TRANSURETHRAL RESECTION OF THE PROSTATE

Anatomy and Physiology of the male

reproductive System

Description of TURP

•-primary approach to surgical resection of the prostate and in the past has been used as the primary intervention for any patient with clinical BPH.

•-surgical procedure is under endoscopic control

•-A rigid cytoscope is inserted into the urethra and bladder, and the prostatic urethra is localized.

TURP description cont…

-Obstructive prostatic tissue is removed by resectoscope.

-A glycine or sorbitol solution is irrigated through the resectoscope during the procedure, removing blood and tissue from the operative field.

RESECTOSCOPE

Actual photo of a TURP

Actual photo of a TURP

Advantages of TURP

•Avoidance of abdominal incision

•Causes less pain•rapid removal of prostatic tissue at the time of surgery

•it can be combined with some other procedures such as removing small bladder stones

•many years of data to support its use with a thorough understanding of its advantages, risks and outcomes

•widespread use throughout hospitals in most countries by urologists

•shorter hospitalization and recovery period

Disadvantages of TURP

•Inability to pass urine after the procedure

•Requires a high skilled surgeon to perform the surgery

Cont. disadv.

•surgical operation•Stricture, obstruction and urethral trauma may occur

•Delayed bleeding may occur

Indications of TURP

– -Obstructive uropathy related to benign prostatic hypertrophy (BPH)

– -Acute urinary retention related to prostatic hypertrophy

Indications cont.……

-Recurrent urinary infections or febrile urinary infection related to benign prostatic hypertrophy

-Recurrent bleeding from the prostate

Indications cont.……

-Bladder stones with prostate enlargement

-Increased pressure on the ureters and kidneys (hydronephrosis) from urinary retention

NURSING MANAGEMENT OF THE PATIENT UNDRGOING TURP

Preoperative Care

Preoperative Care

1.Preoperative assessment

2.Proper explanation of surgical procedure

3.Proper explanation of the complications and risks

Preoperative Care4.Ensure that informed

consent has been signed

5.Notify physician for allergies

6.Notify physician of all medications taken

7.Notify for history of bleeding disorders

Intraoperative Care

Intraoperative Care

1.Maintain Safety and Prevent Injury

2.Position in Client3.Provide

Equipment Safety

Intraoperative Care

4.Maintain Surgical Asepsis5.Assist in Wound Closure6.Monitoring:

– V/S (Body temperature)– Malignant Hyperthermia– Cardiac Respiratory Arrest

• -Allergic Reactions

Procedural Steps: (Nagle & Bollinger, 1997.

Genitourinary Surgery.) 1. The urethra is lubricated generously

with water soluble jelly and dilated with van Buren sounds.

2. The smallest resectoscope sheath, consistent with removal of the amount of hyperplastic prostate tissue present in a reasonable period of time ( 1 to 1 ½ hours or less ), is chosen.

Procedural Steps:3. Resection of prostatic tissue begins

with the middle lobe to the crossing fibers of the bladder neck. This opens the prostatic urethra proximally to facilitate the balance of the resection.

4. Resection of the lateral lobe component is begun at the anterior aspect of the prostatic urethra to allow the lobes to “fall” into the prostatic urethra. This allows for an easier resection. The lateral lobes are resected to their attachment in the surgical capsule.

Procedural Steps:5. The distal resection is limited to the

level of the verumontanum to prevent injury of the intraprostatic continence mechanism (sphincter).

6. All prostatic chips are are evacuated from the bladder with a Toomey syringe or Ellik evacuator to prevent catheter obstruction in the early postoperative period. If a continuous-flow resectoscope is used, suction is attached to the outflow. This removes the need to periodically clear the bladder of tissue and fluid.

Procedural Steps:7. Residual arterial bleeders and

significant venous bleeders in the prostatic urethra are located and cauterized.

8. A three-way Foley catheter with a 30 cc balloon, large enough to accommodate blood clots that may form during the postoperative period, is inserted and generally attached to continuous irrigation. If the resection is small and only a small volume of tissue is removed, a two-way catheter may be sufficient, or no catheter may be needed at all.

Procedural Steps:9. The Vaportrode and Sled are also

being increasing frequency to promote hemostatis and ablation. An adequate prostatic urethral channel must be created to allow for voiding.

10.Blood for serum electrolytes, hemoglobin, and hematocrit is drawn in the immediated postoperative period if blood loss is significant or the operative time is more than 1 hour.

Procedural Steps:

POST OPERATIONAL Phase:

POST OPERATIONAL Phase:(Phipps

and Marek,1999. Medical-surgical nursing: Concepts & clinical practice)

1.Maintaining patency of catheter system

2.Monitoring urine appearance3.Monitoring signs of water

intoxication4.Avoid enemas and rectal

thermometer use5.Instruct patient not to void

around catheter

POST OPERATIONAL Phase:6.Give prescribed

medications7.After catheter removal8.Frequently change

dressings9.Give opportunities to

discuss any concerns 10.Do health teachings to

client

Post OPERATIONAL Phase:• Complications/Risks

1. Hemorrhage2. Transurethral resection

(TUR) syndrome3. Acute urinary retention4. Stress urinary incontinence5. Erectile dysfunction

Sample nursing care of a client undergoing TURP surgery

CASE: taken from (Phipps and Marek,1999. Medical-surgical nursing: Concepts & clinical practice)

• DATA : Mr. Bee is a 67-year-old retired married automobile mechanic. His physician has diagnosed benign prostatic hypertrophy. Mr. Bee has undergone medical examinations on an outpatient and has never been admitted to the hospital. He is slight obese. On admission his blood pressure is 140/90 mm Hg. He denies any history of HP. He takes only OTC Tylenol for in frequent headaches. He had TURP performed today.

Possible Nursing Dx:• Preoperative nursing care

– Knowledge deficit r/t procedure, goals, anesthesia, and potential untoward effects.

POSTOPERATIONAL Care: Altered tissue perfusion (peripheral,

prostatic vascular bed) r/t surgical incision

Altered tissue perfusion (deep leg veins) r/t surgical position for transurethral resection of prostate

Urinary retention (potential) r/t surgical resection of prostate adenoma

Potential TUR syndrome r/t surgical resection of benign prostatic adenoma

POSTOPERATIONAL Care:Pain r/t prostatic resectionPain r/t bladder spasmAltered patterns of urinary

elimination r/t surgical resection of benign prostatic adenoma

Risk for fluid volume excess related to absorption of irrigating fluid

POSTOPERATIONAL Care: Risk for fluid volume excess related to

absorption of irrigating fluid Risk for infection/injury (hemorrhage) r/t to

surgical resection of the prostate adenoma Risk for stress or urge incontinence r/t catheter

use Risk for sexual dysfunction r/t surgical resection

of benign prostatic adenoma Knowledge deficit (activity restriction,

prevention of complications) r/t lack of information

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BIBLIOGRAPHY:• Black, J. & Hawks, J. (2005). Medical-Surgical Nursing:

Clinical Management for Positive Outcomes. 7th ed. USA: Elsevier Inc.

• Doughty, D. (2000). Urinary and fecal incontinence: Nursing management. 2nd ed. St. Louis, Missouri: Mosby, Inc.

• Gray, M. (1992). Genitourinary disorders. St. Louis, Missouri: Mosby, Inc.

• LeMone, P. & Burke, K.M. (1996). Medical-surgical nursing:Critical thinking in client care. California: Addison-Wesly Nursing of the Benjamin/Cumming Publishing Company, Inc.

• Marieb, E. & Hoehn, K. (2007). Anatomy and physiology. 7th ed. San Francisco, CA, USA: Pearson Education, Inc.

• Nagle, G. & Bollinger, J. (1997). Genitourinary Surgery. St. Louis, Missouri: Mosby, Inc.

• Phipps, W.J., Sands, J.K., & Marek, J.F. (1999). Medical-surgical nursing: Concepts & clinical practice. 6th ed. St. Louis, Missouri: Mosby, Inc.

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