TURP: Removing the Prostate Through the Urethra
The reference method used for many years in benign prostate enlargement. No incision; the prostate tissue is shaved away through the urinary passage. Who is it suitable for, how does it go and what should you watch for?
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 45–75 minutes
- Anesthesia
- Spinal or general anaesthesia
- Hospital stay
- 1–2 nights
- Stay in Türkiye
- 5–7 days
- Return to work
- 2–3 weeks
- Flight clearance
- 7–10 days
About the condition
TURP (transurethral resection of the prostate) removes the tissue that is narrowing the urinary passage in benign prostate enlargement, without any incision. A slim instrument is passed along the penis to the bladder neck and the prostate tissue pressing on the channel is shaved away in small pieces and removed. Not the whole prostate but only the inner part blocking the channel is taken; the outer capsule stays in place.
TURP has been regarded for many years as the reference method for the surgical treatment of benign prostate enlargement. Newer methods are assessed by comparison with it. It is widely chosen for moderately sized prostates; for very large glands, enucleation techniques (HoLEP, ThuLEP) or open surgery may come into consideration.
Two different energy systems can be used. In monopolar TURP the irrigation fluid contains no salt; if too much of it passes into the circulation it can cause TUR syndrome, a picture marked by a fall in the blood sodium level. In bipolar TURP the irrigation is done with saline and this risk disappears. The bipolar system also allows longer procedures.
TURP is not a cancer operation; it relieves the obstruction caused by benign enlargement. All the removed tissue is nevertheless sent for pathology, because cancer cells can be found unexpectedly. If that happens the treatment plan is reconsidered.
RETROGRADE EJACULATION IS AN EXPECTED OUTCOME. Because the procedure widens the bladder neck, semen may pass back into the bladder instead of outwards during ejaculation and is then passed with the urine. This does not abolish the sensation of orgasm and is not harmful; it does, however, affect fertility. If you are planning to father children, be sure to discuss this before surgery. Erectile function is usually unaffected, but no operation can carry a guarantee on this point.
Who is it suitable for?
May be suitable
- Men who do not respond adequately to medication or cannot continue it because of side effects
- Men with a moderately sized prostate and a markedly impaired urinary flow
- Men who cannot pass urine at all, have a catheter in place and wish to be rid of it
- Men with recurrent urinary tract infections caused by prostate enlargement
- Men who have developed bladder stones or deteriorating kidney function because the bladder does not empty fully
- Men with recurrent bleeding arising from the prostate
May not be suitable
- Men with a very large prostate — enucleation techniques or open surgery may be more appropriate
- Men with an untreated active urinary tract infection — the infection is treated first
- Men with an uncontrolled bleeding disorder
- Men with mild symptoms who are comfortable on medication — there is no hurry to operate
- Men whose bladder muscle has lost its function — symptoms may persist even once the obstruction is relieved, so urodynamic assessment is needed first
Technology used
- Bipolar resection system (saline irrigation, removing the risk of TUR syndrome)
- Continuous-flow resectoscope
- High-definition endoscopic imaging
- Pathological examination of all removed tissue
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Before surgery
Assessment
Symptoms are scored, urinary flow rate is measured, and prostate volume and residual urine after voiding are determined by ultrasound. PSA is checked and any adjustment of blood-thinning medication is planned.
- Day of surgery
The procedure
Under spinal or general anaesthesia the urinary passage is entered without any incision. The obstructing tissue is shaved away and a catheter is placed at the end. The procedure usually takes 45–75 minutes.
- Days 1–2
Catheter period
The bladder is irrigated continuously to prevent clots forming. As the bleeding settles the irrigation is stopped and the catheter removed. Most men are discharged during this period.
- Week 1
Early recovery
Burning on passing urine and a sudden, frequent urge are expected findings. Plenty of fluids are taken, and constipation and heavy lifting are avoided.
- Weeks 4–6
Scab separation and settling
Temporary bleeding can appear in the urine as the healing tissue at the operated area separates. By the end of this period the urinary flow is markedly improved.
Method comparison
| Criterion | TURP | HoLEP / ThuLEP | Rezūm |
|---|---|---|---|
| Suitable prostate volume | Moderate | Any volume, especially large | Small to moderate |
| How tissue is removed | Shaved piece by piece | Lobe separated as a whole | No tissue removed, shrunk by vapour |
| Anaesthesia | Spinal or general | Spinal or general | Local or light sedation |
| Catheter time | 1–2 days | 1–2 days | A few days |
| Retrograde ejaculation | Common | Common | Less common |
| Onset of effect | Immediate | Immediate | Gradual, over weeks |
| Pathological examination | Possible | Possible | Not possible, as no tissue is taken |
No one method is the single right answer that replaces the others. The decision is made by weighing prostate volume, bladder function, bleeding risk, expectations around sexual function and accompanying illnesses together.
Risks
- RETROGRADE EJACULATION: a common and expected outcome; semen passes into the bladder, fertility is affected, the sensation of orgasm is usually preserved
- Bleeding — during the procedure or in the scab-separation period; a transfusion is rarely needed
- Urinary tract infection
- Narrowing of the urinary passage or of the bladder neck — can develop later and may require a further procedure
- Urinary leakage — usually temporary; permanent leakage is uncommon
- TUR syndrome — only relevant to the monopolar system; this risk does not exist with the bipolar system
- The need to repeat the operation as the tissue regrows over the years
- A change in erectile function — not generally expected, but it cannot be guaranteed
Alternatives
- Medication (alpha blockers, 5-alpha reductase inhibitors or a combination)
- Rezūm water vapour therapy — for men with suitable anatomy whose priority is preserving sexual function
- HoLEP or ThuLEP enucleation — particularly for large prostates
- Prostatic urethral lift systems — in selected men
- Open (adenomectomy) surgery — for very large prostates
- Lifestyle adjustment and surveillance where symptoms are mild
Recovery
First 48 hours
The catheter is in place and the bladder is irrigated. Pink-to-red urine is expected. Plenty of fluids are advised.
Week 1
The catheter has been removed. Burning, urgency and frequent passing of urine may occur; these lessen with time. Gentle walking is allowed, heavy lifting is not.
Weeks 2–3
A return to desk work is possible. Avoiding constipation matters; straining can trigger bleeding.
Weeks 4–6
Temporary bleeding may occur as the scab separates; increase fluids rather than taking alarm. A return to sexual activity is planned during this period.
Month 3
Urinary flow and the symptom score are measured again to assess the outcome.
Frequently asked questions
Is TURP open surgery — is an incision made?
No. No incision is made in the abdomen or anywhere else. The procedure is carried out entirely through the urinary passage with a slim instrument passed along the penis. There is therefore no visible scar.
Is the whole prostate removed?
No. Only the inner part pressing on the urinary channel is taken; the outer capsule of the prostate stays in place. That is why PSA follow-up can still be carried out afterwards, and why the remaining tissue can regrow over the years.
Why is there no semen after the operation?
This is called retrograde ejaculation and is a common, expected situation after TURP. Because the bladder neck has been widened, semen passes into the bladder instead of outwards and is later passed with the urine. The sensation of orgasm is usually preserved, but fertility is affected. If you are planning to father children, be sure to say so before surgery.
Will my sexual function be affected?
A marked change in erectile function is not generally expected. That said, no surgical procedure can carry an absolute guarantee on this. Recording your current sexual function before the operation makes assessment afterwards easier.
What is the difference between monopolar and bipolar?
The difference lies in the energy system and the irrigation fluid. Monopolar uses a salt-free fluid, and if this passes into the circulation it can cause TUR syndrome. Bipolar uses saline, so this risk disappears and longer procedures can be performed safely.
How long does the catheter stay in?
In most men 1–2 days. While it is in place the bladder is irrigated continuously to prevent clots. Once the bleeding settles the irrigation is stopped and the catheter removed. This period can be longer in men with a very large prostate or more bleeding.
Is it normal to see blood in the urine after the operation?
Yes. Pink-to-red urine is expected in the first few days. In addition, a second episode of bleeding can occur at 4–6 weeks as the healing tissue separates; this too is expected. Dark bleeding with clots, or an inability to pass urine, requires prompt medical attention.
Will the operation have to be repeated?
Because the whole prostate is not removed, the remaining tissue can regrow over the years and some men need a second procedure years later. This does not mean the operation failed; it is a known feature of the method.
Which is better, TURP or HoLEP?
There is no single "better" method. TURP has been the reference method for moderately sized prostates for many years. HoLEP and ThuLEP stand out particularly for large glands because they separate the lobe as a whole. The choice is made together with you according to prostate volume, bleeding risk and your expectations.
When can I fly and return to work?
Flying is usually permitted after 7–10 days; a stay of 5–7 days is planned for patients travelling from abroad. A return to desk work is possible within 2–3 weeks; for heavy physical work and lifting, waiting 4–6 weeks is advised.
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This page is for general information only and is not a substitute for medical advice.
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