TURP (Transurethral Resection of the Prostate)
TURP (Transurethral Resection of the Prostate) is the most common procedure used to treat BPH. It can be carried out through endoscopy. The surgical and optical instrument is introduced directly through the urethra to the prostate, which can then be viewed directly. The gland is removed in small chips with an electrical cutting loop.This procedure, which requires no incision, may be used for glands of varying size and is ideal for patients who have small glands and for those who are considered poor surgical risks.Newer technology uses bipolar electrosurgery and reduces the risk of TUR syndrome (hyponatremia, hypovolemia).TURP usually requires an overnight hospital stay. Urethral strictures are more frequent than with (non-trans-urethral procedures, and repeated procedures may be necessary because the residual prostatic tissue grows back.
TURP rarely causes erectile dysfunction, but may trigger retrograde ejaculation because removal of the prostatic tissue at the bladder neck can cause seminal fluid to flow backward into the bladder rather forward through the urethra during ejaculation.
- Inform the patient about the procedure and the expected postoperative care, including catheter drainage, irrigation and monitoring of hematuria.
- Discuss the complications of surgery which include:
- Incontinence or dribbling of urine up to 1 year after surgery and that Kegel’s exercise will help alleviate this problem
- Retrograde ejaculation
- Bowel preparation is given.
- Optimal cardiac, respiratory and circulatory status should be achieved to decrease risk of complications.
- Prophylactic antibiotics are ordered.
- Urinary drainage is maintained and observed for signs of hemorrhage.
- Maintain patency of urethral catheter.
- Avoid overdistention of bladder, which could lead to hemorrhage.
- Administer anti-cholinergic medications to reduce bladder spasms.
- Maintain bed rest for the first 24 hours.
- Encourage early ambulation, thereafter to prevent embolism, thrombosis and pneumonia.
- Wound care is provided to prevent infection.
- Administer pain medications.
- Promote comfort through proper positioning.
- Administer stool softeners to prevent straining that can lead to hemorrhage.
- Reduce anxiety by providing realistic expectations about postoperative discomfort and overall progress.
- Encourage patient to express fears related to sexual dysfunctions and to discuss with partner.
- Teach measures to regain urinary control.
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