Transurethral Resection of the Prostate (TURP)
Benign prostatic hyperplasia with lower urinary tract symptoms / urinary retention
Same
Transurethral resection of the prostate (TURP), [monopolar / bipolar]
[***, MD/DO]
[Resident/Fellow/PA name]
Spinal / general
Patient presents with [symptomatic BPH / urinary retention / recurrent UTIs / gross hematuria / bladder stones from BPH] refractory to [or not a candidate for] medical management. Prostate volume approximately [X] grams on TRUS/MRI. AUA symptom score [X]. Risks including retrograde ejaculation (65-75%), bleeding, TUR syndrome (hyponatremic form eliminated with bipolar/saline; fluid overload remains possible with prolonged resection in either approach), urethral stricture, bladder neck contracture, and urinary incontinence discussed. Consent obtained.
Cystoscopy revealed [X]-gram appearing prostate with [lateral lobe / median lobe / trilobar] hyperplasia. Bladder mucosa [normal]. No evidence of bladder tumor. Ureteral orifices visualized bilaterally. Bladder capacity approximately [X] mL.
The patient was placed in dorsal lithotomy position and prepped and draped in sterile fashion. A [26-French] continuous flow resectoscope with [bipolar electrode and normal saline irrigant / monopolar electrode and glycine 1.5% irrigant] was introduced under direct visualization. Cystourethroscopy was performed confirming [above] findings.
Resection was initiated at the [bladder neck / median lobe] and carried systematically through the [lateral lobes], using the verumontanum as the distal resection landmark to protect the external sphincter. [Bipolar resection was performed with normal saline irrigant, which eliminates the risk of hyponatremic TUR syndrome; fluid balance and signs of absorption were monitored throughout.] [Monopolar resection was performed with glycine 1.5% (non-conducting) irrigant; resection time limited and intraoperative serum sodium monitored given risk of TUR syndrome.] Obstructing tissue was resected systematically. Hemostasis was achieved by roller-ball coagulation. The surgical capsule was identified bilaterally, confirming adequate resection.
Resected chips were evacuated with Ellik evacuator. Estimated resected tissue weight [X] grams. Final cystoscopy confirmed adequate channel, hemostasis, and intact ureteral orifices.
A [22-French] three-way Foley catheter was placed and the balloon inflated to [30] mL for traction hemostasis. Continuous bladder irrigation initiated. Patient tolerated the procedure well.
None
Prostate chips sent to pathology
Minimal to [X] mL (intravascular irrigation losses not quantifiable)
[22-Fr] three-way Foley catheter to continuous bladder irrigation
Patient was taken to PACU in stable condition. Admitted overnight for catheter irrigation. Catheter removed when urine is clear and trial of void confirms adequate emptying.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: Benign prostatic hyperplasia with [lower urinary tract symptoms / urinary retention]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Transurethral resection of the prostate (TURP), [monopolar / bipolar]
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: Spinal / general
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with symptomatic BPH [/ urinary retention / recurrent UTIs / gross hematuria] refractory to medical management. Prostate volume approximately *** grams; AUA symptom score ***. Risks including retrograde ejaculation (65-75%), bleeding, TUR syndrome (eliminated for hyponatremic form with bipolar/saline; fluid overload remains possible), urethral stricture, and incontinence discussed. Informed consent obtained.
FINDINGS: Cystoscopy: approximately *** gram prostate with [lateral / median / trilobar] hyperplasia. Bladder normal. No tumor. Ureteral orifices normal bilaterally.
DESCRIPTION OF PROCEDURE:
Dorsal lithotomy. Prepped sterile. 26-Fr continuous flow resectoscope with [bipolar/saline / monopolar/glycine 1.5%] introduced. Cystourethroscopy confirmed findings. Resection initiated at bladder neck/median lobe, carried through lateral lobes; verumontanum as distal landmark. [Bipolar/saline: hyponatremic TUR syndrome eliminated; fluid balance monitored.] Obstructing tissue resected systematically. Hemostasis: roller-ball coagulation. Surgical capsule identified bilaterally. Chips evacuated with Ellik; estimated resected weight *** grams. Final cystoscopy: adequate channel, hemostasis, orifices intact. 22-Fr three-way Foley placed; balloon 30 mL traction; CBI initiated. Patient tolerated procedure well.
ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: Prostate chips to pathology
COMPLICATIONS: None
DRAINS: 22-Fr three-way Foley to CBI
DISPOSITION: PACU. Admitted overnight for CBI.
Signed: .ME, .MYDEGREE
.TODAYVariants
Holmium laser enucleation of the prostate (HoLEP)
Per 2023 AUA BPH guideline, HoLEP is size-independent and is the preferred approach for large glands (>80 g) and very large glands (>150 g); it can be performed for any prostate size when expertise is available. Document laser settings, systematic enucleation of median and lateral lobes, morcellation, and estimated specimen weight.
Photoselective vaporization — GreenLight PVP
80W, 120W, or XPS 180W KTP/LBO laser. Vaporizes prostatic tissue without specimen recovery. Document laser energy delivered (Joules), vaporization of each lobe, and lack of chip/specimen for pathology (PVP is not routinely sent for pathology). If tissue sampling is desired, send separately obtained biopsies.
Bipolar TURP (standard of care in most centers)
Bipolar uses normal saline irrigant, which eliminates hyponatremic TUR syndrome (free water absorption causing dilutional hyponatremia). Note: fluid overload/dilutional effects from saline absorption remain possible with prolonged resection time or large volume absorption — monitor fluid balance.
Transurethral incision of prostate (TUIP)
For small glands (<30 g, no significant median lobe). Two incisions from bladder neck to verumontanum at 5 and 7 o'clock positions to relieve outflow obstruction without tissue removal. No chips sent to pathology. Document gland size, incision locations, and absence of resection.
Charting Tips
- Document monopolar vs. bipolar and specific irrigant used. Monopolar requires electrolyte-free non-conducting solution (glycine 1.5%, sorbitol, or mannitol — not just glycine; each has different toxicity profiles). Bipolar uses normal saline. Document both choice and reason (bipolar eliminates hyponatremic TUR syndrome).
- Document verumontanum as distal resection landmark (prevents external sphincter injury and incontinence).
- Document gland volume (preoperative imaging) and estimated resected weight on pathology (supports medical necessity and completeness of resection).
- All prostate chips must be sent to pathology — incidental prostate cancer found in approximately 4-14% of TURP specimens. Document specimen sent.
- For monopolar cases, document resection time, irrigant type and approximate volume, and any signs of fluid absorption or TUR syndrome (hyponatremia, visual symptoms, bradycardia).
- Catheter traction hemostasis: document balloon volume and that traction was applied. Standard 3-way Foley balloon rated to 30 mL — do not overfill.
Documentation & Reimbursement Considerations
- Report Transurethral Resection of the Prostate (TURP) as the primary service when it is the definitive operation performed.
- The 90-day global includes all post-op catheter management, office cystoscopy, and routine follow-up.
- Document the prior TURP, approximate time since prior procedure, and current symptoms. If the repeat TURP is performed within the 90-day global period of the original, use related unplanned return-to-the-operating-room reporting (unplanned return to OR for a complication of the primary procedure).
- It is mutually exclusive with the primary service (you cannot incise and resect in the same procedure).
- Global period is 90 days (major).
- These replace open prostatectomy in many high-volume centers. Document gland weight — medical necessity for open simple prostatectomy requires gland size exceeding the threshold for safe endoscopic resection.
- Document gland weight/volume resected (grams on pathology). This supports medical necessity and differentiates complete from partial resection. All prostate chips must be sent to pathology — incidental prostate cancer is found in approximately 4-14% of TURP specimens.