Name of the Procedure:

Transurethral Resection of Bladder Neck (TURBN)

Summary

A Transurethral Resection of the Bladder Neck (TURBN) is a minimally invasive surgical procedure used to remove scar tissue or excess growth from the bladder neck through the urethra, which allows better urine flow.

Purpose

The TURBN procedure addresses urinary flow issues caused by bladder neck obstruction (BNO). The goal is to relieve symptoms like difficulty urinating, frequent urination, or incomplete bladder emptying, and to improve the patient's quality of life.

Indications

• Symptoms of bladder neck obstruction (BNO) such as weak urine stream, straining to urinate, and urinary retention
• Bladder neck contracture
• Failed conservative treatments for urinary symptoms

Preparation

• Patients are typically instructed to fast for at least 8 hours before the procedure.
• Medication adjustments may be required, particularly for blood thinners.
• Pre-procedure diagnostics may include a physical examination, urinalysis, and possibly imaging studies like ultrasound or CT scans.

Procedure Description

1. The patient is given anesthesia (typically general or spinal).
2. A resectoscope, which is a special instrument equipped with a camera and cutting loop, is inserted through the urethra.
3. The surgeon visually guides the resectoscope to the bladder neck.
4. Using the cutting loop, the surgeon carefully removes the scar tissue or excess growth.
5. The pieces of tissue are irrigated out of the bladder.
6. Once the necessary tissue is removed, the resectoscope is withdrawn, and a catheter may be placed to aid urine drainage as the bladder heals.

Duration

The TURBN procedure typically takes about 30 to 60 minutes, depending on the amount of tissue that needs to be removed.

Setting

This procedure is commonly performed in a hospital operating room or an outpatient surgical center.

Personnel

• Urologist (surgeon)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks include bleeding, infection, and temporary difficulty urinating.
• Rare risks include injury to the bladder or urethra, blood clots, and reactions to anesthesia.
• Long-term complications can include scar tissue formation and the need for repeat procedures.

Benefits

The expected benefits include relief from urinary symptoms, improved urine flow, and enhanced quality of life. Patients may notice improvements soon after the catheter is removed.

Recovery

• Post-procedure care includes managing mild discomfort with pain medications and ensuring adequate hydration.
• Patients may need to avoid strenuous activities for a few weeks.
• Follow-up appointments are necessary to monitor recovery and ensure proper bladder function.
• Most patients recover within 2-4 weeks, although individual recovery times can vary.

Alternatives

• Medication therapies, such as alpha-blockers or 5-alpha-reductase inhibitors, can relieve mild symptoms.
• Minimally invasive procedures like balloon dilation or laser therapy may be considered.
• Each alternative comes with its own set of benefits and drawbacks compared to TURBN, particularly concerning efficacy and recovery time.

Patient Experience

During the TURBN procedure, patients are under anesthesia, so they do not feel any discomfort. Postoperatively, patients might experience some burning during urination and mild discomfort, which can be managed with medications. Drink plenty of fluids and follow all care instructions to ensure a smooth and speedy recovery.