TURP (Transurethral Resection of the Prostate)
TURP is the long-standing benchmark surgical treatment for BPH — the operation every other procedure is measured against — resecting obstructing transition-zone tissue chip by chip.
The big picture
TURP is the long-standing benchmark surgical treatment for BPH — the operation every other procedure is measured against. It works by endoscopically resecting the obstructing transition-zone tissue, chip by chip, opening the prostatic channel. Knowing it cold means knowing who needs it, who shouldn't have it, how it's done, and the complications that define it — above all TUR syndrome, the dilutional emergency unique to the monopolar technique.
The framework: indications and contraindications, monopolar vs bipolar technique, TUR syndrome, and the early and late complications.
Mechanism pathway
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Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Absolute indications: retention, recurrent UTI, bladder stones, recurrent haematuria, renal insufficiency from obstruction — operate regardless of IPSS.
TURP suits 30–80 cc; very large glands → HoLEP/simple prostatectomy.
Can't stop anticoagulation → laser (HoLEP/ThuLEP/PVP), not monopolar TURP.
Monopolar uses hypotonic glycine/sorbitol → TUR syndrome; bipolar uses saline → avoids it.
TUR syndrome risk: gland >45 cc, resection >90 min — limit both.
Retrograde ejaculation is very common after TURP (~65–75%) — counsel.
Exclude active UTI, stricture/contracture, and an underactive detrusor first.