TURP Surgery in Singapore | Enlarged Prostate Treatment

TURP (Transurethral Resection of the Prostate) surgery in Singapore is a surgical procedure that removes portions of an enlarged prostate gland to restore normal urine flow. During this procedure, a urologist inserts a specialised instrument called a resectoscope through the urethra (the tube that carries urine from the bladder) to reach the prostate without making any external incisions.

The resectoscope contains a wire loop that uses electrical current to cut away excess prostate tissue that’s pressing against the urethra. As tissue is removed, the surgeon continuously flushes the area with fluid to maintain clear visibility and wash away tissue fragments. This procedure specifically targets the inner portion of the prostate that surrounds the urethra, leaving the outer prostate capsule intact.

TURP surgery effectively treats moderate to severe symptoms of benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that affects approximately 50% of men over 60 and up to 90% of men over 80. The procedure has been performed successfully for decades and remains one of the most effective surgical treatments for enlarged prostate symptoms.

Ideal Candidates

• Men with moderate to severe BPH symptoms that significantly impact daily life
• Patients who haven’t responded adequately to medication therapy
• Those experiencing urinary retention requiring catheter use
• Men with recurrent urinary tract infections due to incomplete bladder emptying
• Patients with bladder stones caused by urine retention
• Those with kidney problems resulting from urinary obstruction
• Men whose prostate size is between 30-80 grams (determined through ultrasound or examination)
• Patients healthy enough to undergo surgery with spinal or general anaesthesia

Contraindications

• Active urinary tract infection (must be treated before surgery)
• Uncorrected bleeding disorders or use of blood thinners that cannot be stopped
• Severe heart or lung conditions making surgery unsafe
• Neurogenic bladder dysfunction
• Prostate cancer requiring different treatment approaches
• Urethral strictures that prevent instrument insertion
• Very large prostates (over 100 grams) may require alternative procedures

A thorough evaluation by an MOH-accredited urologist is essential to determine if TURP surgery is appropriate for your specific condition. Your surgeon will consider your symptoms, prostate size, overall health, and personal preferences when recommending treatment.

Standard TURP (Monopolar TURP)

Standard TURP uses monopolar electrical current to remove prostate tissue. The electrical current passes through the wire loop, through the tissue, and returns via a grounding pad placed on the patient’s body. This traditional approach requires glycine irrigation fluid during the procedure. While effective, surgeons must monitor fluid absorption carefully to prevent complications. This technique has been used successfully for decades and provides good long-term results for appropriately sized prostates.

Bipolar TURP

Bipolar TURP represents a refinement of the traditional technique. In this approach, both electrical poles are contained within the resectoscope, allowing the use of normal saline irrigation instead of glycine. This modification reduces the risk of TUR syndrome (a rare complication from fluid absorption) and allows for longer operating times if needed. Bipolar TURP also typically results in less bleeding and may permit earlier catheter removal.

Technology & Equipment Used

Modern TURP procedures utilise high-definition camera systems providing magnified views of the surgical field. The resectoscope features precise wire loops available in various sizes to match patient anatomy. Continuous flow systems maintain clear visualisation by simultaneously irrigating and draining fluid. Some centres employ laser-assisted visualisation to enhance tissue identification. Contemporary coagulation settings on the electrical generator help minimise bleeding during tissue removal.

Pre-Treatment Preparation

Before your TURP surgery, you’ll undergo blood tests, urine analysis, and possibly an electrocardiogram to ensure you’re fit for the procedure. Your urologist may perform a cystoscopy to examine your urethra and bladder. Stop blood-thinning medications as directed, typically 5-7 days before surgery. You’ll need to fast from midnight before your procedure. Arrange for someone to drive you home after discharge, as you won’t be able to drive immediately post-surgery. Your surgeon may prescribe antibiotics to start the day before surgery to prevent infection.

During the Procedure

Upon arrival, you’ll change into a hospital gown and receive either spinal anaesthesia (numbing from the waist down while remaining awake) or general anaesthesia. Once comfortable, you’ll be positioned with your legs elevated in stirrups. The surgeon inserts the resectoscope through your penis into the urethra, advancing it to the prostate. Using the wire loop, they systematically remove prostate tissue in small chips, starting from the middle and working outward.

The procedure typically takes 60-90 minutes, depending on prostate size. Throughout surgery, irrigation fluid continuously flushes the area, maintaining visibility and removing tissue fragments. The surgeon carefully controls bleeding using the coagulation function. Once adequate tissue is removed to create a wide channel for urine flow, the resectoscope is withdrawn and a catheter is inserted to drain your bladder.

Immediate Post-Treatment

After surgery, you’ll recover in the post-anaesthesia care unit where nurses monitor your vital signs and comfort level. The catheter will continuously drain urine mixed with blood, which is normal. Continuous bladder irrigation may run through the catheter to prevent blood clots. Most patients stay in hospital for 1-2 nights. Pain is usually minimal, though you may experience bladder spasms. Your medical team will encourage early walking to prevent blood clots and promote recovery.

First 24-48 Hours

During the initial recovery period, expect blood-tinged urine, which gradually lightens in colour. Drink plenty of water to flush your bladder and prevent clots. Bladder spasms may cause sudden urges to urinate around the catheter—these are normal and manageable with medication. Avoid straining during bowel movements; your doctor may prescribe stool softeners. Walk regularly but avoid strenuous activity. Most patients have their catheter removed before discharge, though some may go home with it for a few extra days.

First Week

Once home, continue drinking 8-10 glasses of water daily to maintain clear urine. You may notice occasional blood in your urine, especially after activity—this is normal. Urinary frequency, urgency, and mild burning during urination are common as your body adjusts. Avoid heavy lifting (over 5kg), strenuous exercise, and sexual activity. Take prescribed antibiotics as directed. Return to light activities and work (if sedentary) within a few days. Contact your doctor if you experience fever, inability to urinate, or heavy bleeding with clots.

Long-term Recovery

Complete healing typically takes 6-8 weeks. During weeks 2-4, gradually increase activity levels but continue avoiding heavy lifting and strenuous exercise. You may return to sexual activity after 3-4 weeks, though retrograde ejaculation (semen entering the bladder) is common and permanent in most cases. By week 6, most men can resume all normal activities. Improvement in urinary symptoms continues for several months as swelling resolves. Follow-up appointments at 6 weeks and 3 months assess your progress and symptom improvement.

TURP surgery provides significant improvements in urinary symptoms for most men with enlarged prostates. Patients typically experience stronger urine flow, with studies showing flow rates improving by 70-120%. The constant feeling of needing to urinate decreases dramatically, and most men can sleep through the night without multiple bathroom trips. Complete bladder emptying becomes possible again, reducing the risk of urinary tract infections and bladder stones.

The procedure offers long-lasting results, with 85-90% of men experiencing sustained symptom relief for 10-15 years. Many patients report improved quality of life, better sleep, and increased confidence in social situations. Unlike medication that requires daily compliance, TURP provides a one-time solution for most patients. The minimally invasive nature means no external incisions, faster recovery than open surgery, and minimal scarring. For men who’ve struggled with catheter dependence, TURP often restores natural urination.

Common Side Effects

The most frequent side effect is retrograde ejaculation, occurring in 75-90% of patients, where semen flows backward into the bladder during orgasm. While this affects fertility, it doesn’t impact the sensation of orgasm or erectile function. Temporary urinary incontinence affects some men but typically resolves within weeks to months with pelvic floor exercises. Blood in urine intermittently appears for several weeks post-surgery, especially after physical activity. Urinary tract infections occur in about 5-10% of patients despite preventive antibiotics.

Rare Complications

Serious complications are uncommon with experienced surgeons. TUR syndrome, caused by excessive fluid absorption, occurs in less than 1% of cases with modern techniques. Urethral stricture (scarring) may develop months later in 2-5% of patients, treatable with dilation. Significant bleeding requiring transfusion affects fewer than 5% of patients. Complete urinary incontinence is rare, occurring in less than 1% of cases. Some men (5-10%) may require repeat surgery years later if the prostate continues growing.

Choosing an experienced MOH-accredited urologist and following post-operative instructions carefully minimises these risks significantly. Modern surgical techniques and equipment have made TURP safer than ever.

TURP surgery costs in Singapore vary based on several factors including hospital choice, room type, and surgeon’s fees. The total cost typically encompasses surgeon fees, anaesthetist charges, hospital stay (1-2 nights), operating theatre time, equipment and consumables, medications, and follow-up consultations. Private hospital costs generally exceed those at restructured hospitals.

The procedure cost may increase if complications arise requiring extended hospitalisation or additional treatments. Pre-operative tests and post-operative medications are usually charged separately.

During your consultation, request a detailed cost estimate including all components. Consider the value of experienced surgical care and comprehensive follow-up when making your decision. Quality outcomes often justify the investment in your long-term health and quality of life.