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

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.

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