The most common long-term complication following a Transurethral Resection of the Prostate (TURP) is retrograde ejaculation. This condition is highly prevalent, occurring in as many as 90% of cases.
Understanding Retrograde Ejaculation
Retrograde ejaculation is a condition where semen, during orgasm, travels backward into the bladder instead of being expelled forward through the penis. While not harmful to health and typically not affecting the sensation of orgasm, it can lead to infertility.
How TURP Contributes to Retrograde Ejaculation:
During a TURP procedure, excess prostate tissue is removed to relieve urinary symptoms. This surgical intervention can alter the internal structures responsible for ejaculation:
- Bladder Neck Widening: The procedure often widens the bladder neck, the muscular opening at the base of the bladder that normally closes during ejaculation to prevent semen from entering.
- Sphincter Damage: In some instances, the internal urethral sphincter, which helps direct semen forward, can be affected, leading to its inability to close properly.
As a result, the path of least resistance for semen becomes the bladder, leading to its mixture with urine.
Other Potential Complications of TURP
While retrograde ejaculation is the most common long-term complication, it's important to understand that TURP, like any surgical procedure, carries a range of potential risks and complications. These can be broadly categorized into immediate (perioperative) and longer-term issues.
Learn more about TURP complications from reputable health organizations.
Common TURP Complications
| Type of Complication | Description | Prevalence / Impact |
|---|---|---|
| Immediate | ||
| Bleeding | Blood in the urine (hematuria) is common initially, with severe bleeding requiring transfusion in a small percentage of cases. | Typically resolves within days; rarely severe. |
| Infection | Urinary tract infections (UTIs) are a risk after any catheterization or surgery involving the urinary tract. | Managed with antibiotics. |
| TURP Syndrome | A rare but serious condition caused by excessive absorption of irrigation fluid, leading to electrolyte imbalance. | Occurs in about 0.5-1% of cases; potentially life-threatening if not managed. |
| Long-Term | ||
| Retrograde Ejaculation | Semen flows backward into the bladder during orgasm. | Most common; up to 90% of cases. |
| Erectile Dysfunction | Difficulty achieving or maintaining an erection. | Less common than previously thought, affecting a small percentage of men. |
| Urinary Incontinence | Leakage of urine, ranging from mild dribbling to complete loss of bladder control. Usually temporary, but can be persistent in some cases. | Affects 2-5% long-term; often temporary stress incontinence. |
| Urethral Stricture | Narrowing of the urethra due to scar tissue, which can obstruct urine flow. | Occurs in 2-10% of cases; may require further procedures. |
| Bladder Neck Contracture | Narrowing of the opening of the bladder, similar to urethral stricture, causing obstruction. | Less common, affecting around 1-5% of patients. |
| Need for Re-treatment | In some cases, prostatic tissue can regrow, leading to a recurrence of symptoms and potentially requiring another TURP or alternative treatment. | Varies; long-term rates suggest 10% may need re-treatment within 5-10 years. |
Managing and Addressing Complications
For patients experiencing complications after TURP, various strategies are available:
- Retrograde Ejaculation:
- Often, no treatment is needed as it is not medically harmful.
- For men desiring fertility, sperm retrieval techniques and assisted reproductive technologies may be considered.
- Some medications can help tighten the bladder neck, but success rates vary.
- Urinary Incontinence:
- Pelvic floor exercises (Kegels) can strengthen muscles.
- Medications or surgical options (e.g., slings, artificial urinary sphincters) may be considered for persistent, severe cases.
- Urethral Strictures/Bladder Neck Contracture:
- Can be treated with endoscopic procedures (dilation, incision) or open surgery.
Understanding the potential complications, especially the high likelihood of retrograde ejaculation, is crucial for patients considering TURP, allowing them to make informed decisions and prepare for potential post-operative changes.
