TURP Surgery in India and UAE | Complete Patient Guide

• Eligible patients: Men with moderate-to-severe BPH (IPSS ≥ 8–19 with bother, or IPSS ≥ 20) who have failed or are intolerant of medical therapy (alpha-1 blockers such as tamsulosin/silodosin, or 5-alpha reductase inhibitors such as finasteride/dutasteride, or combination therapy)

• Patients with prostate volume typically 30–80 mL are ideal for standard bipolar TURP; HoLEP may be preferred for glands > 80 mL

• Patients with recurrent acute urinary retention, obstructive uropathy, bladder stones secondary to BPH, or recurrent UTIs attributable to incomplete bladder emptying

• Required pre-operative diagnostics: Digital rectal examination (DRE), PSA assay (to exclude prostate cancer), uroflowmetry with post-void residual (PVR) ultrasound, TRUS for prostate volume measurement, flexible cystoscopy (if bladder pathology suspected), urinalysis and urine culture, full blood count, coagulation profile (PT/INR/aPTT), renal function panel (eGFR, serum creatinine), ECG, and cardiopulmonary clearance (echocardiography where cardiac history warrants)

• Contraindications: Active urinary tract infection (must be eradicated pre-operatively), uncontrolled coagulopathy or concurrent anticoagulation that cannot be bridged safely, small fibrotic prostate (volume < 20 mL — may indicate alternative aetiology), suspected prostate malignancy requiring further oncological staging, severe untreated cardiovascular instability, and patient refusal of transfusion in scenarios carrying significant bleeding risk

• Relative contraindications/special considerations: Large prostate > 100 mL (HoLEP or open simple prostatectomy may be preferred), prior pelvic radiation, urethral stricture disease (requires prior treatment), and patients on novel oral anticoagulants (NOACs) requiring protocol-driven perioperative bridging

STANDARD BIPOLAR TURP The contemporary benchmark technique. A bipolar resectoscope (e.g., Olympus or Karl Storz systems) uses a cutting-coagulation loop in a closed electrical circuit between two electrodes within normal saline irrigant. This eliminates TURP syndrome risk, allows resection of glands up to 80 mL, and achieves Qmax improvement of 9–15 mL/s over baseline. Operating time is typically 45–90 minutes. Published data demonstrate equivalent or superior safety outcomes compared to monopolar TURP, with reduced catheterisation time and hospital stay.

MONOPOLAR TURP (CONVENTIONAL) Historically the global standard, still performed in lower-volume centres. Uses glycine or sorbitol-mannitol irrigation; carries a 0.5–2% risk of TURP syndrome in prolonged procedures. Being progressively replaced by bipolar systems in accredited centres in India and the UAE.

HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HoLEP) Considered the most anatomically complete endoscopic procedure available. A 100W holmium:YAG laser enucleates the entire transitional zone along the surgical capsule plane, followed by morcellation. Gland-size independent — suitable for prostates of any volume including those > 100 mL. Offers the lowest retreatment rates of any endoscopic technique (< 2% at 5 years), near-elimination of bleeding risk (safe in anticoagulated patients), and overnight hospital stay in expert hands. Available at tertiary urology centres in India (e.g., Apollo, Fortis, Manipal) and the UAE (Cleveland Clinic Abu Dhabi, Mediclinic City Hospital Dubai).

GREENLIGHT PHOTOVAPORISATION OF THE PROSTATE (PVP / XPS 180W) A 532 nm potassium-titanyl-phosphate (KTP) laser selectively absorbed by oxyhaemoglobin vaporises prostatic tissue with minimal bleeding. Particularly advantageous for patients on antiplatelet agents or anticoagulants who cannot safely discontinue therapy. Catheter removal often within 24 hours; suitable for day-case or 23-hour admission in selected patients.

TURP WITH PLASMA VAPORISATION (TUVP) Uses a roller-ball or thick-loop electrode to vaporise rather than resect tissue, producing a coagulative necrotic zone. Reduces intraoperative bleeding; useful in patients with smaller glands and elevated bleeding risk.

RESISTIVE HEATING / WATER VAPOUR THERAPY (REZŪM) AND UROLIFT — OFFICE-BASED ALTERNATIVES For carefully selected patients with smaller prostates (< 80 mL, no median lobe) and mild-to-moderate LUTS who prioritise ejaculatory function preservation, minimally invasive office-based therapies such as prostatic urethral lift (UroLift) and convective water vapour ablation (Rezūm) are available at select centres. These carry lower efficacy durability than TURP/HoLEP but preserve sexual function in over 95% of cases.

ROBOTIC-ASSISTED SIMPLE PROSTATECTOMY For very large glands (> 100–150 mL) where endoscopic enucleation is not available, robot-assisted laparoscopic simple prostatectomy (Millin technique) using the da Vinci Surgical System is performed at select centres in India and the UAE, offering the tissue removal of open surgery with minimally invasive recovery.

PHASE 1 — REMOTE PRE-CONSULTATION (Weeks 1–2 Before Travel) GAF Healthcare coordinates a telemedicine consultation between the patient and the assigned urologist. The patient submits existing diagnostic records: uroflowmetry reports, PSA results, ultrasound prostate volume, IPSS questionnaire, medication list, and comorbidity summary. The surgical team determines technique selection (TURP vs. HoLEP vs. PVP), anaesthesia plan, and any cardiac or haematological optimisation required before travel.

PHASE 2 — ARRIVAL & PRE-OPERATIVE WORKUP (Days 1–2 In-Country) GAF Healthcare's ground team receives the patient at the airport. On Day 1, the patient is admitted or attends a pre-admission clinic. A comprehensive workup is completed or verified: blood panel, coagulation screen, urine culture (antibiotic commenced if positive), ECG, anaesthetic assessment, and — if not previously done — TRUS prostate volume and flexible cystoscopy. Anticoagulants are managed per bridging protocol. Anaesthesiologist obtains consent; surgeon reviews imaging and confirms operative plan. Nil-by-mouth from midnight before surgery.

PHASE 3 — SURGICAL DAY (Day 2 or 3) The patient is taken to theatre. Spinal anaesthesia is preferred (allows intraoperative neurological monitoring and reduces anaesthetic-related cardiopulmonary risk); general anaesthesia is used when spinal is contraindicated. The resectoscope (or laser fibre for HoLEP/PVP) is passed under direct vision. Procedure duration: bipolar TURP 45–75 min; HoLEP 60–120 min depending on gland size. A three-way urethral catheter (20–22 Fr) is placed at conclusion for continuous bladder irrigation (CBI) until effluent clears.

PHASE 4 — IN-HOSPITAL RECOVERY (Days 2–4 Post-Op) CBI is titrated down as haematuria resolves, typically within 12–24 hours. The catheter is removed on post-operative Day 1 or 2 (Day 2–3 for HoLEP). A voiding trial is conducted; if successful (Qmax ≥ 10 mL/s, PVR < 100 mL), the patient is mobilised. Haemoglobin is checked; transfusion is rarely required with bipolar or laser techniques. Oral antibiotics (commonly trimethoprim-sulfamethoxazole or ciprofloxacin) and alpha-blocker therapy may be continued short-term. Pain is typically mild (NSAID + paracetamol level); urethral discomfort resolves within days.

PHASE 5 — POST-DISCHARGE OBSERVATION IN-COUNTRY (Days 4–14) The patient remains at the accommodation arranged by GAF Healthcare. A follow-up clinic visit occurs on Day 5–7: urine flow measurement, symptom check, wound inspection (none externally), and review of resected specimen histopathology (reported within 5–7 days to confirm benign tissue). Mild terminal haematuria is expected for 2–4 weeks — patients are counselled to maintain high fluid intake. Strenuous activity, heavy lifting, and sexual activity are restricted for 4–6 weeks.

PHASE 6 — FIT-TO-FLY ASSESSMENT & DEPARTURE (Week 2–3) The treating urologist clears the patient for air travel once: haematuria has settled to trace levels, voiding is stable, no UTI is present, and there is no catheter in situ. For most standard TURP/PVP patients this is Day 10–14. HoLEP patients, who have larger initial tissue defects, are typically cleared at Day 14–21. DVT prophylaxis guidance (compression stockings, hydration, ambulation during flight) is provided in writing. A comprehensive discharge summary with operative notes, histology, and follow-up plan is sent electronically to the patient's home urologist.

PHASE 7 — REMOTE FOLLOW-UP (Weeks 4–12 Post-Op) GAF Healthcare schedules two teleconsultation follow-ups at 4 weeks and 12 weeks post-surgery. IPSS score and uroflowmetry results (performed locally at home) are reviewed. PSA is remeasured at 3 months (expected 50–80% reduction confirming complete resection). Long-term: annual PSA surveillance is recommended given the ongoing prostate remnant.