Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
Living with an enlarged prostate can make a man start to feel old. He might remember his father always needing to be near a bathroom, or his grandfather who needed to wear diapers just before the end of his life. Do these new symptoms signal the beginning of the end for him?
Perhaps his doctor has told him about a promising procedure called transurethral resection of the prostate, or TURP surgery. But by now his antennae are up. Is the surgery dangerous? Could he die from it?
Such questions are even more pressing for older men who have seen peers decline and pass away after seemingly minor accidents and surgeries. So what do the data tell us about the repercussions of TURP surgery? Can a man realistically expect to live a long and healthy life after the procedure, or does it entail a high post-operative mortality rate?
The symptoms experienced by some (but certainly not all) men with enlarged prostate are caused by the oversized gland pressing up against the narrow tube that carries urine from the bladder, called the urethra. The urethra extends all the way to the glands of the penis, to the opening from which urine is expelled from the body. The prostate surrounds one section of the urethra even in its normal state, but it does not block the urethra until the prostate undergoes excessive growth starting in middle age.
The TURP procedure is a method of taking pressure off the urethra by cutting away the parts of the prostate that are encroaching on it. Rather than making an incision, the surgeon inserts a long, narrow device into the urethra at the opening of the penis, through which the urinary tract can be viewed. Using the same device, which is equipped with an electrified wire loop, the surgeon cuts the excessive tissue off the prostate.
A TURP is done in the hospital under anesthesia. It takes about an hour or hour and a half and usually requires a hospital stay of one to three days, during at least part of which a catheter is used for urination.
TURP surgery recovery can often take a few weeks, with most men resuming normal activity well within six weeks. One of the most common questions asked is, “How long does it take to pee normally after TURP surgery?” The answer varies from one person to the next, but sometimes the bladder’s muscles need to be retrained. For up to six weeks, you might struggle with urinary incontinence or leakage. And there may be burning or discomfort when you urinate for the first few days after the TURP.
Occasionally the procedure is associated with new-onset erectile dysfunction or ejaculation problems. However, TURPs are 85%-90% effective at improving urinary symptoms, with only about 8% of men needing additional surgical intervention after five years.
It’s very rare to die during or from a TURP procedure. The current estimate is that fewer than one in 1,000 TURP patients die as a direct result of TURP. When a TURP turns fatal, it’s generally because of heart-related complications or from post-surgical infections.
Several studies have looked at the longer-term risks of death after TURP.
At first glance, one paper published in the Journal of the American Geriatric Society in 2018 raises eyebrows. Among the men studied who had had TURP or a similar procedure called TULIP, 32% were dead within one year. But these men were not at all representative of the broad population of TURP candidates. They were nursing home residents with an average age of almost 81, and 61% of them were using catheters before the procedure. Many were frail going into the TURP. A high rate of death among men with those characteristics over a one-year period is to be expected.
Other results are both more applicable and more reassuring. In 2022, the World Journal of Urology published data showing that, among men who underwent TURP for BPH, only 1.16% died within 90 days of their procedure. The figure for the rate of “excess mortality,” meaning the percentage of deaths higher than what one would normally expect to find in a given population, was only 0.5%. Unsurprisingly, once again the men who died tended to be older and sicker, with more comorbidities (simultaneously occurring conditions), especially an irregular heart rhythm called atrial fibrillation. But were these men dying from things related to BPH? Were they dying from complications of the TURP? The answer to both of these questions appears to be no. The most common causes of death were cancer and heart disease, which together accounted for more than 65% of deaths.
But what about death from prostate cancer? Could the act of resecting the prostate stimulate the growth of cancer cells, leading to increased risk of death from prostate cancer? Another 2022 study looked at the outcomes of 64,000 men who had undergone TURP procedures. Some men had prostate cancer at the time of their TURP, but around two-thirds of the men’s enlarged prostates were benign (BPH). After 15 years, 1.4% of the entire study population (combining both those who had had cancer at the time of the TURP and those who hadn’t) had died from prostate cancer. That’s a very reassuring number, given that the death rate for prostate cancer in the general population is one in 44 men, or 2.27%. (That 2.27% figure is for a whole lifetime rather than just a 15-year period).
The numbers looked even more promising for men with lower levels of prostate-specific antigen, or PSA, which is often used as an indicator of the presence of cancer. For men whose PSA levels were lower than 10 nanograms per milliliter (ng/mL) at the time of their TURPs, the mortality rate from prostate cancer was only 0.8% at the 15-year mark. The study authors concluded that “men with low PSA levels and a benign TURP can be reassured about their cancer risk and do not need to be monitored differently than any other men.”
