Transurethral resection of the prostate (TURP) is the “gold standard” for the treatment of prostate enlargement in older men.
Pre-operative routine preparation
One week before surgery, no smoking.
The day before surgery, take an antibiotic skin test.
Take a laxative to empty the gastrointestinal tract the evening before surgery.
④Eat a normal diet at noon the day before surgery and a light and easily digestible diet the evening before surgery.
⑤ Fasting after 8:00 p.m. the night before surgery.
⑥No drinking after 12:00 p.m. the night before surgery.
On the day of surgery (before entering the operating room)
①Laxative enema in the morning of surgery.
② Receive the first surgical patient between 7:30-8:30 a.m. on the morning of surgery.
③The following items need to be brought to the operating room at the same time.
1.Antibiotics.
2.Medical records.
④After the patient is pushed into the operating room, the family will wait in the waiting area. After the surgery, the physician in charge will notify the patient’s family to the meeting room by radio and inform them about the surgery.
On the day of surgery (during surgery)
①Anesthesia is usually epidural, but can also be combined epidural and lumbar or general anesthesia with tracheal intubation.
②It takes 30-50 min from the induction of anesthesia to the completion of anesthesia.
③It takes about 60-100min from the start of surgery to the end of surgery.
④A postoperative urinary catheter is left in place and bladder irrigation is continued.
Day of surgery (return to the ward after surgery)
①Continue bladder irrigation after surgery, pay attention to the color of the irrigation fluid, and notify the responsible nurse and the physician in charge in time if there is fresh bleeding (contact the nurse on duty during off hours).
② Encourage the patient to breathe deeply.
③Encourage patients to move their limbs in bed.
④Can lie in lateral position.
⑤Pillow can be rested for 6 hours after returning to the ward (under epidural and combined epidural and lumbar anesthesia).
(6) Strictly abstain from eating and drinking on the day of surgery (including abstaining from drinking water).
⑦Patients can moisten their lips and mouth with water with cotton swabs to relieve thirst, but not to drink water.
⑧Family members assist the patient to move the lower limbs once an hour (to avoid venous thrombosis of the lower limbs).
⑨ Due to irritation of the bladder triangle by the ureter, some patients may experience bladder spasm (mainly manifested as a sense of urination that cannot be suppressed by itself) after surgery, which can be relieved by intramuscular injection of mebendazole, anal plug of diclofenac sodium, oral tolterodine and other drugs.
⑩ Gauze is sometimes wrapped around the urethral orifice ureter to pull the balloon and compress bleeding spots on the prostate wound. The urethral gauze can be loosened 4-6h after returning to the ward (long-term compression can cause urethral necrosis).
The first day after surgery
Normal diet (transurethral electrolysis of the prostate is low level of anesthesia, short, and has little effect on the gastrointestinal tract, but pay attention to eating less and more). Bladder irrigation can usually be stopped and more water is required (ensure urine volume of 2000-300m/day). Eat fruits and use Chinese herbal medicines to promote gastrointestinal recovery and soften stools if necessary. There will be some blood and urethral secretions attached around the urinary catheter (especially the part near the urethra), which needs to be washed with warm towels in time.
Anti-inflammatory and supportive treatment
Get out of bed (the sooner you get out of bed, the faster you will recover after surgery). Diet and water intake on the 2nd-5th postoperative days are the same as before.
The duration of the urinary catheter is decided by the physician in charge according to the situation related to the surgery. Generally, the longer the duration of the urinary catheter is left in place for 3-5 days, the more common the occurrence of urethral infection and urethral stricture, and the less common the urinary frequency, urinary urgency and hematuria after the catheter is removed (personal opinion). The shorter the duration of urinary catheterization, the less frequent the occurrence of urethral infection and urethral stricture, and the more common the urinary frequency, urgency and hematuria after extubation.
Post-discharge precautions
①It takes 3-4 months for the prostate wound to heal completely after surgery, and hematuria may occur during this period.
②Dry stools, prolonged sitting, bicycle riding, and sexual intercourse can cause hematuria to appear or worsen.
③Oral finasteride (5mg once a day) can reduce the symptoms of hematuria.
④Oral medication to improve local edema.
⑤The urinary flow rate and residual urine volume (to clarify the improvement of voiding obstruction) need to be rechecked 1 month after surgery.
⑥Patients with elevated PSA need to continue to recheck PSA (PSA is an important marker molecule of prostate cancer).
(7) If the symptoms of dyspareunia reappear after short-term improvement after surgery, we need to be careful of the possibility of urethral stricture and urethral dilatation if necessary.