Learn about the Transurethral Resection of the Prostate (TURP) Procedure for Handling Benign Prostate Enlargement

Benign Prostatic Hyperplasia (BPH), also known as benign prostatic enlargement, is a condition when the prostate gland becomes enlarged, which causes the flow of urine to be uneven and urination to feel incomplete. It is not known what causes benign prostate enlargement. However, this condition is thought to be related to changes in the balance of sex hormone levels as men age.

There are several factors that can increase a person's risk of developing benign prostate enlargement, namely:

1. Over 60 years old

2. Lack of exercise

3. Having excess body weight

4. Suffering from heart disease or diabetes

5. Routinely consume beta-blocker hypertension drugs

6. Have a family with prostate problems.

The main symptoms of benign prostatic hyperplasia include:

1. Urine difficult to pass at the beginning of urination

 2. Need to strain when urinating

 3. The flow of urine is weak or stagnant

4. Urine drips at the end of urination

5. Urination feels incomplete

6. Urinating at night becomes more frequent

7. Beser or urinary incontinence

Management of an enlarged prostate consists of administering drugs and undergoing surgery. Administration of drugs using alpha-blocker type drugs, 5-alpha reductase inhibitors, and phytopharmaca. Operative management is intended for someone who has benign prostate enlargement that does not respond to drugs, has a history of repeated catheter insertion, has recurrent urinary tract infections, has blood in the urine (hematuria), has bladder stones, and has kidney problems caused by benign prostate enlargement.

There are a number of prostate surgery methods that urologists can perform to treat benign prostate enlargement, one of which is transurethral resection of the prostate (TURP). TURP is the most frequently performed surgical method to remove prostate tissue. This method is intended for patients who do not experience narrowing of the lower urinary tract, benign enlargement of the prostate, or disturbances of heart and respiratory function, and who can mobilize. Therefore, patients must undergo an initial examination to detect these conditions.

TURP Action: Risks and Complications

Although the TURP procedure is a minimally invasive action that causes minimal tissue damage, it has several risks, including:

- Infection

- Bleeding

- Bladder trauma Trauma to the lower urinary tract

- Electrolyte disturbances

- Impaired heart function

Complications that can arise include:

- TURP syndrome is a life Threatening condition due to the TURP procedure taking too long

 - Infection and bleeding

- Narrowing of the lower urinary tract and bladder neck.

Implementation of TURP actions

Preparation for TURP is almost the same as open surgery. A few days before surgery, the doctor will advise the patient to stop taking medications that increase the risk of bleeding, such as blood thinners. In addition, the doctor will order several laboratory tests and several supporting examinations as needed. For the purposes of anesthesia, patients are generally fasted 8 hours before surgery.

The TURP procedure takes about 60 to 90 minutes in the patient's condition under anesthesia. Anesthesia can be in the form of general anesthesia or regional anesthesia, according to the judgment of the anesthesiologist. The patient is also given antibiotics to prevent infection. In this procedure, the obstructing prostate tissue is removed little by little using a special tool that is inserted through the urethra. When small pieces of tissue are removed from within the prostate, the irrigation fluid carries them to the bladder, where they are eventually expelled. The pieces of tissue taken will be examined in the laboratory to determine whether there is malignancy. This entire process uses a special camera device (endocam) so that it can be seen on a monitor screen.

After the TURP procedure is complete, the doctor will place a urinary catheter for at least 3 days. If the patient is in a stable condition and can urinate spontaneously, the doctor will allow him to go home and explain what must be done during treatment at home.

Post-TURP treatment at home

After being discharged by the doctor, the patient is advised:

- Strive for fluid intake of 2–2.5 liters per day.

- Patients limit physical activities such as going up and down stairs, walking long distances, driving motorbikes, riding bicycles, and pushing and lifting heavy objects.

- No sexual intercourse for 1 month after the procedure.

- Do not strain during bowel movements.

- Eat foods rich in fiber.

Furthermore, the patient needs to return to the hospital for control 6-7 days after discharge for post-TURP assessment and to find out the results of the prostate tissue examination. If the results of the network do not find any malignancy, then no further treatment is needed. However, if there is malignancy, special management of prostate malignancy is necessary.

Written by : dr. Magda Valentina

Reviewed by : dr. Ken Ramadhan, Sp.U(K)