BPH and the TURP procedure
Dr. Kevin Zorn, MD, FRCSC, FACS, Urologist
The standard of care for BPH if you aren't doing well on medications is to surgically remove all of that obstructive tissue in what’s called the transition zone. It’s in this zone that tissue grows and kind of squeezes around the urethra to create an obstruction. There different types of procedures with different energies that can remove this tissue but the standard of care, which I think all urologist from residency training learn, is called a TURP. This procedure uses something that looks like a paper clip. It's a small metal loop that connects up with your provincial hydro power source, and that current will pass through the loop and like a hot knife through butter will be able to sliver and cut out the small strips of prostate tissue. Surgeons do the best they can in an hour to remove as much tissue as possible. There's more bleeding with this procedure than some so patients are usually hospitalized a day or two and require irrigation.
The TURP is usually easy to access as most urologist offer it and have the correct equipment. The TURP is considered the global universal standard of care for these reasons. The downside is that the procedure takes time, however, you can't really go past an hour as patients may absorb too much of the fluid that is used during the procedure which can cause electrolyte abnormalities. There's also a lot more bleeding postoperatively than in some minimally invasive procedures that are now offered. There are also potential issues with sexual function, specifically some degree of lack or loss of ejaculation because you create a huge opening above the ejaculatory duct so that sperm will probably go in the bladder. These are all things to discuss with the patient.
A TURP is a surgical extra bit of tissue removing techniques accessible everywhere across the globe, but comes with issues of bleeding and retrograde ejaculation. Also, because surgeons have an hour to remove as much as they can, it's not something that's very consistent. For example, if you have Dr. X, Y and Z doing TUPR, every doctor will remove a different amount of tissue based on their speed or technique. This explains why we see variable recurrence rates from 5 to 10% Within the first 10 years after surgery.
Presenter: Dr. Kevin Zorn, Urologist, Montreal, QC
Local Practitioners: Urologist
