Complications of Transurethral Resection of the Prostate (TURP)

Major Complications

TURP has several significant complications including sexual dysfunction (65%), irritative voiding symptoms (15%), bladder neck contracture/urethral stricture (7%), bleeding requiring transfusion (8%), urinary tract infections (6%), and TURP syndrome (dilutional hyponatremia) which occurs in less than 1% of cases 1, 2
TURP syndrome is a unique and potentially life-threatening complication characterized by dilutional hyponatremia that occurs when irrigant solution is absorbed into the bloodstream during the procedure 1
Bleeding requiring transfusion occurs in approximately 8% of cases, representing a significant risk during the procedure 2

Sexual dysfunction, including retrograde ejaculation, occurs in approximately 65% of patients, making it the most common long-term complication 2, 1
Erectile dysfunction affects approximately 10% of patients following TURP 2

Prostate size is associated with increased risk of bleeding and longer operative times, with larger prostates posing a greater risk 1
Anticoagulation therapy is associated with a significantly increased risk of bleeding complications, and discontinuation of anticoagulants before TURP is recommended 3

Anticoagulation management, including discontinuation of anticoagulants before TURP, is recommended to reduce bleeding risk 3
TURP syndrome requires immediate recognition, cessation of the procedure, and correction of hyponatremia 1
Bleeding may require transfusion (in 8% of cases) or transurethral fulguration (in 3.5% of cases) 2
Bladder perforation requires placement of a large-caliber urethral catheter and possible surgical repair, although the American Urological Association guideline recommends this approach 4

Transurethral incision of the prostate (TUIP) is associated with lower complication rates for smaller prostates, particularly regarding retrograde ejaculation (18% vs 65% with TURP), according to the European Association of Urology 2