Name of the Procedure:

Transurethral Resection; Residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete (TURP) (Includes vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy)

Summary

Transurethral resection of the prostate (TURP) is a surgical procedure primarily used to treat urinary problems due to an enlarged prostate. The procedure involves removing portions of the prostate gland via the urethra to relieve symptoms and improve urine flow.

Purpose

Medical Condition: TURP addresses benign prostatic hyperplasia (BPH), a condition where the prostate is enlarged but not cancerous, causing urinary difficulty.

Goals/Outcomes:

• Alleviate urinary symptoms such as difficulty starting urination, weak stream, and the need to urinate frequently or urgently.
• Reduce the risk of urinary tract infections, bladder stones, and other complications from untreated BPH.
• Aid in controlling postoperative bleeding.

Indications

Symptoms/Conditions:

• Severe BPH symptoms unmanageable with medications.
• Persistent urinary tract infections.
• Bladder stones caused by impaired urine flow.
• Bladder damage due to chronic retention of urine.
• Kidney damage due to back pressure from the bladder.

Patient Criteria:

• Male patients diagnosed with significant BPH.
• Patients for whom less invasive treatments were ineffective or unsuitable.

Preparation

Pre-Procedure Instructions:

• Fasting for 6-8 hours before surgery.
• Temporary discontinuation of certain medications (e.g., blood thinners) as advised by the physician.
• Arrangements for a ride home post-procedure due to sedation or anesthesia use.

Diagnostic Tests:

• Blood tests, urinalysis, and prostate-specific antigen (PSA) tests.
• Imaging studies like ultrasound or MRI.
• Urodynamic tests to measure bladder function and urine flow.

Procedure Description

• Step-by-Step:

  1. Administration of spinal or general anesthesia for sedation.
  2. Insertion of a resectoscope (a special instrument) through the urethra to the prostate.
  3. Trimming away the excess prostate tissue blocking urine flow with an electrical loop on the resectoscope.
  4. Simultaneous control of bleeding using heated electrode cautery.
  5. Removal of all excised tissue fragments.
  6. Placement of a catheter in the bladder to allow urine drainage and facilitate healing.

• Tools/Equipment: Resectoscope, electrical loop, catheter.

• Anesthesia: Spinal or general anesthesia.

Duration

Typically, the procedure takes about 60 to 90 minutes.

Setting

TURP is usually performed in a hospital or an outpatient surgical center.

Personnel

• Urologist (surgeon)
• Anesthesiologist or nurse anesthetist
• Operating room nurses
• Surgical technicians

Risks and Complications

Common Risks:

• Bleeding during or after the procedure
• Urinary tract infection
• Difficulty urinating

Rare Risks:

• Retrograde ejaculation (semen enters the bladder instead of exiting through the penis)
• Temporary urinary incontinence
• Erectile dysfunction

Management:

• Antibiotics for infection prevention.
• Monitoring and managing bleeding through observation and additional procedures if required.

Benefits

Expected Benefits:

• Improved urine flow and reduced urinary symptoms.
• Decreased risk of urinary tract infections, bladder stones, and other complications.
• Relief usually noted within days to weeks after surgery.

Recovery

Post-Procedure Care:

• Hospital stay for observation for 1-2 days.
• Catheter typically stays in place for a couple of days.
• Instructions on fluid intake to flush out the bladder.
• Pain management with prescribed medications.

Recovery Time:

• Full recovery usually within 4-6 weeks.
• Restrictions on heavy lifting and strenuous activities until cleared by the doctor.
• Follow-up appointments to monitor progress.

Alternatives

Other Treatment Options:

• Medication (alpha blockers, 5-alpha-reductase inhibitors)
• Minimally invasive therapies (e.g., laser therapy, prostatic urethral lift)
• Open prostatectomy for severe cases

Pros and Cons:

• Medications and minimally invasive therapies have shorter recovery times but may be less effective for severe BPH.
• Open prostatectomy offers more complete removal but has a longer recovery time and higher risk of complications.

Patient Experience

During the Procedure:

• Under anesthesia, so no pain during the surgery.

After the Procedure:

• Possible discomfort or soreness in the bladder or urethra.
• Temporary mild bleeding, urinary urgency, or frequent urination.
• Pain management with prescribed medications to ensure comfort.