Transurethral resection of the prostate
Encyclopedia
Transurethral resection of the prostate (also known as TURP, plural TURPs and as a transurethral prostatic resection, TUPR) is a urological
operation. It is used to treat benign prostatic hyperplasia
(BPH). As the name indicates, it is performed by visualising the prostate
through the urethra
and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter
is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients.
antagonists such as flomax or alpha-1A reducatase inhibitors
such as proscar and avodart. If medical treatment does not reduce a patient's urinary symptoms, a TURP may be considered- following a careful examination of the prostate/bladder through a cystoscope. As medical management of BPH improves, the numbers of TURPs have been decreasing. If TURP is contraindicated a Urologist may consider: a simple prostatectomy
, in and out catheters, or a supra-pubic catheter to help a patient void urine effectively.
Postoperative complications include
Additionally, transurethral resection of the prostate is associated with a low risk of mortality.
Urology
Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
operation. It is used to treat benign prostatic hyperplasia
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
(BPH). As the name indicates, it is performed by visualising the prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
through the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients.
Indications
BPH is normally initially treated medically. This is done through alphaAlpha blocker
Alpha-1 blockers constitute a variety of drugs which block α1-adrenergic receptors in arteries and smooth muscles.-Pharmacology:...
antagonists such as flomax or alpha-1A reducatase inhibitors
5-alpha-reductase inhibitor
5α-Reductase inhibitors are a group of drugs with antiandrogenic activity, used in the treatment of benign prostatic hyperplasia and androgenic alopecia...
such as proscar and avodart. If medical treatment does not reduce a patient's urinary symptoms, a TURP may be considered- following a careful examination of the prostate/bladder through a cystoscope. As medical management of BPH improves, the numbers of TURPs have been decreasing. If TURP is contraindicated a Urologist may consider: a simple prostatectomy
Prostatectomy
A prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra....
, in and out catheters, or a supra-pubic catheter to help a patient void urine effectively.
Risks
Because of bleeding risks associated with the surgery, TURP is not considered safe for many patients with cardiac problems.Postoperative complications include
- Bleeding (most common)
- Clot retention and clot colic
- Bladder wall injury such as perforation (rare)
- TURP Syndrome: Hyponatremia and water intoxication (symptoms resembling brain stroke in an elderly presenting patient) caused by an overload of fluid absorption from the open prostatic sinusiods during the procedure. This complication can lead to confusion, changes in mental status, vomiting, nausea, and even coma. To prevent TURP syndrome the 1) length of the procedure is limited to less than one hour in more centers, and 2) the height of the container of irrigating solution above the surgical table determining the hydrostatic pressure driving fluid into the prostatic veins and sinuses is kept to a minimum.
- Bladder neck stenosisStenosisA stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
- Urinary incontinenceUrinary incontinenceUrinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
due to injury of external sphincter system which may be prevented by taking the Verumontanum of the prostate as a distal limiting boundary during TURP - Retrograde ejaculationRetrograde ejaculationIn the human male reproductive system, retrograde ejaculation occurs when semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least...
due to injury of preprostatic (internal) sphincter system
Additionally, transurethral resection of the prostate is associated with a low risk of mortality.
See also
- Transurethral needle ablation of the prostateTransurethral needle ablation of the prostateTransurethral needle ablation is a technique that uses low energy radio frequency energy delivered through two needles to ablate excess prostate tissue. It can be done with a local anesthetic on an outpatient basis...
- Transurethral incision of the prostateTransurethral incision of the prostateTransurethral incision of the prostate is a surgical procedure for treating prostate gland enlargement .-Benefits:...
- ProstatectomyProstatectomyA prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra....
- Prostatic stentProstatic stentA prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms . Prostatic obstruction is a common condition with a variety of etiologies...