Transurethral resection of the prostate - Risks of surgery

Transurethral resection of the prostate (TURP) is generally a safe procedure. However, as with all surgery, TURP is associated with potential risks.

The most common risks are described below.

Retrograde ejaculation

Retrograde ejaculation is the most common long-term complication of a TURP and can occur in as many as 9 out of 10 cases.

Retrograde ejaculation means semen you ejaculate during sexual intercourse or masturbation does not come out of your penis, but flows into your bladder instead.

It is caused by damage to the nerves or muscles surrounding the neck of the bladder, which is the point where the urethra connects to the bladder.

You will still experience the physical pleasure associated with ejaculation (the climax) in the normal way. However, retrograde ejaculation can affect your fertility, so speak to your surgeon to discuss alternative procedures if this is a concern.

It may be possible to have a transurethral incision of the prostate (TUIP) instead, which carries a lower risk of causing retrograde ejaculation. 

It is also sometimes possible to lower this risk when performing a TURP by leaving prostate tissue located near the urethra intact.

Urinary incontinence

Urinary incontinence affects around 10% of men after a TURP. It usually gets better over time, but can be a long-term problem.

It usually takes the form of urge incontinence – when you have a sudden urge to pass urine and lose control of your bladder if you do not find a toilet quickly enough. Taking medication to help relax the muscles of the bladder may reduce the urge to urinate.

Around 2% of men will develop long-term stress incontinence, where small amounts of urine leak out during physical activities, such as coughing, sneezing, laughing and heavy lifting.

Read more detailed information about the treatment of urinary incontinence.

Urethra strictures

Narrowing of the urethra (urethra strictures) is estimated to develop in up to 4% of cases. It is thought some of the electric current used during the procedure may move back into the urethra, causing scarring and narrowing of the urethra.

Symptoms of a urethra stricture include:

• straining to pass urine
• spraying of urine or a ‘split-stream’ of urine
• dribbling drops of urine once you have finished going to toilet
• mild pain when passing urine

If the narrowing of the urethra is mild, it can usually be treated by inserting a rod to widen the urethra.

More extensive narrowing may require surgery to correct.

Less common risks

The less common risks of a transurethral resection of the prostate are described below.

• Bleeding - In around 3-5% of cases there may be persistent bleeding after the operation and further treatment may be needed. A blood transfusion may be necessary in some cases, if there is significant bleeding.
• Urinary tract infection (UTI) - In around 5-10% of cases, a UTI could develop after surgery. UTIs can usually be successfully treated with antibiotics. Read more about the treatment of UTIs.
• Urinary retention - In around 2% of cases, the muscles that control the bladder may be temporarily damaged. This can lead to problems fully emptying the bladder. It is normally recommended to wait four to six weeks to see if the bladder muscles regain their normal functions.
• Erectile dysfunction (impotence) - Around 5-10% of men may find it difficult getting and maintaining an erection after the procedure. However, this is usually temporary while your body recovers from surgery. Your surgeon may be able to provide more information on your individual risk (although this can only ever be an informed ‘guess’ rather than a completely accurate prediction).

TURP syndrome

A rare but potentially serious risk associated with a transurethral resection of the prostate is known as TURP syndrome.

During the procedure, it is necessary to pump a fluid called glycine through the urethra to clear away blood and debris. In cases of TURP syndrome, the glycine becomes absorbed into the bloodstream, leading to a potentially dangerous build-up of fluid in the blood.

Initial symptoms of TURP syndrome include:

• feeling or being sick
• disorientation
• dizziness
• headache
• swelling of your abdomen
• slow heartbeat (bradycardia)

Left untreated, additional and more serious symptoms can develop such as:

• twitching
• seizures (fits)
• shortness of breath
• blue skin (cyanosis)
• heart pain
• coma

If you start to experience the symptoms of TURP syndrome during your procedure, the surgeon will stop the surgery, remove the resectoscope and inject you with a diuretic, which is a type of medication used to remove fluid from the body.

Nowadays, the risk of TURP syndrome is estimated to be less than one in 100. It is likely to become even lower if a new method, known as bipolar TURP, is used, which does not involve pumping water into the urethra.

Death

A TURP carries a very small risk of causing death. The risk of dying during the procedure is now estimated to be less than one in 1,000.

The risk usually arises from complications involving the heart, or a serious post-operative infection.