TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)
Transurethral Resection of the Prostate (TURP) is a surgical procedure primarily used to treat urinary problems due to an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). It's one of the most effective options for treating this condition, especially when medication isn't sufficient or not an option. Here's a detailed overview of the procedure:
Procedure
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Access: The surgeon inserts a resectoscope (a thin, tube-like instrument with a light, camera, and loop of wire) into the urethra. There's no need for an external incision.
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Resection: The wire loop is heated and used to remove (resect) the enlarged prostate tissue that's blocking the flow of urine.
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Removal of Tissue: The resected tissue is carried by fluid into the bladder and then flushed out at the end of the procedure.
Anesthetic Implications for Transurethral Resection of the Prostate (TURP)
Anesthesia type: General, spinal, epidural
Airway: ETT or LMA
Preoperative:
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Patients are usually elderly often with multiple comorbidities
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Neuraxial anesthesia needs to be at the T10 level (blocks the pain from bladder distention by the irrigating fluid)
Intraoperative:
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Position: lithotomy
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Duration: 1-2 hours
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A resectoscope is inserted, and electrodissection is done
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Movement can cause injury or perforation
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The prostate gland has an extensive plexus of venous sinuses which can absorb the irrigating fluid
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Absorption of a large volume of fluid can result in signs of “water intoxication”
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TURP Syndrome: “water intoxication” with hypervolemia and dilutional hyponatremia
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TURP Syndrome: seizures, arrhythmias, bradycardia (vagal response), and unexplained hypotension or hypertension
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The time of transurethral resection should not exceed 2 h because excessive absorption of the irrigating fluid
Postoperative:
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Pain management
Complications:
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Bleeding
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TURP Syndrome: volume overload, cerebral edema, hemolysis, hemoglobinuria, and hyponatremia
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Urinary Incontinence (injury to external sphincter)
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Erectile Dysfunction
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Retrograde Ejaculation
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Urethral Stricture
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Postoperative septicemia
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Aspiration
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Hypothermia
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Myocardial ischemia
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DVT
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Postoperative cognitive impairment
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Acute renal failure
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Pulmonary edema
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Bladder perforation
Sources:
Elisha, S. (2010). Case Studies in Nurse Anesthesia.
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.