
Maintain adequate irrigation throughout the procedure to ensure good visibility 3
Achieve meticulous hemostasis during and after resection using the cautery loop 1

Maintain crystalloid administration at 1-4 ml/kg/hr as maintenance fluid during TURP procedures to prevent TURP syndrome 3
Preserve enough tissue at the bladder neck to prevent bladder neck contracture 2
Exercise extra caution near the apex to avoid urethral sphincter damage and subsequent incontinence 2
Regularly monitor vital signs, urine output, and fluid balance during the procedure 3

TURP Syndrome occurs when irrigant solution is absorbed into the bloodstream, causing dilutional hyponatremia (<1% of cases) 2
Prevention of TURP Syndrome: Limit resection time to under 90 minutes and use bipolar TURP when available 3
Bleeding occurs in approximately 8% of cases requiring transfusion 2
Sexual Dysfunction: Retrograde ejaculation occurs in approximately 65% of patients 2
Bladder Perforation requires immediate recognition and management 4
Urethral Stricture/Bladder Neck Contracture occurs in approximately 7% of cases 2

Monitor for signs of TURP syndrome, including confusion, nausea, hypertension, and visual disturbances 2

TURP syndrome is a life‑threatening complication arising from absorption of electrolyte‑free irrigating fluid during transurethral resection of the prostate, resulting in dilutional hyponatraemia, hypervolaemia, and possible cardiovascular and neurological collapse. 5, 6, 7

The syndrome occurs in fewer than 1 % of TURP procedures; its pathophysiology involves rapid fluid absorption causing circulatory distress, glycine‑related toxicity, dilution of plasma proteins and electrolytes, and disturbance of renal function. 5, 6, 7