What Is A Transurethral Resection Of The Prostate
The prostate gland is found only in males. It sits below the bladder andwraps around the urethra. The urethra is the tube that carries urine out ofthe body. The prostate helps produce semen.
A transurethral resection of the prostate is surgery to remove partsof the prostate gland through the penis. No incisions are needed.
The surgeon reaches the prostate by putting an instrument into the end ofthe penis and through the urethra. This instrument, called a resectoscope,is about 12 inches long and .5 inch in diameter. It contains a lightedcamera and valves that control irrigating fluid. It also contains anelectrical wire loop that cuts tissue and seals blood vessels. The wireloop is guided by the surgeon to remove the tissue blocking the urethra onepiece at a time. The pieces of tissue are carried by the irrigating fluidinto the bladder and then flushed out at the end of the procedure.
Getting Ready For The Operation
If you smoke, try and cut down or preferably stop, as this reduces the risks of heart and chest complications during and after the operation. If you do not exercise regularly, try and do so for at least half an hour per day e.g. brisk walk or swimming.
You will be given a form to have routine pre operative blood tests and a urine test to exclude infection before your surgery if you have lost your a form please contact Dr Nathans rooms.
If you are on medication to thin the blood such as warfarin, aspirin, Plavix, Iscover, Brilinta, Pradaxa, Xarelto or supplements such as fish oils please let Dr Nathan know at least 2 weeks before surgery as these medications may need to be discontinued to prevent excessive bleeding at the time of surgery. You can continue to take your other medications as normal.
Speak to the anaesthetist about your anaesthetic
Less Common Side Effects Of Turp
Less common unwanted effects of surgery include:
- urinary symptoms do not change sometimes surgery does not cure your urinary problems. Even though the blockage has been cleared, the bladder irritability may continue and you may still have symptoms such as being unable to empty your bladder completely, and nocturia
- erectile dysfunction some men are unable to get or maintain an erection sufficient for sexual intercourse after surgery. This is more of a problem for men who had erectile difficulties before their operation. This problem may be treated by medication
- urethral strictures when scarring occurs in and around the urinary tract, it can cause further blockage to urine flow. Strictures may need to be dilated or need further surgery
- urinary incontinence sometimes surgery results in being unable to hold or control the flow of urine. This may be due to continuing bladder problems or, less often, to sphincter muscle damage
- infertility retrograde ejaculation is not harmful, but it can result in infertility. It causes the seminal fluid to collect with the urine and it doesn’t come out as ejaculate. This makes ‘natural’ insemination impossible. However, in vitro fertilisation may be used to achieve a pregnancy. The sperm can be removed from the urine and injected into the womans harvested eggs.
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Cost/ Benefit Ratio Of B
In alternative to PVP, other laser technologies aiming to prostate enucleation rather than vaporization were largely adopted during the last 20 years. The main advantage of those techniques is that they allow a complete enucleation of the adenoma, achieving similar results to open simple prostatectomy without the comorbidity of a major surgery. The main two widespread techniques are Holmium Laser Enucleation of the Prostate and Thulium Laser Enucleation of the Prostate .
First proposed by Fraundorfer and Gilling,30 laser enucleation techniques were encouraged to overcome the problem of treating large-sized adenomas . The mostly widespread technique is HoLEP. Although many papers report short- and long-term functional results comparable with OP and TURP, a relative cost/ benefit analysis has not frequently been assessed.
Fraundorfer et al31 outlined a comparative cost-analysis of Holmium Laser Resection of the Prostate and B-TURP. Due to reduced catheterization time, reduced LOS, less risk of bleeding and reduced incidence of complications observed following HoLRP, while offering equivalent functional outcomes, HoLRP showed a 24.5% cost savings over TURP, when in-hospital and post-discharge events were analyzed.
The other main laser enucleation technique is ThuLEP. For its physical properties, Thulium laser achieves both enucleation and vaporization of prostatic tissue, therefore it should be considered also in terms of Vapoenucleation or Vaporesection .34
Immediately After A Prostatectomy
After the operation, you can expect that:
- Nurses will monitor your vital signs.
- You may be given oxygen for up to 24 hours following surgery.
- You will probably be given antibiotics to prevent infection.
- For a day or so, you will have a catheter in your urethra and bladder with a continuous wash-out. This is to prevent blood building up and clotting, which could cause a blockage.
- If you had an open prostatectomy, your wound will be dressed and you will have a tube draining your abdomen. The tube will be removed after several days.
- Pain will be managed with injections, tablets or both. Pain is rarely a significant problem following TURP.
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What Are The Risks And Complications Of Turp
The main risk is to your sex life.
Some men have problems getting an erection after surgery. For some men, that lasts a few months. In about 1 in 10 men, erectile problems are permanent.
Between half and three-quarters of men have permanent problems with ejaculation after a TURP. Usually the problems arise from the semen flowing backwards into the bladder during ejaculation this is known as retrograde ejaculation. Although it is not life threatening, it can cause infertility in couples and can change the sexual experience for men.
Other problems such as bleeding, infection, frequency of urination and urgency can occur. Occasionally, a man develops urinary incontinence after a TURP.
Its important to talk to your partner and your doctor about the impact this surgery might have on your sex life, and to look at alternatives.
Bipolar Turp Advantages For Prostate Cancer Patients
Bipolar TURP can also be used to resect enlarged prostates due to cancer. Dr. Roehrborn recommends this procedure in prostate cancer patients because it leaves behind a clean, symmetrical surface that is optimized for radiation therapy. Additionally, through this method, prostate tissue can be salvaged for further histological analysis.
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Bipolar Turp Complications In Large Prostates
When discussing bipolar TURP complications for large prostates, it is subjective because of varying surgical skill levels. However, Dr. Roehrborn personally defines large prostates as those greater than 80 g. Although bipolar TURP is a viable surgical option for large prostates, it carries an increased risk of hypothermia due to the temperature of the saline solution, trainee visual disorientation due to increased surface area during resection, and postoperative bleeding due to multiple coagulation sites. Instead, he prefers to perform a transvesical robotic assisted laparoscopic enucleation and encourages urologists to assess their own skill level and those of their trainees before choosing to perform a bipolar TURP on large prostates.
Why Might I Need Turp
TURP is most often done to relieve symptoms caused by an enlarged prostate.This is often due to benign prostate hyperplasia . BPH is not cancer.It is a common part of aging. When the prostate gland is enlarged, it canpress against the urethra and interfere with or block the passage of urineout of the body.
Sometimes a TURP is done to treat symptoms only, not to cure the disease.For example, if youre unable to urinate because of prostate cancer, butsurgery to remove the prostate isnt an option for you, you may need aTURP.
There may be other reasons for your healthcare provider to recommend aTURP.
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Bipolar Turp Procedure Advantages & Complications
Quynh-Chi Dang Jun 5, 2021 140 hits
The bipolar transurethral resection of the prostate procedure involves the use of a resectoscope containing a bipolar current to resect excess prostate tissue, alleviating symptoms in patients with benign prostate hyperplasia . Before choosing to embark on a bipolar TURP procedure, urologists must consider the scenarios in which a bipolar TURP is prefered, such as the presence of a substantial intravesical lobe or in prostate cancer patients, and those in which a bipolar TURP may be technically challenging, such as in large prostates or during trainee operations.Weve provided the highlight reel in this article, but you can listen to the full podcast below.
How Long Will It Take Me To Get Back To My Daily Activities
Usually, you can leave the hospital 2 or 3 days after surgery. The length of hospital stay can vary in different countries. There may be some blood in your urine for several days. You may also suffer from urgency and feel pain when you urinate, which can last up to several weeks.
For 4-6 weeks after the surgery:
- Drink 1-2 litres every day, especially water
- Do not lift anything heavier than 5 kilograms
- Do not do any heavy exercise and avoid bike riding
- Do not take thermal baths or go to the sauna
- Prevent constipation by adapting your diet
- Discuss any prescribed medication with your doctor
Avoid having sex for 2-3 weeks. After TURP, you may suffer from retrograde ejaculation. This is a chronic condition where semen can no longer leave through the urethra during orgasm. Instead, it goes into the bladder and later leaves your body during urination.
You need to go to the doctor or go back to the hospital right away if you:
- Develop a fever
- Are unable to urinate on your own
- Have heavy blood loss or pain
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Other Forms Of Treatment For Benign Prostate Disease
Other forms of treatment may include:
- monitor symptoms the condition is monitored closely. Treatment only begins once the condition has progressed and is causing problems
- medical treatment symptoms of benign enlargement can be treated by medications that relax the muscles around the bladder or that shrink the prostate and delay the need for surgery.
Bipolar Versus Monopolar Transurethral Resection Of The Prostate For Lower Urinary Tract Symptoms Secondary To Benign Prostatic Obstruction
Review question
How does surgery using bipolar technology compare with traditional monopolar technology for men with an enlarged prostate causing difficulty with urination?
Background
People with an enlarged prostate can experience difficulty passing urine. This occurs because the enlarged prostate compresses the urinary tube from which urine leaves the bladder. One option for treatment of this condition is telescopic surgery, which acts to remove prostate tissue and relieve the blockage. This is traditionally performed using a technology called monopolar TURP . In recent times, a technique called bipolar TURP has been developed. This approach uses saline instead of other watery fluids and may put men at lower risk for a problem called TUR syndrome, which is a rare but potentially serious complication caused by fluid absorption, but it is unclear how the two procedures compare overall.
How up-to-date is this review?
The studies included in this review are those that were available via an electronic database search conducted on 19 March 2019.
Study characteristics
We searched the medical literature for clinical trials up to 19 March 2019. We found 59 randomised trials that compared BTURP with MTURP. These studies included a total of 8924 patients. The longest period of follow-up for the outcomes of interest was 12 months after treatment.
Key results
Compared to MTURP, BTURP probably results in similar reduction in urinary symptoms and bother.
Quality of evidence
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How Do I Get Ready For A Turp
Some things you can expect before the procedure include:
- Your healthcare provider will explain the procedure and you can ask questions.
- You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything isnt clear.
- Your healthcare provider will review your medical history, and do a physical exam to be sure youre in good health before you have the procedure. You may also need blood tests and other tests.
- You will be asked not to eat or drink anything for 8 hours before the procedure, generally after midnight.
- Tell your healthcare provider if you are sensitive to or allergic to any medicines, latex, iodine, tape, contrast dyes, or anesthesia.
- Make sure your healthcare provider has a list of all medicines herbs, vitamins, and supplements that you are taking. This includes both prescribed and over-the-counter.
- Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines , aspirin, or any other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
- If you smoke, stop as soon as possible to improve recovery and your overall health.
- You may be given a sedative before the procedure to help you relax.
Based on your medical condition, your healthcare provider may request otherspecific preparation.
Other Surgical Procedures For Prostate Disease
Alternative surgical procedures to TURP include:
- open enucleative prostatectomy this involves making a cut in the abdomen to remove a very enlarged prostate. This is the least common form of surgery. The average hospital stay is seven to 10 days
- laser TURP a laser is used to remove prostate tissue from the middle part of the prostate, which has the advantage of less bleeding and therefore safer for people on anti-coagulation therapy for other problems, including coronary stents, heart valve or vascular disease
- transurethral incision of the prostate similar to TURP except that no prostate tissue is taken out. One to three cuts are made in the prostate near the bladder neck to release the ‘ring’ of enlarged tissue and make a larger opening around the urinary tract
- UroLift® this technique is useful for men for whom medication has not been successful but their prostates are not so enlarged that they need a TURP. It involves the transurethral insertion of staples to separate the lobes of the prostate. It has minimal side effects and preserves ejaculatory and erectile function.
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Common Side Effects Of Turp
Common side effects after surgery include:
- bleeding after the operation this usually reduces over time and should stop after four weeks
- retrograde ejaculation most men are able to have erections and orgasms after surgery to treat an enlarged prostate. However, they may not ejaculate because the bladder neck is removed along with prostate tissue. This causes the ejaculate to collect with urine and pass out of the body in the next urination.
Functional Outcomes Among B
Preoperative total IPSS score was similar between groups . After surgery, total IPSS score improved at 1-and 3-months in each group as compared to baseline evaluation . However, at each follow up assessment, total IPSS score did not differ according to prostate volume. Both storage and voiding symptoms significantly improved after surgery, irrespective of PV . The ICIQ-SF score was higher at 1 months after surgery in each group as compared to baseline , but it returned to preoperative value at 3 months. No differences were found in terms of ICIQ-SF scores at each follow up assessment according to prostate size.
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Bipolar Transurethral Resection Of The Prostate: Darwinian Evolution Of An Instrumental Technique
- Charalampos MamoulakisCorrespondenceAddress correspondence to: Charalampos Mamoulakis, M.D., M.Sc., Ph.D., F.E.B.U., Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Voutes-Stavrakia 71110 Heraklion Crete, Greece.
- Jean J.M.C.H. de la RosetteAffiliations
Prostate Size And Blockage Of The Urethra
If the inner part of the prostate gland obstructs the urethra during urination, this will irritate the bladder and cause urinary symptoms.Urinary symptoms may include:
- frequent urination, particularly at night
- urgency and possible urgency incontinence
- passing drops of urine involuntarily after you think you’ve finished
- blood in the urine although this can never be assumed to be due to the prostate until other causes have been excluded.
The actual size of the prostate does not appear to determine whether or not there is a blockage. Some men with large prostates never develop obstruction, but some men with small prostates can have severe bladder obstruction, which causes difficulty with urinating.Around one in three Victorian men over the age of 50 years have some urinary symptoms. In most cases, these symptoms are due to a blockage caused by an enlarged prostate, but they may be due to other causes.
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The Backtable Urology Brief
Different BPH surgical options can be categorized based on invasiveness, use of ablation, implantation, energy source, and anatomical approaches. The TURP procedure involves the use of a resectoscope carrying an electrical current to trim away excess prostate tissue in BPH patients. TURP procedures can be categorized as bipolar or monopolar . Bipolar TURP is a viable surgical option for prostates over 80 g, but the risks of hypothermia, visual disorientation, and postoperative bleeding are present. Using this procedure to resect large prostates may be technically challenging for trainees. When a substantial intravesical lobe is present, the bipolar TURP procedure allows the surgeon to disconnect the lobe elegantly and safely. Additionally, bipolar TURP is the ideal option for prostate cancer patients, as it optimizes radiation therapy and histological analysis of prostate tissue.
Benefits Of Button Turp
Button TURP appears to be just as effective as traditional TURP at shrinking the prostate. A few studies have hinted at some advantages of this newer procedure, but there isnt much long-term evidence to prove that its any better than regular TURP.
One theoretical advantage of button TURP is that all the energy stays inside the device. In regular TURP, the electric current can leave the wire and damage tissues around the prostate.
Some studies have found that button TURP reduces complications, like bleeding after surgery. It may also lessen the time men need to use a catheter for irrigation or drainage after surgery. Yet other studies have found no difference in complication rates.
One post-surgery problem button TURP does seem to prevent is a rare but very serious condition called TUR syndrome. During TURP, the surgeon washes out the surgical area with a low sodium solution to keep the area clean. Because this solution can get into the bloodstream in greater amounts through the venous areas of resected prostate tissue, it can cause dilution to a below-normal sodium level in the bloodstream.
In contrast, button TURP uses a saline solution with more sodium in it than what is used in a TURP, which seems to help prevent TUR syndrome. The reduced risk of TUR syndrome allows surgeons to spend more time doing the procedure. This means they can work on larger prostates or perform more complex surgeries with button TURP.
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