A transurethral resection of the prostate (TURP) is a procedure designed to reduce the size of the prostate gland and is generally carried out when benign prostate disease develops. An oversized prostate is generally referred to as a benign prostatic hyperplasia and can lead to a number of problems with the urinary system, such as pain or difficulty when urinating along with swelling and discomfort in the prostate area.

What is the prostate gland?

Located between the bladder and the penis, the prostate gland is essential in maintaining a healthy urinary system. The urethra, which allows for the flow of urine from the bladder to the penis, runs directly through the prostate gland. This means that a healthy prostate gland is important to ensure that waste materials can exit the body easily and the process of urination is not interfered with.

The prostate gland also plays a role in protecting sperm during ejaculation by excreting a liquid which nourishes the sperm and is released with the semen. An enlarged prostate can seriously affect the gland’s ability to produce this protective liquid.

It is very common that the condition of the prostate gland deteriorates over time. The body’s natural aging process causes the gland to become larger and heavier. At the age of 20, for example, the average weight of the prostate gland is 20 grams, but this will usually double in size to around 40 grams by the time a man reaches 70 years old. The growth process usually begins to accelerate at the age of 40.

What causes an enlarged prostate?

The prostate grows in size when the number of cells in the gland reproduce at an advanced rate. This process is known as hyperplasia. It is not known for sure just why hyperplasia begins, but studies suggest there are a number of potential factors involved such as increased production of testosterone and male hormones such as androgens and estrogens. Hyperplasia may also be part of body’s natural ageing process.

What are the symptoms of an enlarged prostate?

Although some men will experience no adverse symptoms as the prostate grows, the majority of cases involve issues with the urinary system to some extent.

As the prostate becomes larger it begins to exert more pressure upon the urethra, which in turn places force upon the bladder. This can restrict the bladder’s capacity and usually means that it is not able to fully empty itself. Inability to urinate or troubling urinating until the bladder is empty is therefore one of the primary symptoms of an enlarged prostate. You may also experience difficulty is starting to urinate but have a normal flow of urine once you do. Another symptom of an enlarged prostate is more frequent urination, especially during the night, which is caused by the bladder not fully emptying each time. This can also result in a greater urgency to urinate, often before you have chance to reach a toilet in time.

One of the more serious symptoms of an enlarged prostate is blood in the urine. This can can indicate that the passage of urine through the urethra is being severely restricted, and medical assistance should be sought immediately.

In rare cases an inflammation of the prostate gland can be caused by a bacterial infection, known as prostatitis. This can manifest as a fever or flu-like symptoms, as well as pain in the lower back and groin area. Prostatitis often requires hospital admission and can be treated with a course of antibiotics.

It is important to note that the size of the enlargement of the prostate gland doesn’t always correlate with the severity of the symptoms. A slightly enlarged prostate can still result in painful symptoms, whilst a prostate gland that is extremely enlarge may not bring any adverse side-effects.

How is an enlarged prostate treated?

No matter how insignificant you think it may be, if you suspect that you might be experiencing symptoms of an enlarged prostate you should consult a doctor as soon as possible. Your doctor can run a series of tests and examinations which can determine exactly what is causing your symptoms.

A physical examination is usually the most effective way of diagnosing an enlarged prostate. The doctor will examine the entire rectal area to see whether the prostate gland is an abnormal size. Blood and urine tests will also be carried out to assess whether the kidney is functioning correctly. To test the speed with which you are able to urinate a flow-rate check might also be performed. If the doctor has any suspicion that the enlarged prostate may be caused by cancer, they might refer you to a specialist in order to carry out more extensive tests.

Once it has been established that your prostate is in fact enlarged, you will need to speak with your doctor about how best to treat it. If your symptoms are mild then it you may be told simply to closely monitor the situation and not take any immediate action. If the symptoms are causing you significant discomfort and interfering with your daily activities then treatment is advised as soon as possible.

The symptoms of an enlarged prostates can be controlled with medication but they are never as effective as surgery.

Hospital - surgery team in the operating room or Op of a clinic operating on a patient, perhaps it's an emergency

Transurethral resection of the prostate (TURP) – how does it work?

When an enlargement of the prostate is causing concern then a transurethral resection of the prostate is often the advised course of action. Although it will not totally cure the root cause of the enlarged prostate, a TURP can effectively relieve the symptoms on a long-term basis.

Most TURP procedures are carried out by inserting a small instrument called a resectoscope down the urethra, which the doctor uses to manually pick away at the core of prostate. The resectoscope is able to remove any excess tissue from the prostate which is blocking the urethra. This lessens the pressure on the bladder and urethra and is able to provide significant relief from symptoms.

Many other variations on the procedure have developed in recent years as surgeons begin to utilize advancements in technology for greater and more accurate results. Some transurethral resection of the prostate surgeries now use laser technologies, which heat the tissue of the enlarged prostate to the point where it dies and is flushed through the urethra. This provides similar results to the the traditional scraping method but is less time-consuming and results in less bleeding.

A transurethral resection of the prostate is able to provide significant relief from the symptoms of an enlarged prostate in around 75-80% of cases.

What are the potential risks and side-effects of transurethral resection of the prostate (TURP)?

The common side-effects of TURP surgery include bleeding and soreness around the penis and prostate in the days following the procedure. You will need to wear a catheter for up to 3 days, which will allow urine to drain whilst the gland heals. It is also likely that blood will be found in the urine during this time, and a solution might be added to the catheter to prevent blood clots from forming.

For up to 3 weeks after the surgery you may have difficulty urinating, or you may find that your urination habits are uncontrollable. This should ease off as you become accustomed to the new size of the prostate gland.

Urinary tract infections are also relatively common following a TURP procedure, particularly when the catheter is needed for more than a few days. This can be treated with the use of antibiotics and can be prevented by ensuring that you drink plentiful fluids.

Around one-quarter of men who undergo a transurethral resection of prostate experience a phenomenon called retrograde ejaculation, whereby semen enters the bladder during sexual climax rather than exiting via the penis. Whilst this isn’t harmful it can affect your fertility and hinder your chances of successful reproduction. Similarly, erectile dysfunction is another potential side-effect of TURP. It is for this reason that the procedure is not advised for men who still wish to have children in the future.

In very rare cases the bleeding may become so severe that a blood transfusion is required; the bigger the prostate is, the higher the chances of excess bleeding.

How much does transurethral resection of the prostate cost?

A TURP surgery must be carried out by a urologist who is both trained and qualified to carry out the procedure. The surgery also requires the use of specialist equipment and tools, as well as the assistance of a team of nurses and doctors who are qualified to treat urology patients. This combination of expertise and specialist equipment means that a transurethral resection of the prostate can be an expensive procedure.

In the US, the average cost of a TURP procedure is $9,570, although this can fluctuate greatly between states. Prices as low as $4,500 may be available in some states, but the cost of TURP could be as high as $20,000 in others.

For patients in the United Kingdom who are in urgent need of a transurethral resection of the prostate the procedure is generally available for free on the National Health Service (NHS). The procedure does have a long waiting list, however. At a private hospital in the UK, TURP surgery will cost in the region of $9,500.

Transurethral resection of the prostate (TURP) abroad

If you are considering undergoing TURP surgery but find the cost of the procedure prohibitive, you may want to consider traveling abroad. An increasing number of patients who require treatment for an enlarged prostate are looking further afield in order to save on costs.

While the cost of a TURP procedure abroad can be significantly more affordable, the quality of care remains high. Hospitals and specialist urology clinics are internationally-accredited, and many urology specialists in countries such as Thailand and India have qualified, trained and worked internationally.

Average cost of transurethral resection of the prostate (TURP) abroad: