Turp

PROSTATECTOMY

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Methods of Prostatectomy - TURP - Open prostatectomy - Laparoscopic - Robotic - Robotic assisted

 Open Prostatectomy approach - Transvesical - Retropubic ( Millin ) - Perineal

 INDICATIONS - enlarged lateral lobes of prostate - enlarged median lobe

 TRANSURETHRAL RESECTION -

Removal of prostatic tissue perurethrally No incision Less operative time Early mobilization Less post – op. complications Early recovery

 INSTRUMENTS & MATERIALS - Cystoscope - Resectoscope - Cautery ( diathermy ) - Irrigating fluid

 ANAESTHESIA - Spinal anaesthesia - Epidural anaesthesia - General anaesthesia

 POSITION OF THE PATIENT - Lithotomy position

 PROCEDURE - P & D done in Lithotomy position - Cystoscope introduced per urethra - confirm enlarged lobes of prostate

 contd.. - Resectoscope introduced through the cystoscope & enlarged lobes resected using a cautery device - Irrigating fluid passed through the scope flushes prostatic tissue bits in bladder

 Prostatic tissue bits collect in bladder  removed after flushing the bladder  Bleeding at the resected site controlled by cautery

 Prostatic tissue bits send for Histopathological exam.  Haemostasis achieved  No 20 / 22 Fr Triple lumen catheter passed per urethrally

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Balloon inflated by 35 – 40 cc of NS.

 

Traction given to the catheter so that balloon retains in the Prostatic fossa Traction helps to achieve haemostasis

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Traction to be applied for at least 24 hrs

 Irrigation to be given by NS  Irrigation to be continued till the draining fluid is clear  Indicates haemostasis at the prostatic fossa

 Traction to be discontinued after 24 hrs to avoid Prostatic fossa necrosis  Foley’s Catheter to be kept at least for 5 days post operative

 COMPLICATIONS -

Haemorrhage Stricture rupture urethra Incontinence