1 of 7
What is the prostate?
Your prostate is part of your reproductive system. It is a plum-sized gland and is
only found in men. It lies at the base of your bladder and surrounds your urethra
(tube that takes urine from the bladder, along the penis and out of your body).
Your prostate produces nutrients for your sperm and makes up part of the milky
fluid (semen) when you ejaculate.
2 of 7
As men get older the cells of the prostate begin to swell, which increases the
size of the prostate. This is called benign prostatic hyperplasia (BPH), which
means extra growth of normal (non-cancerous) cells. This isn’t usually serious,
but sometimes the prostate grows so large that it puts pressure on your urethra .
This can make it difficult for you to pass urine and may cause other urinary
symptoms such as:
• not being able to empty your bladder completely, so you may need to go
to the toilet more often (referred to as frequency)
• having a weak urine flow
• having to strain to pass urine.
Because of the squeeze on your urethra, you may have to use a lot of pressure to pass urine.
A trans-urethral resection of the prostate (TURP) is an operation to remove the parts of your
prostate that are pressing on your urethra, to make it easier for you to pass urine. It involves a
surgeon inserting a special tube down your urethra, through which a heated wire loop is passed.
This wire loop is used to shave off the overgrown areas of your prostate.
Why do I need a TURP?
Not everyone who develops an enlarged prostate will need treatment. However, your consultant
or nurse specialist has recommended a TURP because of your symptoms. A TURP is the most
common type of surgery for an enlarged prostate. It will make it easier for you to pass urine and
may relieve your other symptoms, although it will not always resolve all of them. If you don’t
have treatment, your prostate will continue to grow, which may make your symptoms worse and
increases the possibility of problems with your bladder and/or kidneys.
Are there any alternatives?
There are several alternative treatment options outlined below, although they will not
necessarily be appropriate for you. Your consultant or nurse specialist will discuss these with
you if they are suitable for your situation:
• Observation of your symptoms. Some men may want time to think about surgery, or want
to wait and see if their symptoms become any worse before opting for treatment.
• Medicines. There are two types of medicines available. They either shrink your prostate or
relax the muscles in your prostate and bladder to improve the flow of urine. However, the
effects only last as long as you take the medicines and you may have already tried this
option without success.
• Laser prostatectomy. This is an operation to remove the parts of your prostate that are
pressing on your urethra, to make it easier for you to pass urine. It involves a surgeon
inserting a special tube down your urethra then using a laser to destroy the prostate tissue
or cut it into pieces.
• Open (tradional) surgery (Millin’s prostatectomy). This is considered if your prostate is too
large to be removed via a TURP.
• Prostatic stent. This is where an expandable tube is inserted to push back the prostatic
tissue, widening your urethra.
• Use of a permanent catheter. This is an option for men who do not want, or who are not
considered suitable, to have a TURP.
3 of 7
You will be offered a choice of dates for your surgery. It is important that you attend your pre-
admission appointment, which is given to you when you are offered a date for surgery or sent to
you in the post. We no longer offer a routine appointment service – patients walk in from clinic.
We will assess your suitability for surgery and anaesthetic at this appointment. You will not be
able to have surgery until you have been deemed fit for surgery at the pre assessment clinic.
You will come into hospital either the day before your surgery or arrive at the surgical
expect to stay in hospital for two to four days. When you arrive on the ward you will be seen by
a nurse who will show you around the ward and take some of your details, fill in any paperwork
needed and carry out any further tests requested by your consultant’s team. If you arrive at the
SAL the nurses there will prepare your for surgery.
If you smoke, you should try to stop, as this increases the risk of developing a chest infection or
healing because it reduces the amount of oxygen that reaches the tissues in your body. If you
would like to give up smoking, please speak to your nurse or call the NHS Smoking Helpline
on 0800 169 0 169.
Please continue to take all your medicines unless you are told otherwise and remember
to bring them into hospital with you.
Asking for your consent
We want to involve you in all the decisions about your care and treatment. If you decide to go
ahead, you will be asked to sign a consent form by your consultant or one of his team to confirm
that you agree to have the procedure and understand what it involves. It is your right to have a
copy of this form. You should receive the leaflet, Helping you decide: our consent policy,
which gives you more information. If you do not, please ask us for one.
There are risks associated with any operation. Your consultant will explain the specific risks for
a TURP, outlined below, in more detail before asking you to sign a consent form.
• Retrograde ejaculation. This is where your semen travels to your bladder when you
ejaculate rather than out through your penis. This is not harmful; the semen will leave your
bladder the next time you pass urine and will make your urine appear cloudy
of men will experience this after a TURP.
This is a long-term side effect. You will still be able
to have an erection and orgasm, but your fertility may be affected. However, you should not
rely on this as a form of contraception.
• Erectile dysfunction. The nerves that control your erections are very close to the prostate
gland. If these are damaged during surgery you may have difficulty getting an erection
afterwards. This happens to less that one in 10 patients having a TURP.
• A urine infection. This can cause symptoms such as pain or burning when passing urine,
but can be treated with antibiotics. This happens to about three in 100 patients.
• Bleeding. If the bleeding is severe you may need a blood transfusion or another operation
to stop the bleeding. This happens to about three in 100 patients having a TURP.
• Self-catheterisation. Occasionally, if your bladder is weak as a long term result of BPH, you
may need to use a catheter to empty your bladder. If this risk applies to you, your consultant
will discuss this with you in more detail.
4 of 7
future and you may need a repeat procedure if your symptoms return. This happens to about
one in 10 patients within ten years of their TURP.
• Deep vein thrombosis. (DVT) Any surgery carries the risk of DVT. This is where a blood
clot can form in the veins or arteries, most commonly in the legs (this happens to less than
one in 100 people)
• Injury to the urethra, causing delayed scar formation. This does not delay your recovery,
the flow of your urine. This happens to about two in 100 patients who have the procedure.
• Loss of control (incontinence), frequency and urgency of when you urinate. This can
be temporary or permanent and occurs in about one in 100 patients.
• TUR syndrome. This is where the fluids used to flush your bladder are absorbed into your
blood stream. This can cause a salt imbalance in your blood, which can make you confused,
feel sick, unsteady on your feet or cause heart failure. This is a rare complication; however,
you should tell a member of staff immediately if you experience these symptoms.
The evening before or morning of your procedure the anaesthetic team will visit you and review
your suitability for anaesthetic. You will be given either a general or a spinal anaesthetic. A
general anaesthetic is where you are asleep for the whole procedure, so you will not be aware
of anything until you wake up after the treatment has finished. A spinal anaesthetic is where you
are awake, but your body is numb from the waist downwards and you do not feel pain
should have been given the Having an anaesthetic leaflet – please ask the staff if you have
not received this.
You will be able to eat and drink as normal the evening before your surgery. However, you will
water) for six hours before surgery. We will give you clear instructions about when to start
fasting. This is also explained in Having an anaesthetic leaflet. It is important to follow the
instructions. If there is food or liquid in your stomach during the anaesthetic it could come up to
the back of your throat and damage your lungs.
You may have a drip, which is a bag of fluid connected to a small tube in your vein. This is
On the morning of your surgery, you will be asked to take a shower, change into a clean gown
during surgery. You will need to be ready at least one hour before your operation. When
everything is ready, you will be taken down to theatre by one of the nurses.
5 of 7
You will be anaesthetised so you will not feel any pain. You will then be taken through to the
operating theatre. The surgeon will insert a special tube (called a resectoscope) down your
urethra, through which a heated wire loop will be passed. This heated loop will be used to shave
or chip away the overgrown portion of the prostate. The pieces of removed prostate will also be
looked at under a microscope to check there are no abnormal cells.
The operation usually takes about 30–40 minutes. When it is finished, a catheter (thin flexible
bladder via the catheter to flush out any blood clots or prostate tissue that have been removed.
This solution will then be drained out of your bladder with your urine, through the catheter.
After your surgery
Once you have recovered from the anaesthetic you will be taken back to your ward. If you feel
well enough you may eat and drink, but we suggest you try something light, such as tea and
toast before attempting to eat a full meal.
The catheter will remain in your urethra and will be connected to two large bags of saline fluid
or until the day after your surgery.
If you had a fluid drip, this will be removed when you are drinking enough to replace your own
litres (about five pints) per day while there is still blood in your urine.
You should not have any pain from the operation, but you may have some discomfort from the
caused by the catheter rubbing against the trigone (muscle) inside of your bladder. The spasms
result in urine passing down the sides of the catheter or make you have the urge to pass urine,
which can be uncomfortable. If you experience these spasms, please tell a member of staff, as
they can often be relieved in a number of ways.
When your urine is suitably clear, your catheter will be removed. At first, you will need to pass
bladder to make sure you are able to empty it properly. This is usually two days after your
What problems might I experience after the surgery?
You may experience a mild burning feeling or find it a little uncomfortable to pass urine at first.
This is because your urethra will be swollen and sore from the surgery and having the catheter
in place. This is normal and should not last long.
Some men find that they cannot pass urine when the catheter has been removed. If this
several weeks to allow your bladder to rest. If this happens to you, you will be taught how to
look after the catheter and we will arrange for a district nurse to visit you at home. You will also
be given or sent an appointment to have your catheter removed.
6 of 7
this, please tell your nurse, who will explain how to perform pelvic floor exercises to improve
your control. Once you can pass urine comfortably, you will be allowed home. Once home
please make sure you drink enough (about one and a half to two litres per day), as poor
drinking habits may make it more difficult to regain control of your bladder. It also helps to avoid
the possibility of a urine infection. Please ask a nurse on the ward for a copy of the Fluid
It is normal to have blood in your urine for a couple of weeks. This may increase about 10 to 14
days after your TURP, as the scab formed on your prostate due to surgery falls off. At this time
your urine will be very bloody, this is normal and should only last for about 24 hours. Drinking a
few extra glasses of water should help to clear this. If it lasts longer than 48 hours, please
contact your ward for advice (contact details at the back of this leaflet).
You will be followed up about eight to 12 weeks after your surgery. This appointment will be
given to you before you leave hospital. Some of the investigations you had previously, such as
flow rate (you will need to attend this appointment with a full bladder) and symptoms score
sheet will be repeated to see the improvement in your symptoms following the surgery.
You will also be given any histology results then, which will show whether the tissue removed
bleeding and you and your partner both feel ready.
Heavy lifting. You should avoid heavy lifting for the first week or so following the procedure.
However, return to light exercise and work activities should be possible within a week or so.
It is important to note that there is a small risk of erectile dysfunction (on page 3 under risks).
There is also the possibility that you will have retrograde ejaculation. This is where your semen
travels to your bladder when you ejaculate rather than out through your penis. This is not
harmful; it will pass out of your bladder the next time you pass urine and will make your urine
Driving. Please discuss this with your consultant before you leave hospital. You
should also check with your insurance company that you are covered after having anaesthetic.
For further information or advice on having a TURP, please contact Aston Key Ward on
020 7188 0709 or 020 7188 0706 or Florence Ward on 020 7188 8818. Alternatively,
you can call one of the prostate nurse specialists:
Sharon Clovis on 020 7188 7339/07500 814 939 or bleep 1005
or bleep 1596
7 of 7
If you have any questions or concerns about your medicines, please speak to the staff caring for
you or call our helpline.
t: 020 7188 8748 9am to 5pm, Monday to Friday
Patient Advice and Liaison Service (PALS)
To make comments or raise concerns about the Trust’s services, please contact PALS. Ask a
member of staff to direct you to the PALS office or:
e: 020 7188 8801 at St Thomas’ t: 020 7188 8803 at Guy’s
Knowledge & Information Centre (KIC)
For more information about health conditions, support groups and local services, or to search
the internet and send emails, please visit the KIC on the Ground Floor, North Wing, St
t: 020 7188 3416
Language support services
If you need an interpreter or information about your care in a different language or format,
please get in touch using the following contact details.
Offers health information and advice from specially trained nurses over the phone 24 hours a
Provides online information and guidance on all aspects of health and healthcare, to help you
make choices about your health.
Membership is free and it is completely up to you how much you get involved. To become a member
of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark,
Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five
years. To join:
t: 0848 143 4017
Date published: September 2013
Review date: September 2016
© 2013 Guy’s and St Thomas’ NHS Foundation Trust