Transurethral prostate resection (commonly known as TURP , plural TURPs , and rarely as transurethral prostate resection , TUPR ) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As its name suggests, this is done by visualizing the prostate through the urethra and removing the tissue with electrocautery or sharp dissection. This treatment is considered the most effective for BPH. This procedure is performed under general or spinal anesthesia. The three lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Results are considered excellent for 80-90% of BPH patients.
Video Transurethral resection of the prostate
Indication
BPH is usually initially treated medically. This is done through alpha antagonists such as tamsulosin or 5-alpha-reductase inhibitors such as finasteride and dutasteride. If medical treatment does not reduce the patient's urinary symptoms, TURP may be considered after prostate/bladder examination through a cystoscope. If TURP is contraindicated, an urologist may consider a simple prostatectomy, an inlet and outgoing catheter, or a supra-pubic catheter to help the patient excrete urine effectively. As BPH's medical management improves, the TURP has decreased.
Maps Transurethral resection of the prostate
TURP Type
Traditionally, a cystoscope [resectoscope with a 30-degree viewing angle, together with resectoscopy sheath & amp; work element] has been used to do TURP. The scope is passed through the urethra to the prostate where the surrounding prostate tissue can then be excised.
The monopolar device utilizes a wire loop with an electric current flowing in one direction (so monopolar) can be used to cut the network through a resectoscope. EARTE grounding pad and irrigation by a non-conductor fluid is required to prevent this current from interfering with surrounding tissue. This fluid (usually glycine) can cause damage to surrounding tissue after prolonged exposure, resulting in TUR syndrome, resulting in limited operating time.
TURP using a bipolar device is a new technique that uses bipolar currents to lift the network. [6] [7] Bipolar TURP allows saline irrigation and eliminates the need for an ESU runway base thereby preventing post-TURP hyponatremia (TUR syndrome) and reduces other complications. As a result, Bipolar TURP is also not subject to the same operating time constraints of conventional TURP.
Other transurethral methods use laser energy to remove tissue. With prostate laser surgery, Urethane-driven fiber-optic cables are used to deliver lasers such as holmium-Nd: high-red "YAG" or "green" potato titanil phosphate (KTP) to evaporate adenomas. Recently the ID card lasers have been replaced by higher power laser sources based on lithium tribal crystals, though still commonly referred to as "GreenLight" or ID card procedures. Specific advantages of using laser energy over traditional electrosurgical TURP are decreased relative blood loss, elimination of risk of post-TURP hyponatremia (TUR syndrome), ability to treat larger glands, and treat active patients treated with anti-coagulation therapy for unrelated diagnoses.
Risk
Due to the risk of bleeding associated with surgery, TURP is not considered safe for many patients with heart problems.
Postoperative complications include
- Bleeding (most common). Bleeding can be reduced by pre-treatment with anti-androgens such as finasteride or flutamide.
- Former retention and colicky clay
- Injury to the bladder wall such as perforation (rare)
- TURP syndrome: Hyponatremia and water intoxication (symptoms resembling a brain stroke in elderly patients) caused by excess fluid absorption (eg 3 to 4 liters) of open prostate sinuses during the procedure. These complications can cause confusion, changes in mental status, vomiting, nausea, and even coma. To prevent TURP syndrome, 1) the length of the procedure is limited to less than an hour in many centers, and 2) the height of the irrigation solution container above the surgical table determining the hydrostatic pressure driving fluid into the prostate and sinus veins is kept to a minimum.
- Bladder stenosis of the bladder
- Urinary incontinence due to injury of the external sphincter system that can be prevented by taking Verumontanum prostate as a distal limiting limit during TURP
- Retrograde ejaculation due to a preprostatic (internal) sphincter system injury. This is one of the most frequent complication procedures.
In addition, transurethral resection of the prostate is associated with a low risk of death.
See also
- Translate the transurethral needle from the prostate
- Transurethral incision of the prostate
- Prostatectomy, explaining monopolar and bipolar [electrocautery] TURP
- Stent prostate
- arterial embolization of the prostate, alternative to TURP for BHP
References
External links
- Medscape: Transurethral Resection from Prostate
Source of the article : Wikipedia
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