General · EdgepediaOctober 21, 202610 min read

Transurethral resection of the prostate

Transurethral resection of the prostate (TURP) is a surgical operation in which obstructing prostate tissue is removed chip by chip through a wire loop passed up the urethra, with no external incision, to relieve blocked urine flow. It is performed mainly for lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), an enlargement of the prostate that compresses the urethra as it passes through the gland.¹^•²

Key fact	Detail
Purpose	Relieves urinary symptoms of BPH and treats or prevents complications of blocked urine flow, such as repeated urinary tract infections, bladder stones, kidney or bladder damage, and blood in urine²
How it is done	A long, thin tube with a camera and cutting tools is passed into the penis and up to the prostate; small pieces of prostate are removed, with no stitches or dressings needed¹
Duration and stay	The operation takes around an hour; most people leave hospital 1 to 4 days afterwards¹
Typical gland size	TURP and photoselective vaporization are the mainstay of treatment for small to moderate glands of 30 to 80 cc, which account for the majority of men electing surgery³
Complication rates	In a 2024 meta-analysis of 103 randomized trials (8,521 patients, 2000 to 2022): TURP syndrome 2%, bleeding 8%, transfusion 6%, urinary retention 4%, incontinence 8%, urethral stricture 3%, bladder neck stenosis 2%⁴
Guideline status	The 2019 AUA guideline recommends TURP as a treatment option for men with LUTS/BPH (Grade B), by monopolar or bipolar technique depending on surgeon expertise⁵
Origin	The resectoscope was introduced by Maximilian Stern in 1926; Reed Nesbit added a spring for one-handed use in 1939⁶

Why it is done

TURP eases the urinary symptoms of benign prostatic hyperplasia: frequent or urgent need to urinate, trouble starting, slow or prolonged urination, nighttime trips to the bathroom, stopping and starting during urination, and the feeling that the bladder cannot be fully emptied.² It is also done to treat or prevent complications of blocked urine flow, including repeated urinary tract infections, kidney or bladder damage, inability to urinate, bladder stones, and blood in the urine.²

Guidelines distinguish absolute from relative indications. The 2010 Canadian Urological Association update lists intractable urinary retention and renal insufficiency caused by benign prostatic obstruction as absolute indications for TURP, and failure of medical therapy, recurrent cystitis, bladder calculi, and persistent prostatic bleeding as relative indications.⁷ The 2019 AUA amendment recommends surgery for renal insufficiency secondary to BPH, refractory urinary retention, recurrent urinary tract infections, recurrent bladder stones or gross hematuria due to BPH, and LUTS/BPH refractory to or unsuitable for other therapies.⁵ For men with small glands, under 30 grams, transurethral incision of the prostate (TUIP) gives similar symptom improvement with a lower incidence of retrograde ejaculation.⁷

The procedure

TURP is done in hospital under a general anesthetic, where the patient is asleep, or a spinal anesthetic, numbing the body from the waist down. The surgeon passes a long, thin tube carrying a camera and working tools into the penis and up to the prostate, and removes small pieces of the gland through it. A catheter is left in place to empty the bladder afterwards, and a small sample of prostate tissue may be sent to a laboratory to check for conditions such as cancer.¹

Recovery follows a defined course. Blood mixed with urine may appear in the catheter bag for a few days, and urination may be frequent, sore, or briefly uncontrollable once the catheter is removed. Most people leave hospital 1 to 4 days after the operation, resume usual activities in 2 to 4 weeks, and take up to 6 weeks to fully heal; heavy lifting and intense exercise are avoided for about 6 weeks. A second episode of blood in the urine 10 to 14 days after surgery is part of normal healing.¹

Risks

The characteristic risks of TURP include short-term trouble urinating requiring a catheter for a few days, urinary tract infection, and dry orgasm (retrograde ejaculation), in which semen passes into the bladder during orgasm; retrograde ejaculation is a common and long-term effect of any type of prostate surgery and can reduce fertility, though it is not harmful and does not tend to affect sexual pleasure. Erectile dysfunction can occur but the risk is very small. Heavy bleeding very rarely requires transfusion, and men with larger prostates seem to be at higher risk of heavy blood loss. Long-term loss of bladder control is rare.²

TUR syndrome. Rarely, the body absorbs too much of the fluid used to wash the surgical field, producing low blood sodium (hyponatremia) with excess fluid; this is called TUR syndrome and can be life-threatening without treatment. A technique called bipolar TURP eliminates the risk of this condition.² The hazard has a documented history: in 1947 Creevy became worried about TUR syndrome and introduced 4% glycine as an irrigating fluid to replace water.⁶ Some men also need re-treatment because symptoms return or do not improve, or because TURP causes narrowing of the urethra or bladder neck, called a stricture.²

History

The operation developed from a century of instruments for cutting tissue at the bladder neck. John Hunter and his nephew Everard Home (1756 to 1832) were the first to describe the prostate as a source of urinary outflow obstruction; before that, surgeons such as Ambroise Paré believed in "urethral carnosities" and tried to scrape them out with a sharp sound.⁶

The instrument timeline runs as follows:⁶

1830: George Guthrie of London described a spring-loaded knife in a hollow sound to cut through the "bar" at the bladder neck; in 1836 the Parisian Mercier described a "punch" to remove pieces of this bar.
1874: Enrico Bottini of Italy electrified his prostatic incisor, but the instrument was used blind until Freudenberg added a cystoscope.
1909: Hugh Hampton Young modified his urethroscope into a prostatic punch to cut tissue from the bladder neck, adding an electric cautery blade in 1911; both instruments worked under local anesthetic and in air. Edwin Beer was the first to apply an electrical current under water, using the Oudin unipolar current.
1926: Maximilian Stern (1873 to 1946) presented his "resectoscope", capable of working under water and using a tungsten wire loop to remove "spaghetti-like" pieces of prostate. Theodore Davis, an electrical engineer turned surgeon, improved it, and Joseph McCarthy (1874 to 1965) produced a popular version whose loop was pulled backwards, out of the bladder toward the user, as is done today.
1939: In 1939, Reed Nesbit altered the Stern-Davis-McCarthy resectoscope, incorporating a spring that allowed single-handed operation.
1947: Creevy introduced 4% glycine as an irrigant to replace water.
1970s: Iglesias modified a 1930s irrigating cystoscope into a continuous-irrigation resectoscope.

The new technologies carried significant morbidity and mortality in inexperienced hands, and take-up in the United Kingdom was slow; pioneering urologists such as John Blandy and the members of the Punch Club championed transurethral prostate surgery in Britain.⁶ Blandy's textbook Transurethral Resection, first published in 1971, set the standard for transurethral surgery for a generation of urologists, and Reed Nesbit's 1943 Transurethral Prostatectomy remains a classic account of the technique and of the resectoscope's early development.⁸ In the 1970s and 1980s, better lenses, fiber-optic lighting, and closed-circuit video completed the modern resectoscope, and Winston Mebust's 1989 case series, the most influential published on TURP, helped solidify monopolar TURP's position as the gold standard of surgical BPH management in the early 1990s.⁹ Before the PSA era, TURP also became the preferred therapy for relieving obstruction from prostate cancer.¹⁰

Outcomes and standing today

A 2024 systematic review and meta-analysis of 103 randomized clinical trials covering 8,521 patients from 2000 to 2022 found that TURP significantly improved symptom score (IPSS), peak urinary flow (Qmax), and post-void residual urine, with the most recent studies showing better IPSS and Qmax results at 3 years than the 2000 to 2004 studies. No negative impact on erectile function was observed. Complication proportions included TURP syndrome (2%), bleeding (8%), blood transfusion (6%), urinary retention (4%), incontinence (8%), urethral stricture (3%), and bladder neck stenosis (2%), with high heterogeneity between studies for some outcomes, which the authors read as a lack of standardization in TURP procedures. Symptomatic improvement was uniform across the period, supporting the procedure's role as a historical benchmark surgical treatment for BPH.⁴

TURP remains widely practiced because of its proven efficacy, easy availability, cost effectiveness, and its place in urological training, though it has notable limitations, including size dependency and unsuitability for patients on blood thinners.⁴ A 2021 historical review in World Journal of Urology by Räto T. Strebel, a urologist at Kantonsspital Graubünden in Switzerland, and Steven A. Kaplan of the Icahn School of Medicine at Mount Sinai argues that TURP offers an excellent balance between high efficacy in symptom relief and low morbidity, along with low costs and favorable long-term outcomes, a century after its introduction.¹¹

Alternatives

Several transurethral alternatives compete with TURP. Bipolar TURP, which resects in saline, probably produces similar IPSS improvement to monopolar TURP at 12 months (mean difference −0.24, 95% CI −0.39 to −0.09; 2,531 participants in 16 randomized trials).¹² Holmium laser enucleation of the prostate (HoLEP) and standard TURP may relieve urinary symptoms and improve quality of life to a similar degree with similar serious complications in the first year after surgery, though HoLEP complication rates continue to fall with surgeon experience, settling only after about 350 operations.¹³

For laser vaporization, the GOLIATH trial, a European multicenter randomized trial in 281 people aged 40 to 80 with prostate volume under 100 ml who were not on anticoagulation, showed no statistically significant difference in symptom improvement (IPSS or Qmax) between the GreenLight XPS 180 W laser and TURP up to 2 years, with shorter catheterization and hospital stay for the laser group.¹⁴ A meta-analysis of randomized trials found GreenLight procedures took about 10 minutes longer (95% CI 5 to 15) but reduced catheterization time by a mean of 1.3 days and hospital stay by a mean of 2.1 days compared with TURP.¹⁵ In a large prospective observational cohort of 713 GreenLight and 234 TURP patients, post-operative complication rates were 10.3% for TURP and 5.2% for GreenLight (P=0.006), though the authors could not categorically state which procedure was superior.¹⁶

For large glands, the AUA panel notes that "large" is relative, since some providers achieve excellent results with transurethral approaches such as bipolar TURP and HoLEP in prostates over 60 g, while open, laparoscopic, or robot-assisted simple prostatectomy remains an option depending on surgeon expertise.⁵ Open prostatectomy is indicated when the treating urologist judges the prostate too large for TURP because of the risk of incomplete resection, significant bleeding, or dilutional hyponatremia (TUR syndrome).⁷ In one randomized comparison in patients with small-volume BPH, GreenLight PVP and HoLEP gave comparable symptom relief and flow improvement, with PVP having the shortest operative time, while TURP was associated with higher rates of bladder neck contracture and early urinary incontinence.¹⁷

References

Initially written Oct 21, 2026