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Transurethral resection of the prostate (TUR-P) for prostate cancer


Medical editor Bjørn Brennhovd
Urologist
Oslo University Hospital
Norway

General

Transurethral resection of the prostate (TUR-P) is performed as palliative treatment for prostate cancer:

  • when the tumor obstructs emptying of the bladder
  • for bleeding due to tumor breakthrough of the urethra/neck of the bladder 

Indications

  • Obstruction symptoms
  • Urine retention 
  • Bleeding

Goal

  • Palliation

Equipment

  • Resectoscope
  • Xylocain gel®
  • Ellik® evacuator
  • 3-way catheter
  • NaCl for irrigation

Preparation

  • A urine sample must be provided for a bacterial test.

If a urinary infection is present, the patient should be treated with antibiotics pre-, per-, and postoperatively.   


Implementation

The procedure is done under spinal or general anesthesia. The patient should have leg supports.

  • Wash the perineum and external genitalia with chlorhexidine.
  • Drape the area allowing for peroperative rectal exploration.
  • Place Xylocain gel® in the urethra.
  • Insert resectoscope, guided by vision, into the bladder.
  • Inspect bladder for pathological findings.
  • Inspect the size of the prostate and possible breakthrough of tumor.
  • Inspect the urethral part of prostate all the way to the colliculus.
  • Resect  tissue of the urethral part of the prostate. Resect tissue to obtain an adequate channel down to the funicle. When the tumor infiltrates towards the sphincter, extended resection may cause incontinence.
  • The tissue specimens remains in the bladder during the resection. The resected surface will always bleed. It is therefore necessary to flush the area during resection to maintain a good view. All rinse fluid is collected in the bladder. When the bladder is full, the resection instrument is retrieved from the resectoscope to release the rinse fluid containing blood. Alternatively, a suprapubic catheter can be installed to drain the rinse fluid during the entire operation.
  • Continually maintain hemostasis during the procedure.
  • Empty the bladder of the resected tissue using an evacuator. Remaining pieces of tissue can cause complications.
  • Check hemostasis.
  • Place a 3-way catheter for continuous flushing.

Follow-up

There should be continuous flushing through a 3-way catheter for approximately 24 hours is done, depending on bleeding. If there is no ongoing bleeding, the catheter can be removed after 24 hours. When there is spontaneous voiding and residual urine < 50 ml, the patient can be discharged. If the patient had a urinary tract infection during the procedure, antibiotics should be given for one week based on a bacterial resistance test.

Complications

  • Per- and postoperative bleeding (frequent due to abundance of vessels in the tumor). Coagulated blood in the bladder must be evacuated.
  • Infections
  • Incontinence (rare, but can occur if tumor infiltrates down to the sphincter area)

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