DR CHEW-LIN YIP | UROLOGIST

Dr Chew-Lin Yip performs transurethral resection of the prostate (TURP) for men with urinary symptoms caused by benign prostate enlargement, with assessment and follow-up consultations in Mandurah, Murdoch and Rockingham.

Dr Yip performs TURP at Peel Health Campus in Mandurah, St John of God Murdoch and Hollywood Private Hospital in Nedlands.

TURP is an operation to remove obstructing tissue from inside the prostate. It is performed entirely through the urethra, with no incision. A telescope with a cutting instrument is passed along the urethra to the prostate. The obstructing tissue is removed in small pieces, leaving the outer shell of the prostate in place. The pieces are washed from the bladder and sent for pathological examination.

Dr Yip uses bipolar resection. In bipolar TURP, the electrical current passes between two points on the instrument and saline is used to irrigate the bladder. Dr Yip will explain why he recommends this technique and the risks that still apply.

TURP is an established surgical option for urinary obstruction caused by benign prostate enlargement. It remains one of several treatment options. Suitability depends on prostate anatomy, symptoms, complications, general health and the patient’s priorities.

TURP is usually considered for men who have:

• prostate size or anatomy that is unsuitable for a less invasive procedure

• symptoms that have not responded adequately to medication, or who do not wish to take medication long term

• been unable to pass urine and required a catheter

• recurrent urinary infections, bladder stones or repeated bleeding caused by the prostate

• changes in the bladder or kidneys resulting from longstanding obstruction

Suitability depends on the size and shape of the prostate, symptoms and test results, general health and fitness for anaesthetic, and the patient’s priorities — particularly around ejaculation, which is discussed below.

Assessment usually includes a symptom score, examination, urine test and PSA where appropriate, together with a urinary flow rate and measurement of urine remaining in the bladder after voiding. An ultrasound or flexible cystoscopy may be arranged to assess the size and shape of the prostate and to look inside the bladder.

Dr Yip will discuss TURP alongside alternatives including medication, Rezūm, UroLift and, where appropriate, monitoring without immediate treatment.

TURP is performed under general anaesthetic and usually takes around 30 to 60 minutes, depending on the size of the prostate.

Before surgery, the hospital will provide fasting instructions and Dr Yip will explain which medicines, particularly blood thinners, need to be managed. Blood-thinning medication should not be stopped unless the prescribing doctor and Dr Yip have given specific instructions.

A catheter is placed at the end of the operation. Fluid is usually passed through it during the early recovery period to wash the bladder and reduce clot formation.

The catheter commonly remains for about two days, and the hospital stay is often about two nights. The timing varies according to bleeding, urine flow and individual recovery. The catheter is removed when the urine has cleared sufficiently, and discharge occurs once the patient is passing urine satisfactorily.

If passing urine remains difficult, the catheter may need to stay in longer or be reinserted. Dr Yip will assess the cause and arrange further review.

The first few weeks. Stinging, urgency, frequency and waking at night to pass urine are usual after TURP and settle gradually. Improvement in the urinary stream may be noticed early, while irritative symptoms can take longer to settle.

Bleeding. Intermittent blood in the urine is expected and may recur around two to three weeks after surgery as the surface heals. Rest and increased fluid intake often help it settle.

Activity. Avoid heavy lifting, straining and vigorous exercise for four to six weeks, and avoid constipation, as these can provoke bleeding.

Work. Many patients take two to four weeks away from work, depending on recovery and the physical demands of the job. Dr Yip will provide individual advice.

Potential benefits. By removing obstructing tissue, TURP may improve urinary flow, bladder emptying and symptoms. It may be considered for some larger prostates, after urinary retention, or when other treatments are unsuitable. The removed tissue is examined by a pathologist and may occasionally show an unexpected abnormality, including prostate cancer. Individual results vary.

Limitations. TURP requires an anaesthetic, catheter and hospital stay. Recovery is generally longer than after Rezūm or UroLift. A permanent reduction or loss of forward ejaculation is common, and further prostate treatment may be needed if symptoms recur or remaining tissue enlarges.

Change in ejaculation (retrograde ejaculation). This is the most common effect of TURP and affects around 70 in 100 men. Semen passes backwards into the bladder at orgasm instead of outwards, and is then passed harmlessly in the urine. The sensation of orgasm is generally unchanged, but the ejaculate is reduced or absent, and fertility is affected. Anyone who may wish to father children should tell Dr Yip before surgery.

Bleeding. Some bleeding is expected. A small number of patients bleed enough to require a blood transfusion, or need to return to theatre to control bleeding or remove clots. The need to return to theatre for bleeding is around 1 in 100.

Infection. Urinary infection can occur and antibiotics are given at the time of surgery. Occasionally infection is more serious and requires treatment in hospital.

Urethral stricture or bladder-neck narrowing. Scarring in the urethra or at the bladder neck can develop months or years later and may require a further procedure.

Urinary incontinence. Temporary urgency and leakage while recovery continues are common. Lasting incontinence affects fewer than 1 in 100 men.

Erectile dysfunction. Most men notice no change in erections. New erectile problems affect around 1 in 10 men.

Absorption of irrigating fluid. The older monopolar technique carried a risk that absorbed irrigating fluid could dilute salts in the blood. Bipolar TURP uses saline and reduces this risk, although fluid and electrolyte complications remain possible.

Need for further surgery. Remaining prostate tissue can enlarge again over time. Around 10 in 100 men require a repeat procedure, typically eight to twelve years later.

Dr Yip will review the patient after surgery to check symptoms, urinary flow and the pathology result.

Seek medical attention promptly if you are unable to pass urine, develop a fever or shaking chills, or pass heavy bleeding or clots that do not settle with rest and fluids.