52601 Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)

Name of the Procedure:

Transurethral Electrosurgical Resection of the Prostate (TURP)

Summary

Transurethral Electrosurgical Resection of the Prostate (TURP) is a surgical procedure used to treat urinary problems due to an enlarged prostate. During the procedure, a surgeon removes prostate tissue using an electric current passed through a wire loop. The procedure can also control postoperative bleeding and includes other interventions such as vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy as necessary.

Purpose

TURP aims to alleviate urinary symptoms caused by an enlarged prostate, such as difficulty starting urination, weak stream, and frequent or urgent need to urinate. The goal is to improve urinary flow, bladder emptying, and general quality of life.

Indications

• Severe urinary symptoms caused by benign prostatic hyperplasia (BPH)
• Inadequate response to medication
• Bladder stones or kidney damage due to BPH
• Recurrent urinary tract infections
• Persistent blood in the urine

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Blood tests, urinalysis, and imaging studies might be required.
• Medication adjustments, especially anticoagulants or blood thinners, may be necessary.

Procedure Description

1. The patient is given spinal or general anesthesia.
2. A resectoscope, a special type of endoscope, is inserted through the urethra to the prostate.
3. An electrically charged wire loop is used to cut away excess prostate tissue.
4. The resected tissue is flushed out with an irrigation solution.
5. Postoperative bleeding is controlled during the procedure.
6. Additional interventions such as vasectomy, meatotomy, cystourethroscopy, urethral calibration, and/or internal urethrotomy may be performed.

Duration

The procedure typically takes 60 to 90 minutes.

Setting

TURP is usually performed in a hospital or surgical center.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common: bleeding, infection, temporary difficulty urinating, retrograde ejaculation
• Rare: incontinence, erectile dysfunction, TURP syndrome (a rare but serious condition caused by fluid absorption)

Benefits

• Improved urinary flow and bladder function
• Relief from urinary symptoms
• Typically, benefits are noticed within a few weeks post-procedure

Recovery

• Patients may need to stay in the hospital for 1-2 days.
• A urinary catheter may be required for a few days post-surgery.
• Avoid heavy lifting and strenuous activity for 4-6 weeks.
• Follow-up appointments are necessary to monitor recovery.

Alternatives

• Medication (for less severe symptoms)
• Minimally invasive procedures like Urolift or Rezum
• Open or laparoscopic prostatectomy (for very large prostates)
• Each alternative has its own pros and cons pertaining to effectiveness, recovery time, and potential risks.

Patient Experience

• During the procedure, patients will be under anesthesia and will not feel pain.
• Post-operatively, patients may experience mild discomfort and the sensation of needing to urinate.
• Pain management strategies and medications will be provided.
• Gradual improvement in urinary symptoms is expected over several weeks.