[Learning Points]
Transurethral prostate curettage involves inserting an endoscope through the urethra to remove the hyperplasia of the prostate and stop bleeding.
If you are using anticoagulants before surgery, you need to inform your doctor and stop taking them one to two weeks before surgery according to the doctor's instructions.
Postoperative treatment and observation: You need to fast for 6 hours after the operation. In order to reduce bleeding, the calf is fixed on the bed with a restraint. The next day, the doctor will evaluate the urine status and release the immobilization.
Observe the volume and color of urine at any time after surgery. If urine is reduced, blocked by blood clots or severe hematuria, single or continuous bladder lavage may be performed.
What is benign prostatic hyperplasia (BPH)?
Prostate is a part of male reproductive system. It's located at the outlet of the bladder, and surrounding aruond the urethra (see below), The part of function of the prostate is semen secretion. Men over 50 years old, most of them have varying degrees prostate hypertrophy, is a normal aging phenomenon, the real reason of the prostate hypertrophy is not clear, may related to aging or hormonal changes.
What are the symptoms?
- Urinate getting slowly: The strength to Urinate getting smaller cannot urinate immediately.
- Frequent urination.
- Nocturia: urinate very often at night.
- Frequent urination and often felt unfinished after urinating.
- Acute urinary obstruction: Bladder inflation and suddenly cannot urinate.
- Urgent urination: have to urinate immediately when bladder inflation.
- Difficulty urinating.
What are the treatments?
According to the conditions, the physician to determine the most appropriate treatment methods:
- Medication.
- Catheterization.
- Transurethral resection of the prostate (TURP)
Surgical indications:
- Moderate to severe urinary symptoms, urinary retention frequently, urinary tract Infection.
- Have kidney damage, hematuria.
- Suspected malignancy tumor
- Medication are not effective
What is Transurethral resection of the prostate
The surgeon reaches the prostate by inserting a resectoscope through the urethra . The surgeon observe the location around the prostate gland, and bladder. and cut of the tissue and seals blood vessels. In the end of the surgeon will put the urinary catheter in the urinary tract.
Transurethral prostate surgery precautions before and after:
This surgery is generally using the spinal anesthesia in the operating room.
Some things you can expect before the procedure include:
- Your doctor will explain the procedure to you and sign a operation and anesthesia consent.
- Before surgery need to understand kidney function and blood clottingunction and do Chest X-ray and ECG.
- shave the hair of perinea area.
- Enema the night before surgery is required.
- You'll be asked to fast for six hours before the procedure, generally after midnight.
- If you're taking any anticoagulant medications, or any other medications that affect blood clotting. Heparin, Aspirin, Tapal, Coumadin, etc. It may be necessary for you to stop these medications for one to two weeks before the procedure.
After the procedure
- Due to the adoption of lumbar spinal anesthesia should be absolutely lying and fasting six hours.
- To reduce the bleeding, postoperative period until the next morning, the catheter will be the full width of fabric glue traction fixed on the inner thigh, calf with restraint strap secured to the bed, hip and knee bend need not be kept straight..
- As the catheter traction, there may be pain and want to urinate and defecate feel unwell if these situations, the staff will assess the deal, to be removed after pulling these symptoms will improve.
- Should always squeeze catheter, to avoid blood clots blocking the catheter.
- After surgery the urine dark red, red or pink, then will gradually become clear, drink plenty of water every day(2000-3000cc) (except dialysis patients and there are contraindications) to facilitate catheter patency.
- After general surgery can get out of bed the next day, a few patients need continuous catheter flushing, no mention of the bag when the activity is too high over the lower abdomen to avoid backflow of urine bag cause infection.
- By prescription taking stool softeners , do not be too hard bowel movement, in order to avoid serious wound bleeding which cause hematuria.
- Always observe the urine volume and color, if the urine decreased blood clots blocking or severe hematuria, you may perform a single or continuous bladder lavage.
Transurethral prostatectomy surgery after curettage how health
- After surgery to remove the catheter, if urgency, urinating more, urinary pain or mild hematuria, is a common phenomenon after surgery may last about a month.
- Please eat more fruits and vegetables to prevent constipation, avoiding bowel movement too hard causing hematuria.
- Within three months to avoid cycling, motorcycle and avoid sex, avoid bleeding wounds to caused hematuria.
- Drink the water during a day, the best day to maintain urine volume over 2000cc.
- If a large number of hematuria or unable urinary, high fever, please go to the hospital emergency room to treatment immediately
- According to physician instructions to outpatient follow-up and examinations to determine the internal wound is heal or not after the surgeon.
- After the TURP surgery, most of the aptients will having retrograde ejaculation may causing infertility, but has no effect on the patient's body. Few of them will have recurrent hyperplasia (estimated 15% after 5 years), therefore the patients still needs to follow-up and having examtion every year to maintain health.
- After the surgeon, if having incontinence, sexual dysfunction or progressive difficulty urinating, should back to the outpatient for further treatment by physician.
Conclusion
During the operation, excessive prostate tissue blocking the urinary tract is scraped to restore smoothness to the urethra. After the operation, when the catheter is removed and urination begins on your own, you may experience symptoms such as frequent urination, urgency, urinary incontinence, pain during urination, and slight hematuria. , as time goes by, symptoms will gradually improve, and the bladder's urine emptying capacity will increase and residual urine will decrease after surgery, which can improve the occurrence of recurrent urinary tract infections.
References
-
Agrawal, M. S., & Mishra, D. K. (2022). Transurethral resection of prostate. Journal of Endourology, 36(S2), S29–S34. https://doi.org/10.1089/end.2022.0305.
- Al Demour, S. H., Abuhamad, M., Santarisi, A. N., Al-Zubi, M., Al-Rawashdah, S. F., Halalsheh, O., Carbone, A., Pastore, A. L., & Ahmad, M. M. (2022). The effect of transurethral resection of the prostate on erectile and ejaculatory functions in patients with benign prostatic hyperplasia. Urologia Internationalis, 106(10), 997–1004. https://doi.org/10.1159/000524957
- Dornbier, R., Pahouja, G., Branch, J., & McVary, K. T. (2020). The new american urological association benign prostatic hyperplasia clinical guidelines: 2019 update. Current Urology Reports, 21(9), 32. https: //doi.org/10.1007/s11934-020-00985-0