It requires special preparation, which the patient is required to strictly follow for the success of the procedure.
TURP involves the use of the resectoscope, an instrument equipped with a light source, a camera and a sort of sharp ring through which electric current flows; during the operation, the operating doctor introduces the resectoscope into the urethra and leads it to the prostate , where it will carry out the foreseen procedures.
TURP is a potentially very effective therapeutic option; however, like any surgery, it can lead to complications, in some cases even unpleasant.
What is the Prostate and What Functions does it cover: a brief review
The prostate (or prostate gland) is the unequal exocrine gland of the male genital system, located in the pelvis, just below the urinary bladder and in front of the rectum.
Similar in shape and size to a chestnut, the prostate surrounds the male urethra in the tract of the latter between the internal urethral sphincter muscle and the external urethral sphincter muscle; the relationship of the prostate with the male urethra, however, is not limited to proximity: the prostate gland, in fact, emits channels, called prostatic ducts, which open on the male urethra, thus putting the two anatomical structures in communication.
The prostate secretes part of the liquid component of the sperm; alkaline in nature and whitish in color, this liquid component has the function of neutralizing the acidic environment of the female vagina, in order to protect the spermatozoa (which would otherwise be affected by the aforementioned environmental conditions) and prolong their life inside the genital system of the woman.
For further information: Prostate: Anatomy and Function or an interventional andrologist.
Benign Prostatic Hypertrophy: What is it?
When we talk about benign prostatic hypertrophy (BPH), benign prostatic hyperplasia, enlarged prostate and prostate adenoma, we refer to a volumetric enlargement of the prostate of a non-cancerous nature.
The enlargement of the organ, in fact, is due to a cellular proliferation of the prostate tissue, which however lacks the infiltrative and metastatic powers that characterize a malignant tumor.
Benign prostatic hypertrophy is an alteration strongly connected to advanced age: according to some statistical research, about 80% of men between 70 and 80 years of age suffer from it.
At present, the precise causes of BPH are unclear; according to the latest research, hormonal changes that occur with aging seem to play a role: this would explain why an enlarged prostate is a typical condition of elderly men.
For further information: Benign Prostatic Hypertrophy: Causes, Symptoms and Therapy ;- Recurrent urinary tract infections;
- Damage to the bladder and / or kidneys;
- Urinary incontinence;
- Bladder stones
- Presence of blood in the urine.
It is important to point out that urologists and andrologists use TURP only after trying to resolve the disorders related to benign prostate hypertrophy with all the various conservative treatments currently available for the aforementioned condition; in other words, they give priority to less "bloody" therapies and risky, and, only if these prove ineffective, they adopt transurethral resection of the prostate.
Non-invasive therapy for benign prostatic hypertrophy is mainly based on the administration of two types of drugs: antiandrogens and alpha-blockers.
and at an ECG.Subsequently, the doctor who should perform the procedure will subject him to a scrupulous physical examination and a "thorough medical history, during which he will ask for information about any chronic diseases, drugs or supplements taken, allergies, particular daily habits (eg: if he smokes ) etc.
These checks are used to establish the patient's state of health and any precautions that the latter must take in view of TURP.
Knowing the patient's general state of health is important, as it allows us to clarify whether the subject is in the physical condition to face a surgical procedure such as TURP.
During the medical history, the doctor wants to know above all if: the patient suffers from coagulation diseases; takes anticoagulant drugs and / or particular food supplements; is allergic to sedatives or anesthetics; smokes.
TURP: Pre-operative Precautions
Here are the main ones:
- On the day of surgery, have a complete fast for at least 8 hours. This means that if the procedure is set for the morning, the last meal allowed is that of the previous evening.
However, it is worth noting the possibility of drinking water up to a few hours before the operation.
To impose fasting is basically anesthesia, which can be general or spinal.
Failure to comply with these precautions will result in the postponement of the TURP to another date. - If the patient is on anticoagulant drug therapy (eg warfarin), he must temporarily suspend this treatment to avoid excessive bleeding during and after surgery.
- If the patient is a smoker, he must stop smoking, at least temporarily. Smoking increases the risk of various complications, including post-operative infections.
- For the return home, get help from a family member or friend. After the surgery, it is highly likely that the patient feels confused, unresponsive, weak and tired; therefore, he is not very autonomous and needs support (eg: it is strongly advised against driving a vehicle).
Any other pre-operative indications depend on the patient and his specific health conditions.
and removal of prostate fragments.
Patient Preparation and Positioning
First, the patient must take off any jewelry, glasses, watch, etc.
After that, he has to undress and put on a smock specially prepared for him.
At this point, the medical staff invites him to sit on the operating table, belly up; once the appropriate position has been taken, a member of the same medical staff is responsible for inserting an intravenous line on his arm for the possible passage of drugs, sedatives, etc.
Anesthesia
Performed by an anesthetist, the anesthesia allows the patient not to feel pain during the operation.
During TURP, the anesthesia can be general or spinal.
General anesthesia requires the patient to fall asleep and remain unconscious for the entire procedure; during spinal anesthesia, however, the patient is conscious for the entire procedure, but is completely numb from the waist down.
Anesthetics take a few minutes to take effect.
Along with them, the doctor may also administer sedatives and antibiotics (the latter serve to reduce the risk of infections).
Monitoring of vital functions
While the specialist practices anesthesia, the medical staff applies to the patient all those devices and instruments that are used to monitor vital functions, such as heart rate, blood pressure, respiratory function, oxygen saturation in the blood, etc.
Inserting the Resectoscope
Once the anesthetics have been activated, the operating surgeon (a urologist or an andrologist) is dedicated to inserting an instrument called resectoscope into the urethra and conducting it to the prostate level.
The resectoscope is a sort of endoscope made for the passage along the urethra and for surgical operations at the level of the prostate and urinary bladder; it is provided, at the extremity that the urologist (or andrologist) inserts in the areas indicated above, with a light source, a camera connected to an external monitor and a small metal ring that emits electrical discharges.
Search and Removal of abnormal portions of Prostate
Thanks to the light source and the resectoscope camera, the urologist (or andrologist) is able to see on an external monitor what is present inside the prostate and urinary bladder, and to identify the portions of prostate tissue to be eliminated.
To remove excess prostate areas, the "metal ring on the resectoscope is used: in fact, the passage of electric current along the" metal ring makes the latter a sort of scalpel capable of cutting and slicing the portions of the prostate on which it is applied.
Washing and Removal of Prostate Fragments
Since the resectoscope does not allow the aspiration or collection of the cut prostate "slices", the operating physician must rely on washing the urethra and urinary bladder with glycine.
To carry out the washing, he takes care, first of all, of extracting the resectoscope; subsequently, he inserts a bladder catheter into the urethra and leads to the bladder; finally, using the bladder catheter, he injects a glycine-based solution which collects the prostate fragments and any blood clots, and discharges them to the outside together with the urine.
The washing process lasts until the urine is clear (generally, it takes 24 to 48 hours).
TURP: How long does the procedure take?
A TURP surgery can last between 45 and 90 minutes, depending on the characteristics of the prostate.
TURP and Laboratory Analysis
Although benign prostatic hypertrophy and prostate cancer are two distinct conditions and without any association, it happens quite frequently that the operating physician deems it appropriate to send the extracted prostate fragments to the laboratory for analysis, for a thorough histological evaluation (prostate biopsy).
(blood pressure, cardiac activity, etc.) and to follow him in the first and more delicate stages of recovery.A very important aspect of the first postoperative phase is bladder catheterization.
TURP and Bladder Catheter
Generally, for at least the first 4 days following a TURP operation, a bladder catheter is used to eliminate urine and any blood clots that may have formed following incisions in the prostate.
The use of the bladder catheter is justified by the fact that patients returning from TURP procedures cannot urinate independently.
Normally, the bladder catheter is connected to an external bag used to collect urine; this solution for urine collection allows the patient greater freedom during hospitalization.
If, once the bladder catheter has been removed, the patient still has some difficulty urinating, a new catheter must be inserted and wait a few more days to remove it definitively.
TURP: How does the patient feel after the procedure?
It is common for patients to complain of:
- Pain when passing urine;
- Frequent and urgent need to urinate
- Presence of blood (or rather blood clots) in the urine (the bladder catheter also serves to facilitate their elimination).
These disorders are considered normal if they do not last beyond 4 weeks. Generally, the improvement is gradual.
Important!
If the urine is completely red, it is best to contact your doctor immediately.
TURP: Recovery at Home
After the days of hospitalization, recovery must continue at home.
For patients returning from TURP surgery, the classic medical indications to follow at home include:
- Drink plenty of water in such a way as to favor, through frequent urinations, the cleansing of the urinary tract (bladder and urethra in particular), in which the remains of a sectioned prostate or blood clots may remain.
- Do not strain the intestines with a wrong diet. It is a good idea to eat foods rich in fiber and avoid those that promote constipation.
If you have constipation, your doctor is likely to prescribe laxatives. - Do not engage in strenuous activities, such as lifting weights.
Typically, this recommendation applies for the first 4-6 weeks. - Do not resume any pharmacological therapies based on antiplatelet and / or anticoagulants earlier than established.
- Temporarily refrain from sexual activity. Generally, this advice should be followed for at least 4-6 weeks.
- Take a pain reliever if you are in pain. The presence of pain should be of concern only when it has been going on for a long time; initially, it is normal to have pain.
- Do not drive until the attending physician allows it.
TURP: Recovery times
Typically, patients undergoing TURP recover from the various effects of the procedure within 6 weeks; obviously, there are men who recover a little earlier and men who recover a little later.
TURP: When to go back to work?
If the work carried out is not heavy, patients returning from TURP can return to work after 2-3 weeks; otherwise, the timing is lengthened.
. It is the condition for which the emission of sperm occurs in reverse, not towards the outside but towards the bladder. It does not alter the sense of pleasure, but it can interfere with the possibility of having children.According to some statistics, this problem occurs in 9 out of 10 cases, so it is very common.
According to some investigations, individuals with severe benign prostatic hypertrophy appear to be more at risk.
In the most unfortunate cases, they can also be a recurring problem.
The initial symptoms are: feeling of malaise, disorientation, dizziness, headache, ascites and bradycardia; to these, over time and especially in case of non-treatment, can be added: spasms, epilepsy attacks, dyspnoea, cyanosis, chest pain and coma.
Often, a newly enlarged prostate requires a second TURP, but in these cases the risk of urethral stricture is greater.
- Recent heart attack or recent heart surgery.
Doctors believe that it is good to wait, in general, from 3 to 6 months, before proceeding with the execution of TURP. - Presence of neurological disorders, such as Parkinson's disease or multiple sclerosis.
These two conditions predispose to urinary incontinence; consequently, a possible intervention of TURP would further increase this risk. - Presence of prostate cancer.
Particularly severe malignant prostate tumors require total removal of the prostate (radical prostatectomy); partial removal, such as that obtained with TURP, would not be sufficient. - Recent radiotherapy for the treatment of prostate cancer.
Some malignant tumors of the prostate can be treated with courses of radiotherapy or brachytherapy (internal radiotherapy); in such cases, it is necessary to wait about 6 months before being able to undergo TURP. - Presence of a urinary, bladder, urethra or kidney infection.
In order to practice TURP, you have to wait for this type of infection to heal.
.jpg)
