Transurethral resection of the prostate (TURP) is generally a safe procedure. However, as with all types of surgery, it is associated with potential risks.
The main risks are described below.
Retrograde ejaculation is the most common long-term complication of TURP and can occur in as many as 90% of cases.
This is where semen doesn't come out of your penis during sex or masturbation, but flows into your bladder instead. It's 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.
Retrograde ejaculation isn't harmful and you'll still experience the pleasure associated with ejaculation (orgasm). However, your fertility may be affected, so you should speak to your surgeon if this is a concern.
It may be possible to have an alternative procedure called transurethral incision of the prostate (TUIP) instead, which carries a lower risk of causing retrograde ejaculation. It's also sometimes possible to reduce the risk when performing a TURP by leaving prostate tissue near the urethra intact.
Some degree of urinary incontinence is quite common after TURP. It usually gets better in the weeks following surgery, but can very occasionally be a long-term problem.
It usually takes the form of urge incontinence – where you have a sudden urge to pass urine and lose control of your bladder if you do not find a toilet quickly enough.
A number of treatments are available for incontinence, including lifestyle changes, medication and surgery. Read more about non-surgical treatments for urinary incontinence and surgical treatments for urinary incontinence.
Up to 10% of men who have a TURP find it difficult getting and maintaining an erection (erectile dysfunction) afterwards. This can be either temporary or permanent.
Medication can be prescribed to help reduce the problem if necessary, but you should speak to your surgeon if this is a concern. Your surgeon may be able to provide more information on your individual risk.
Narrowing of the urethra (urethral strictures) is estimated to develop in up to 4% of cases. It can occur if the urethra is damaged during surgery and becomes scarred.
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 the 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.
Some of the other risks of a transurethral resection of the prostate are described below.
- bleeding – in around 2% of cases there may be persistent bleeding during or after the operation that means a blood transfusion is required
- urinary tract infection (UTI) – in around 5% of cases, a UTI could develop after surgery; UTIs can usually be successfully treated with antibiotics (read more about treating UTIs)
- urinary retention – in around 2% of cases, the muscles that control the bladder may be temporarily damaged, which can lead to problems fully emptying the bladder; in some cases the bladder muscles regain their normal function within a few weeks
- the prostate becoming enlarged again – about 10% of men need to have a TURP again within 10 years
A rare but potentially serious risk associated with a TURP is known as TURP syndrome. This occurs when too much of the fluid used to wash the area around the prostate during the procedure is absorbed into the bloodstream.
Initial symptoms of TURP syndrome include:
- feeling or being sick
- swelling of your tummy
- slow heartbeat (bradycardia)
Left untreated, life-threatening problems can develop, such as seizures (fits), shortness of breath, blue skin (cyanosis) and coma.
If you experience the symptoms of TURP syndrome during your procedure, the surgeon will stop the surgery and inject you with a diuretic, which is a type of medication used to remove fluid from the body. Tell hospital staff immediately if you develop any symptoms after returning to the ward.
Nowadays, the risk of TURP syndrome is estimated to be less than 1% and is likely to reduce even further as new techniques that avoid pumping water into the bladder are increasingly used.
TURP carries a very small risk of causing death. The risk of dying as a result of the procedure is now estimated to be less than 1 in 1,000. The risk usually arises from complications involving the heart or a serious postoperative infection.