Retention of Urine and Incomplete Bladder Emptying after TURP and Bipolar TURP (Transurethral Resection of Prostate)
by Dr. Alex Shteynshlyuger, a board-certified urologist and specialist in the treatment of enlarged prostate, BPH and urinary retention. He is one of the first urologists in the US and NYC to offer Urolift and prostate enucleation, an alternative to traditional TURP as a treatment for enlarged prostate.
What is the Cause of Incomplete Bladder Emptying and Retention after TURP and Bipolar TURP?
Urinary retention after transurethral resection of the prostate (TURP or bipolar TURP) can occur in as many as 20% of men.
Urinary retention after TURP can be transient due to small blood clots obstructing the flow or postoperative swelling. Urinary retention after anesthesia can also occur temporarily.
Some men have persistent urinary retention after transurethral resection of prostate and are unable to urinate after multiple trials of void (multiple attempts to remove the urinary catheter).
Some men have a persistent sensation of incomplete bladder emptying after TURP. They are able to urinate but may not be emptying the bladder completely and may still have persistent urinary symptoms such as frequent urination, slow urine stream and the need to wake up multiple times at night to urinate.
At New York Urology Specialists, we specialize in treating men with persistent urinary retention after TURP and other surgeries.
Most common causes of incomplete bladder emptying and retention of urine after TURP and bipolar TURP as follows:
- Urinary clot retention
- Poorly functioning bladder muscles (detrusor hypotonia)
- Large prostate with incomplete resection of obstructive prostate tissue
- Urethral stricture after TURP or bipolar TURP
- Narcotic pain medications and anticholinergic medications
Treatment of Urinary Retention after TURP and Bipolar TURP
The short-term approach to treating urinary retention after bipolar TURP is to make sure the bladder is emptying completely. Typically, urinary catheterization with a Foley catheter is performed. Foley catheter is a catheter that empties your bladder to a bag that drains urine, typically strapped to your thigh. At New York Urology Specialists, whenever possible, we try to teach patients to do clean intermittent catheterization (CIC) which means the patient uses a small catheter to self-catheterize himself 3-4 times a day to empty the bladder. More than 85% of our patients are able to self-catheterize successfully. This minimizes the risk of infection and complications.
Most of the time, a patient is able to urinate on his own within a few weeks after TURP. If urinary retention or incomplete bladder emptying persists after a few weeks, a thorough re-evaluation should be performed.
Typically, a uroflow test with post-void urinary residual measurement is performed. Cystoscopy is a very valuable test in this situation. If a urodynamic study was not performed prior to TURP, a urodynamic study is used to determine whether the bladder detrusor muscle is functioning normally. Urodynamics study can also help elucidate whether there is a dynamic obstruction during urination.
Treatment Options for Persistent Urinary Retention in Adult Men after Bipolar and Mono-polar TURP.
Urinary retention after TURP can be classified into 2 categories: obstructive urinary retention and non-obstructive urinary retention.
Obstructive urinary retention is caused by urinary blockage, typically persistent obstructive prostate tissue, or development of urethral stricture or bladder neck contraction (a type of scarring after surgery). Meatal stenosis (narrowing of the tip of the penis) is a common type of urethral stricture after TURP and bipolar TURP occurring in 2-5% of patients.
For patients who developed meatal stenosis, urethral stricture or bladder neck contraction, surgical procedure, urethroplasty or internal optical urethrotomy, is typically necessary to correct urethral narrowing.
For patients with obstructive urinary retention caused by persistent obstructive prostate tissue, treatment options include prostate enucleation, open or robotic prostatectomy, repeat TURP, Greenlight laser procedure or a similar transurethral procedure.
At New York Urology Specialists, our extensive experience with prostate enucleation makes it the preferred approach to treating patients with very large prostate including those patients who have persistent urinary retention caused by the large obstructive prostate. Studies show that laser prostate enucleation allows for minimally invasive, optimal removal of blocking tissue in men with very large prostates without the need for open surgery.
Non-obstructive urinary retention is caused by poorly functioning bladder muscle that does not contract properly to expel urine from the bladder. This may be caused by abnormal innervation or abnormal muscle function. Typically, treatment of non-obstructive urinary retention is more challenging. Many patients can be helped with InterStim neuromodulation for non-obstructive urinary retention. Clean-intermittent catheterization is preferred over indwelling urinary catheters whenever practical and possible.
Treatment Options for Persistent Symptoms of Incomplete Emptying after TURP.
For patients who have persistent symptoms of incomplete bladder emptying after TURP, re-evaluation needs to be performed. If patients have a persistent obstruction, depending on the severity of obstruction number of options are available.
If the residual prostate tissue is extensive and obstruction is moderate to severe, laser enucleation of the prostate or Greenlight laser of the prostate can be performed.
For patients with mild residual obstruction, Urolift procedure or Rezum procedure for enlarged prostate can be performed in the convenience of the office without the need for general anesthesia.
For patients who have a large bladder diverticulum, bladder diverticulectomy can often improve voiding function but care needs to be taken before proceeding with bladder diverticulectomy as some patients have small bladder capacity and may be worse off after diverticulectomy than before.
Some patients, timed voiding can help with the urinary symptoms. For patients with nonobstructive incomplete bladder emptying, InterStim procedure can be of benefit.
Why Choose New York Urology Specialists for Treatment of Urinary Retention after TURP
- All treatment is performed by a Board-certified urologist experienced in treating men with symptoms of BPH using medical therapy, minimally invasive therapies, lasers and open surgery.
- We are one of the few practices in the region to offer a full range of options for treatment of BPH.
- We offer BPH treatment options under local anesthesia which avoids the risks, costs, and recovery from general anesthesia. Most men are able to return to office work and other normal activities the next day.
- Extensive Experience: Hundreds of men treated successfully using medical therapy, Urolift, lasers for BPH (Holmium, Thulium, Evolve, Greenlight lasers), Bipolar TURP, traditional TURP, open suprapubic prostatectomy, robotic suprapubic prostatectomy for BPH.
- We treat men with BPH who have heart problems (hypertension, CAD, CHF), renal failure (ESRD) on hemodialysis, men on blood thinners such as aspirin, Lovenox, Coumadin (Warfarin), apixaban, rivaroxaban (Xarelto).
When it comes to experience and innovation – New York Urology Specialists are a step ahead. Better Science Means Better Care. We specialize in minimally invasive highly effective treatment for symptoms of enlarged prostate and BPH. Many treatment procedures are performed in the convenience and privacy of office settings under local anesthesia.
Medicare and major insurances accepted. We offer affordable rates and financing options.
Schedule an Appointment with Dr. Shteynshlyuger:
Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urinary problems in men. He uses modern effective and proven treatment methods including prostate enucleation and Urolift for BPH. He is highly recommended by top primary care physicians in the New York area.
He has successfully performed hundreds of prostate procedures in adults. Urolift procedures are performed in the office under local anesthesia, in a surgical center and affiliated hospitals under anesthesia.
We offer affordable, highest-quality urology care with or without insurance. Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.