TURP(Trans urethral resection of the prostate)

TURP (TRANS URETHRAL RESECTION OF THE PROSTATE)

WHAT IS TURP PROCEDURE :

This procedure done by endoscopically

Transurethral resection of the prostate (TURP) is a surgery used to remove obstruction in urination that are caused by an enlarged prostate.

Bening prostate hypertrophy :

Enlarged prostate is also called bening prostate hypertrophy its common and non cancerous overgrowth of prostate tossue pushes against the urethra & the bladder, blocking the flow of urine.Restrict urine flow, impaired emptying bladder & frequently and urgency of urine due enlarged prostate.

Function of prostate :

-Provides with urine pathway. 

-Assist with passage of semen.

-Make fluids to nourish sperm.

Causes of enlarged prostate:

The prostate gland is located beneath bladder and urethra passes through the centre of the prostate. When prostate enlarged it begins to block urine flow.

Most men have continued prostate growth throughout life, In many man, this continued growth enlarged the prostate enough to causes urinary or to significantly block urine flow.

Symptoms & sign of enlarged prostate:

-Feeling full bladder 

- Pain during the urination. 

-Inflammation in prostate.

-Difficulty in starting in urine. 

-Dribbling at the end of urination. 

-Blood in urine and forceful urination. 

-Urinary retention (patient cannot pass     the urine.

-Urinary track infection. 

-Increased frequency of urination at night (nocturia).

- Incomplete emptying of the bladder. 

-Needing to strain with urination. 

- blood in urine 

-Infertility & sexual dysfunction.

-Cancer of the prostate or bladder.

What happens if enlarged prostate untreated :

1.Prostatitis (infection in prostate )

2.Stone development in bladder

3.Block urinary track & stricture.

4.Peri -urethral absecess (pus formation)

5.infection 

6. Blood in urine 

7.Thick walled  & inflammed bladder.

8. urinary track infection. 

9.kidney damage

10.Urinary retention requiring catheterization. 

General clinical evolution and diagnosed by:

1.Medical history. 

2.Physical exam 

3. Urinary flow diagnose by uroflowmetry procedure. 

4.Bladder ultrasonography 

5. By endoscopic procedure cystoscopy 

Duration of surgery : 20 minutes to 1 hour

Stay of the hospital : two days ( depends on patient condition and doctor advice).

What  should I before the surgery? 

Blood test

HIV and HBSag test

Chest x-ray for cardiac assessment  physical fitness bcoz patient will goes under the anesthesia before the surgery.

Stop eating and drinking at the time your doctor tells you before surgery.(approximately 6 hrs before the surgery )

Procedure of TURP in the operation theatre:

Start intravenously fluid or antibiotic for prevent infection and  fluids allowed to run until administration of the prescribed dose is completed.(as per doctors advised )

TURP  procedure done under the general anesthesia , spinal anesthesia  for pain relief during surgery and comfort to patient.

 The urological surgeon narcotic analgesic such as fentanyl citrate, depending on the level of discomfort anticipated by the surgeon. 

If general anesthesia give than endotracheal intubation will given and hypnotic agent like propofol given. 

Than anesthesist continue watching monitor and watch vital signs including pulse, spo2(saturation ), E.C.G,  body temperature and blood until the  patient  will not shifted from operation theatre to recovery  

Painting and drapping :

Paint and cleanse the Surgical site and space of urethra with betadiene antibacterial solution it contains  Povidone-iodine, then patient draped by sterile drap.

A topical anesthetic, 2% xylocaine jelly this  viscous lidocaine like jelly  is introduced  into the urethra, and  hold the tip of the penile atleast for  five minutes, then removed and introduce the  resectoscope.

An instrument called a resectoscope which connect with camera and light source is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra) with the help of resectoscope and loop  trim away excess prostate tissue that's blocking urine flow.

After the producer withdrawn instruments and appropriately sized its depend of patients age triway Foleys catheter will be inserted for irrigation and urination through the urethra into the urinary bladder, and locked or fix into place by filling its balloon (positioned inside of the bladder near the urethral junction) with sterile water. 

After the removal of enlarged prostate this prostate chips sent to be laboratory for examination.

Reason of foley's  cathetherizatoon

1.It provides drainage of the urine           produced in the kidneys

2.For irrigation all the small pieces of prostate and blot clots are removed through irrigation. 

3.catheterization takes for 24 to 48 hours.

Post operations management :

-Post shifted in recovery room for observation for 2 to 3 hours.

-Continued intravenous fluid as per doctor order

-Give antibiotics for prevents infection. 

-Continue irrigation for preventing blood clot and blockage in catheter.

Complications after the surgery :

-Risk of general anesthesia. 

-Possible heart & lung complications. 

-Bleeding for upto 6 weeks after the operations (have chances to 1% blood transfusion )

-Infection 

-Catheter blockage and dislodgement. 

-Inability to urinate when the catheter comes out.

-Semen is ejaculated into the bladder (retrograde ejaculation) fluid will be passed with next urination. 

-Incontinence (about 1%)

After the hospital discharge :

- Drinks lots of water 

-Take medicines right time.

-Don't take heavy materials for 4 to 6 weeks

-Keep stool loose to avoid straining for bowel.

-Patient may experience burning sensation during urination.

-Patient cannot drive for last two weaks.

-Patient may be see blood in urine for upto 6 wks.

For know more details & appointment contact us : 

+91 7692976910

DR. VIMAL KESWANI

MBBS, MS, DNB Urologist & andrologist, Mumbai

Consultant urosurgeon 

Former consultant at R.G. stone hospital, mumbai