Elsevier

European Urology

Volume 50, Issue 5, November 2006, Pages 969-980
European Urology

ESUT Special Paper
Complications of Transurethral Resection of the Prostate (TURP)—Incidence, Management, and Prevention

https://doi.org/10.1016/j.eururo.2005.12.042Get rights and content

Abstract

Objectives

To update the complications of transurethral resection of the prostate (TURP), including management and prevention based on technological evolution.

Methods

Based on a MEDLINE search from 1989 to 2005, the 2003 results of quality management of Baden-Württemberg, and long-term personal experience at three German centers, the incidence of complications after TURP was analyzed for three subsequent periods: early (1979–1994); intermediate (1994–1999); and recent (2000–2005) with recommendations for management and prevention.

Results

Technological improvements such as microprocessor-controlled units, better armamentarium such as video TUR, and training helped to reduce perioperative complications (recent vs. early) such as transfusion rate (0.4% vs. 7.1%), TUR syndrome (0.0% vs. 1.1%), clot retention (2% vs. 5%), and urinary tract infection (1.7% vs. 8.2%). Urinary retention (3% vs. 9%) is generally attributed to primary detrusor failure rather than to incomplete resection. Early urge incontinence occurs in up to 30–40% of patients; however, late iatrogenic stress incontinence is rare (<0.5%). Despite an increasing age (55% of patients are older than 70), the associated morbidity of TURP maintained at a low level (<1%) with a mortality rate of 0–0.25%. The major late complications are urethral strictures (2.2–9.8%) and bladder neck contractures (0.3–9.2%). The retreatment rate range is 3–14.5% after five years.

Conclusions

TURP still represents the gold standard for managing benign prostatic hyperplasia with decreasing complication rates. Technological alternatives such as bipolar and laser treatments may further minimize the risks of this technically difficult procedure.

Introduction

Despite the introduction of alternative techniques, transurethral resection of the prostate (TURP) still represents the gold standard in the operative management of benign prostatic hyperplasia (BPH) [1], [2], [3], [4], [5], [6], [7]. TURP underwent significant technical improvements during the last decade with major impact on the incidence of intra- and postoperative complications. On behalf of the European Society of Uro-technology, we focused on actual TURP practices [5], with the intention to update the status, technical advancement, prevention, and management of complications.

Section snippets

Methods

MEDLINE search on indications, techniques, technology, and incidence of complications after TURP in larger studies or randomized clinical trials included more than 9000 patients [1], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27]. We classified the relevant studies into three groups according to the periods of publication: early (1979–1993); intermediate (1994–1999); and recent (2000–2005). Additionally, we analyzed the 2003

Indications for TURP

Indications for operative management of BPH include [3], [4]:

  • -

    Recurrent urinary tract infection (UTI) caused by bladder outlet obstruction

  • -

    Recurrent episodes of urinary retention

  • -

    Bladder calculi

  • -

    Recurrent hematuria caused by bladder outlet obstruction

  • -

    Renal insufficiency caused by BPH

Bladder calculi may not be regarded as an absolute indication because only a small percentage of patients (8%) needed prostate surgery after ESWL in a recent study [28].

Contraindications represent untreated UTI and

Discussion

Mortality after TURP has decreased substantially during the past few decades to <0.25% in contemporary series (Table 1) [5], [7]. This might be mainly attributable to the advances in anesthesia and to the technical improvements of TURP [2].

Conclusions

The morbidity of contemporary TURP is lower than previously reported. This is based on a continuously improving armamentarium and technique, but is also related to a significant improvement in teaching modalities, including video technology such as video TUR, hands-on courses with phantoms, TURP courses with live demonstrations, and textbooks with CD-ROMs that demonstrate the steps of the technique [3]. Further technical improvement may also include the use of flexible instruments to improve

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