Management of the Failed Transurethral Resection of the Prostate

Transurethral resection of the prostate (TURP) is the gold standard for treatment of symptomatic benign prostatic enlargement. Failure of TURP and other similar procedures may occur when a patient has poor bladder emptying postoperatively or has persistent or de novo bothersome postoperative lower urinary tract symptoms. Reasons for failure include inadequate resection, clot retention, anesthesia-related side effects, postoperative pain, hypo- or acontractile bladder, and/or poor patient selection. Patients initially can be managed conservatively or proactively. When clinically significant storage or voiding dysfunction persists, evaluation is necessary and may include cystoscopy and/or urodynamics. Depending on the diagnosis and etiology, patients can then be managed with an array of therapies, including urethral catheterization, oral medications, intravesical botulinum A toxin, neuromodulation, or further surgery as indicated.