When to Consider TURP for BPH

Benign prostatic hyperplasia (BPH) is a common condition that affects many men as they age, causing urinary symptoms such as frequent urination and weak urine flow. Medication is usually the first step, and when a procedure is needed, Dr. Shusterman's first-line choice is prostate artery embolization (PAE), with Rezūm as the alternative. Transurethral resection of the prostate (TURP) is a different kind of option: invasive surgery that he reserves for a minority of men. Not all men with BPH need TURP, and factors such as symptom severity, prostate size, and prior treatment history matter when deciding on a treatment plan. In this blog, we will explore when it is appropriate to consider TURP as a treatment for BPH.

What is TURP?

Transurethral resection of the prostate (TURP) is an invasive surgical procedure used to treat benign prostatic hyperplasia (BPH), a common condition in older men that causes the prostate gland to enlarge and obstruct the flow of urine from the bladder. During TURP, a surgeon uses a resectoscope, a special tool with a wire loop at the end, to remove small pieces of the prostate gland that are blocking the urethra. The procedure is performed through the urethra, so no skin incisions are needed, but it requires general or spinal anesthesia, a catheter afterward, and typically a hospital stay of one to two days. TURP can relieve the urinary symptoms of BPH and improve urine flow, reducing the risk of complications such as urinary tract infections and kidney damage.

TURP has some recognized strengths, along with significant trade-offs:

• Established track record: TURP has long been the standard surgical treatment against which other procedures are compared. It can improve urinary symptoms, increase urine flow, and reduce the risk of complications such as urinary tract infections and bladder stones.
• Long-lasting results: The effects of TURP are typically long-lasting, with most men experiencing relief from their symptoms for many years.
• Performed through the urethra: TURP is an endoscopic surgical procedure performed through the urethra, so no external incisions are needed. This can mean less pain and a shorter recovery than open surgery, although it still requires anesthesia and a catheter.
• Sexual side effects: Most men experience retrograde ejaculation after TURP, meaning semen flows backward into the bladder instead of out through the penis. Men who wish to preserve ejaculation should ask about alternative treatments.
• Hospital stay: TURP usually involves a hospital stay of one to two days and a catheter afterward. Same-day discharge is possible only in some cases, which is one reason it is considered invasive surgery rather than a minimally invasive procedure.

However, TURP is not without risks, and potential complications include bleeding, infection, retrograde ejaculation, urethral stricture, urinary incontinence, erectile dysfunction, and, rarely, TUR syndrome caused by fluid absorption. It is important to discuss the risks and benefits of TURP with a healthcare provider to determine if it is the best treatment option for a man’s individual situation.

Symptoms that may warrant TURP

The symptoms of benign prostatic hyperplasia (BPH) can vary in severity, and not all men with BPH require surgery. When symptoms are bothersome or interfere with quality of life, Dr. Shusterman usually recommends prostate artery embolization (PAE) as the first procedure, with Rezūm as the alternative, and reserves transurethral resection of the prostate (TURP) for a minority of men. Symptoms that may lead to a discussion of TURP include:

• Difficulty starting urination
• Weak urine flow or dribbling
• Frequent urination, especially at night (nocturia)
• Feeling like the bladder is not emptying completely after urination
• Urinary retention (inability to urinate)
• Urinary tract infections or bladder stones caused by urine backup
• Repeated blood in the urine caused by the enlarged prostate

If a man is experiencing any of these symptoms, he should talk to his urologist about treatment options. In our practice that usually means PAE first, with Rezūm as the alternative and TURP reserved for selected cases.

Other factors that may indicate TURP

In addition to symptom severity, there are other factors that may contribute to the decision to recommend transurethral resection of the prostate (TURP) as a treatment option for benign prostatic hyperplasia (BPH). These factors include:

• Prostate size: TURP is generally best suited to prostates of about 30 to 80 mL. For larger glands, Dr. Shusterman's answer is prostate artery embolization (PAE), which works well even in very large prostates over 80 to 100 grams.
• Urinary retention: If a man is unable to urinate or has a significant amount of urine that remains in the bladder after urination, a procedure to relieve the obstruction may be needed. PAE is often still an option, with TURP reserved for selected cases.
• Recurrent urinary tract infections: If a man is experiencing frequent urinary tract infections caused by urine backup, relieving the obstruction, with PAE or, in selected cases, TURP, may be needed to prevent further infections.
• Bladder stones: If urine backup is causing bladder stones, TURP may be necessary to remove the blockage and prevent further stone formation.
• Prior treatment history: If other treatments, such as medications or minimally invasive procedures, have not been effective in relieving BPH symptoms, TURP may be considered as a treatment option.

Ultimately, the decision to recommend TURP will depend on a man’s individual circumstances and the advice of his healthcare provider.

In Conclusion

In conclusion, transurethral resection of the prostate (TURP) is an established but invasive surgical treatment for benign prostatic hyperplasia (BPH). It can significantly improve urinary symptoms and urine flow and reduce the risk of complications such as urinary tract infections and bladder stones. It also requires anesthesia and a catheter, often a hospital stay, and most men experience retrograde ejaculation afterward, along with risks of bleeding and incontinence. For most men, Dr. Shusterman recommends prostate artery embolization (PAE) first, with Rezūm as the alternative, and reserves TURP for a minority. The decision should be made in consultation with your urologist, taking into account your individual circumstances and preferences.

Sources

1. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026). American Urological Association, 2026.
2. EAU Guidelines on the Management of Non-neurogenic Male LUTS. European Association of Urology, 2026.
3. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol, 2008.
4. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol, 2006.
5. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol, 2005.
6. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: Time for a bespoke approach?. Int J Urol, 2016.
7. Transurethral resection of the prostate. MedlinePlus (NLM).

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