Our department is one of the early urology departments in Handan to carry out transurethral resection for prostate enlargement and bladder tumor. Now we have completed more than a thousand cases of this type of minimally invasive surgery and have rich clinical treatment experience.
The incidence of prostate hyperplasia (BPH) has increased significantly as human life expectancy has increased, and BPH has become the most common disease in urology in China. At present, there are many ways to treat BPH, and transurethral resection of the prostate is the “gold standard for the treatment of BPH and is an internationally recognized surgical method for treating BPH that is minimally invasive, safe, thoroughly effective and less painful for the patient.
I. Indications for surgery
1.Urinary retention including acute, chronic and recurrent urinary retention.
2.Obstructive symptoms are obvious such as frequent urination, difficult urination, and abnormal urine flow rate examination.
3.Increased residual urine volume causing renal function damage.
4.Recurrent episodes of refractory to know urinary tract infection.
5.Prostate vein bleeding.
6.BPH comorbidity Combined with bladder stone, diverticulum and bladder tumor, etc.
Contraindications to surgery
The following contraindications are not absolute but relative, and TURP surgery can be performed under appropriate conditions.
(A) Systemic diseases
Mainly cardiovascular and cerebrovascular diseases and respiratory diseases and other important organs.
1. Cardiovascular diseases Severe concurrent hypertension, acute myocardial infarction, uncontrolled heart failure, and recent hemiplegia due to cerebrovascular accident.
2.Respiratory system diseases Severe bronchial asthma, emphysema, lung infection and significantly reduced lung function.
3.Liver failure Those with significant abnormal liver function and severe functional insufficiency.
4.Systemic bleeding disorders.
5.Severe diabetes mellitus.
6.Persons with mental disorders who cannot cooperate with treatment.
7.People with pacemakers are generally not suitable for TURP surgery.
(B) Local lesions
1. Urethral and penile lesions Urethritis, urethral stricture, small penis, small urethra and a history of painful penile erection.
2, local comorbidities Combined with a huge bladder diverticulum or secondary to most larger bladder stones that need to be treated together with open surgery.
3.Acute genitourinary system infection.
4.Forced urinary muscle incompetence Urodynamic examination of bladder pressure shows forced urinary muscle incompetence, the symptomatic improvement of surgery is not sure.
Preoperative preparation
1.Treatment of concurrent diseases Combined cardiovascular, pulmonary, hepatic, diabetic and other systemic diseases should be treated appropriately before surgery.
2.Antibiotic application Antibiotic treatment should be applied to those with urinary tract infection.
3.Urethral dilation Urethral stricture should be treated with urethral dilation.
If urinary retention causes renal impairment, the bladder should be drained (indwelling catheter or suprapubic cystotomy), and then TURP should be performed after renal function improves.
5.Blood preparation Preoperative blood preparation of 200-400ml.
6.Intake of beverage 800～1000ml of beverage before bedtime the night before surgery.
IV. Surgical methods and operation steps
(I) Anesthesia position
Generally, epidural anesthesia is used. After anesthesia, the patient is placed in a lithotomy position with both lower limbs spread as much as possible.
(B) Flushing fluid and flushing method
1.Flushing solution Generally, 3% to 5% mannitol solution is used, or 5% glucose solution or 3% to 5% sorbitol solution can be used.
2.Rinsing method is divided into high-pressure rinsing (>7, 8kPa) and low-pressure rinsing.