TRANSURETHRAL RESCTION OF PROSTATE

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Information about TRANSURETHRAL RESCTION OF PROSTATE

Published on February 15, 2009

Author: rhun18

Source: slideshare.net

Description

TRANSURETHRAL RESCTION OF PROSTATE; TURP

CAPITOL UNIVERSITY

Transurethral resection of the prostate

DEFINITION: Transurethral resection of the prostate (TURP) is a surgical procedure by which portions of the prostate gland are removed through the urethra

Transurethral resection of the prostate (TURP) is a surgical procedure by which portions of the prostate gland are removed through the urethra

SHORT DESCRIPTION: Does not involve an external incision. The surgeon reaches the prostate by inserting an instrument through the urethra The actual TURP procedure is simple. It is performed under general or local anesthesia. After an IV is inserted, the surgeon first examines the patient with a cystoscope, an instrument that allows him or her to see inside the bladder. The surgeon then inserts a device up the urethra via the penis opening, and removes the excess capsule material that has been restricting the flow of urine.

Does not involve an external incision. The surgeon reaches the prostate by inserting an instrument through the urethra

The actual TURP procedure is simple. It is performed under general or local anesthesia. After an IV is inserted, the surgeon first examines the patient with a cystoscope, an instrument that allows him or her to see inside the bladder. The surgeon then inserts a device up the urethra via the penis opening, and removes the excess capsule material that has been restricting the flow of urine.

GOAL: The goal of prostate surgery for benign prostatic hypertrophy (BPH) is to remove the obstruction, minimize the damage to surrounding structures, and cause the patient as little discomfort as possible

The goal of prostate surgery for benign prostatic hypertrophy (BPH) is to remove the obstruction, minimize the damage to surrounding structures, and cause the patient as little discomfort as possible

PROCEDURE The urethra may be dilated, as necessary. The irrigation tubing, fiberoptic light cord, and eletrosurgical cord are connected and the bladder is continuously irrigated during the procedure. Cystoscopy is performed to assess the hypertrophy and to inspect the bladder. A resectoscope is passed into the bladder using a water-soluble lubricant. The urethra and bladder trigone are reexamined. Electrodissection (monopolar or bipolar) is employed to excise pieces of hypertrophied prostatic tissue .

The urethra may be dilated, as necessary. The irrigation tubing, fiberoptic light cord, and eletrosurgical cord are connected and the bladder is continuously irrigated during the procedure. Cystoscopy is performed to assess the hypertrophy and to inspect the bladder.

A resectoscope is passed into the bladder using a water-soluble lubricant. The urethra and bladder trigone are reexamined. Electrodissection (monopolar or bipolar) is employed to excise pieces of hypertrophied prostatic tissue .

At intervals, the fragments of tissue and blood clots are washed out of the bladder using an Elik evacuator or Toomey syringe. Total removal of all tissue fragments is desired. When resection is complete, the bladder and prostatic fossa are examined for residual unattached fragments of tissue. When adequate hemostasis is assured, the resectoscope and sheath are removed. A Foley catheter (30-ml balloon) is inserted into the bladder, filled with 5 to 10 ml of fluid, and then drawn into the prostatic fossa, where an additional 12 to 25 ml of fluid is introduced to provide pressure for hemostasis.

At intervals, the fragments of tissue and blood clots are washed out of the bladder using an Elik evacuator or Toomey

syringe. Total removal of all tissue fragments is desired. When resection is complete, the bladder and prostatic fossa are examined for residual unattached fragments of tissue.

When adequate hemostasis is assured, the resectoscope and sheath are removed. A Foley catheter (30-ml balloon) is inserted into the bladder, filled with 5 to 10 ml of fluid, and then drawn into the prostatic fossa, where an additional 12 to 25 ml of fluid is introduced to provide pressure for hemostasis.

PREPARATION OF THE PATIENT The room of choice is the “cysto” room with the “cysto” table. A forced air warming blanket may be placed. Anti-embolitic hose are applied, when ordered. Following the administration of regional (preferred) or general anesthesia, the patient is positioned in lithotomy using padded knee crutches on the “cysto” table. Arms may be extended on padded arm boards. All bony prominences and areas vulnerable to skin and neurovascular pressure or trauma are padded. Electrosurgical dispersive pad is placed.

The room of choice is the “cysto” room with the “cysto” table.

A forced air warming blanket may be placed. Anti-embolitic hose are applied, when ordered.

Following the administration of regional (preferred) or general anesthesia, the patient is positioned in lithotomy using padded knee crutches on the “cysto” table.

Arms may be extended on padded arm boards. All bony prominences and areas vulnerable to skin and neurovascular pressure or trauma are padded. Electrosurgical dispersive pad is placed.

SKIN PREPARATION Cleanse entire pubic area (including scrotum and perineum), extending from the umbilicus to the mid-thighs.The anus is prepped last; discard each sponge after wiping the anus.

Cleanse entire pubic area (including scrotum and perineum), extending from the umbilicus to the mid-thighs.The anus is prepped last; discard each sponge after wiping the anus.

Draping Impervious drape sheet under the buttocks, leggings, and transversesheet or “cysto” drape

Impervious drape sheet under the buttocks, leggings, and transversesheet or “cysto” drape

L I T H O T O M Y

INSTRUMENTS & MATERIALS

CYSTOSCOPE

 

RESECTOSCOPE

CAUTERY (DIATHERMY)

 

Fluid for Irrigation Usually Normal Saline

Usually Normal Saline

COMPLICATIONS Hemorrhage Stricture Rupture urethra Incontinence

THANK YOU!!!! FIN!!!

Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending. -----JAY U. OCATE CUSN4___

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