Transurethral resection of prostate

Trans urethral resection of prostate is the removal of benign prostatic tissue trans cystoscopically

Indication:
a)it is indicated when the prostate is about 20-60gms
b)TURP is usually performed to relieve urinary obstruction caused by benign growth of the prostatic tissue
c)the procedure is particularly desirable when the patient is not fit for open surgery

patient preparation:
a)position:
the patient is positioned on the lithotomy position

b)anaesthesia:
regional or general anaesthesia
c)skin preparation:
paint the entire pubic region including scrotum & perineum with any antibiotic solution
d)draping:

TURP TRAY:
a)gown pack
b)linen pack
c)surgical gloves
d)towel glips
e)sponge holder
f)bowel
g)abdominal swab
h)ot gauze
5% betadine solution
2% Xylocaine jelly
I.V. set
20ml syringe
Y-connection
Diathermy cable
Light source cable
Ellicks evacuator
Fibre optic light source
Urethral dilators
3 way foley catheter
catheter introducer
urobag
normal saline
Glycine 3ltr
SCOPY Instuments:
Cystoscopy sheath with obturator(17,20,21)
Telescope(0,30degree)
Bridge
Turp sheath(22,24,26fr)
Resection loop
Ball electrode
Resectoscope-working element(movement by means of a spring with a movable finger grip) this enables the movement of the resectoscope from the bladder neck

towards the prostate
Resectoscope sheath with obturator (including connecting tubes for inflow & outflow)
Resectoscope sheath with fixed inner tube
*for cotinuos irrigation& suction
*with a protective tefon sheath to to prevent conduction of current & damage to the tip of telescope


PREOPERATIVE ORDERS
Informed consents
Nill from midnight
Preparation of parts
Inj tetanous toxoid ½ cc IM
Dulculox suppository 2 HS
Cross match arrange 2 units of blood
To follow anaesthetist order

Procedure
The external urethral orifice is the narrowest part of the male urethra if necessary do a meatatomy if meatus is narrow or dilate the urethra with sounds

and filiform
Always under vision to prevent false passage and injury
Vision should always be clear
First, do Cystoscopy and only then put resectoscope with visual obturator
Do not resect beyond the level of vermontanum as it may damage the external urethral sphincter leading to incontinence.
The urethral may be dilated if necessary
A well lubricated Cystoscope is inserted into the urethra, the bladder neck, the ureteric orifice, and the urinary bladder are examined
The resectoscope which is complete with the obturator and sheath is passed
The irrigation tubings, the fibrotic light cord and diathermic cable are connected
The abturator is removed & the operative element with the forward oblique telescope & cutting loop is inserted through the sheath
The bladder is continuosly irrigated
The urethra of the bladder trigone are reexamined
Electro resection is employed to remove pieces of hypertropid prostatic tissue
At intervals the fragments of tissue and blood clots are washed out of the bladder. The ellick evacuator may be employed for the same
Total removal of all fragments of tissue is desired
When resection is complete, the bladder and prostatic fossa are examined for residual unattached fragments of tissue
A 3 way foleys catheter is retained in the bladder with ccontinous irrigation
Maintenance of blood volume by adequate transfusion can be done in case of blood loss








Complication
Immediate
Primary haemmorhage : this is the most important and serious complication and may lead to clot retention resulting from blockage of catheter or

drainage tube by blood clots.
A bladder wash may be great use in this case

Bladder perforation:
Cardiovascular and vascular accidents

Inmtermediate (within 10 days)
Secondary haemorrhage:
Infection:
Slight infection after this type of operation is undesirable during to the presence of large raw surface in the prostatic bed. Administration of

prophylatic antibiotic has gone a long way in preventing infection occurring post operatively. In case a culture sensitivity report is in hand, the choice

of the antibiotic should be made according to the same . It is also well worth trying the effect of oral antibiotics post operatively to prevent infection
c)pulmonary embolism infection
d)myocardial infarction , cerebral thrombosis

remote (after 1 month)
incontinence:
it is common unless until the external urethral sphincter is damaged
urethral stricture
osteitis pubis

transurethral resection syndrome
1) it refers to a significant alteration in hemostasis produced by absorbtion of irrigation fluid during trans-urethral resection of the prostate gland
2) it results from the entrance of irrigating fluid into the vascular component through open venous sinuses or perforation in the prostatic capsule
3) even if isotonic irrigation like Glycine is used the problem of expanding the blood volume may cause hypertension and a decrease in electrolyte

concentration
4) the earliest symptom of Tur syndrome is restlessness followed by nausea ,vomiting, abdominal pain& distention the patient pales & perspires
5) the signs & symptoms of Tur syndrome & its complication include an increase in pulse rate, bradycardia & cardio-vascular collapse, dyspnea, cyanosis,

coma, convulsion & death.

TREATMENT OF TUR syndrome
1)it consist of producing a net loss of body water
2)if serum osmolality & plasma sodium are low, furosemide can be administered intra-venously
3)thye patient should be closely observed for signs of cardiovascular collapse with pulmonary or cerebral oedema.