[Abstract] Objective To explore the causes of complications and preventive countermeasures of transurethral resection of the prostate (TURP). Methods The clinical data of 549 patients with benign prostatic hyperplasia (BPH) who underwent TURP were retrospectively summarized. Results Complications included: urethro-prostate electrocutaneous syndrome (TURS) in 4 cases, which manifested as acute renal failure in 1 case with successful rescue, permanent urinary incontinence in 1 case, temporary urinary incontinence in 5 cases, bladder neck contracture in 4 cases, urethral stenosis in 17 cases, early hemorrhage in 7 cases, and delayed hemorrhage in 25 cases. The main reasons include: perforation of the prostate peritoneum and venous sinus incision, hemolysis caused by hypotonic irrigation solution, external sphincter injury, bladder dysfunction, bladder neck electrocision is too deep, urethral mucous membrane damage by friction of electrocathoscopic sheath, incomplete hemostasis, glandular residue and infection, and so on. Preventive measures include: establishing peripheral venous pressure monitoring, mastering the anatomical characteristics of the posterior urethra and the plane of prostate electrocision under the electrodesiccope, operating gently, removing the gland completely, stopping bleeding tightly, applying diuretics and hypertonic saline in time, and treating the primary disease actively. Conclusion The causes of TURP complications are multifactorial, and skillful mastery of its preventive countermeasures and endoscopic surgical operation techniques is the key to improving clinical outcomes. [Keywords] Transurethral resection of the prostate; prostatic hyperplasia; complications Transurethral resection of the prostate (TURP) is the gold standard for the treatment of BPH, but how to improve the technical level of TURP and prevent and minimize complications is still an important topic for clinicians. From January 2002 to February 2008, a total of 549 patients with benign prostatic hyperplasia (BPH) underwent TURP in our hospital, and the therapeutic effects were satisfactory, which are reported as follows. Data and Methods 1. Clinical data: 549 cases in this group, age 50-86 years old, average (61±7) years old, disease duration 2 months-12 years, average (2,7±0,8) years. There were 138 cases of acute and chronic urinary retention, 32 cases of upper urinary tract fluid renal insufficiency, 11 cases of superficial bladder cancer, 13 cases of small bladder stones, 132 cases of hypertension, 187 cases of coronary artery disease, 87 cases of chronic obstructive pulmonary disease, 4 cases of hepatic function abnormality, 65 cases of diabetes mellitus and 2 cases of cerebral infarction. Rectal diagnosis and measurement of prostate volume by abdominal ultrasound: 208 cases of prostatic hyperplasia of the first degree, 312 cases of the second degree and 29 cases of the third degree. Urodynamic examination: 53 cases with unstable bladder, maximum urinary flow rate of 4,3-9,3ml/s, average urinary flow rate of (5,3±1,3)mL/s, residual urine volume of (235±68)mL.Preoperative routine examination of serum total prostate-specific antigen (tPSA) and free prostate-specific antigen (fPSA) was done to screen and exclude prostate cancer. Treatment: Lumbar-hard anesthesia, Shunkang brand 25, 6F gasification electrocautery, electrocutaneous power 160W, gasification power 260W, electrocoagulation power 60W, 5% GS continuous rinsing, with diabetic patients using distilled water, rinsing liquid device is about 60cm away from the surgical table.Combined with superficial bladder cancer and bladder stones were treated at the same time, and resection method used Nesbit method or Silber method, and after resection, the seminal caruncle was kept in the same place. Nesbit method or Silber method was used. After resection, the integrity of the seminal caruncle was maintained, and the membrane urethra was nearly round and open, and the “ejaculation sign” was observed to confirm the smoothness of the electrocutaneous channel, and the “ejaculation sign” was stopped and then the bladder area was pressed with the hand, and if there was still a large amount of urine ejaculation, it could be judged that the urinary sphincter had not been damaged. If there is still a lot of urine ejaculation, it can be roughly judged that the urethral sphincter is not damaged. 20F triple-lumen Foley urethral catheter was left in place and was removed 7d after the operation. During and after the operation, the patient’s mental and vital signs were closely observed, and the laboratory indexes were checked in time to control the speed and quantity of rehydration solution and the ratio of sodium to water in the rehydration solution. Results In this group, there were 371 cases of TURP, 178 cases of TVP + TURP; the operation time was 20-180 min, average (58,0±14,5) min; intraoperative bleeding was 30-600 ml, average (95±35,3) ml, and blood transfusion of 200-400 ml was performed in 5 cases; the resection of prostate tissue was 20-95 g, average (41,5±10,5) g. The patients’ mental and vital signs were closely observed during and after operation, and the speed of rehydration and the proportion of sodium in rehydration fluid were controlled. Complications and causes were: intraoperative limited perforation of prostate peritoneum in 53 cases, large perforation in 6 cases, TURS in 4 cases, which occurred in 1 case during the operation and 3 cases after the operation, which manifested as acute renal failure in 1 case, which was treated in time; external urethral sphincter injury caused permanent urinary incontinence in 1 case, which underwent cystostomy in 3 months, and temporary incontinence was restored to normal in 5 cases in 1-4 months after the symptomatic treatment; Postoperative bladder neck contracture 4 cases, mainly caused by bladder neck electrodes too deep, 17 cases of mild urethral stenosis, mainly caused by friction damage to the urethral mucosa of the mirror sheath inflammation, 20 cases of urethral dilatation 1-3 months to restore urinary patency, 1 case of diabetes mellitus combined with a serious contracture of the bladder neck, urethral dilatation is ineffective to perform a vesicostomy; 7 cases of early postoperative hemorrhage, mainly associated with the operation of bleeding is incomplete, which hemorrhage One case was cured by hemostasis with electrosurgery, and 25 cases of delayed hemorrhage were mainly related to incomplete removal of glands and infections, which were cured by anti-infection and hemostasis; there were no intraoperative hemorrhage and death cases. Discussion TURP has been used to treat BPH for more than 70 years, although its surgical operation is not very difficult, it requires high technical proficiency of the surgeon, and there are still some clinical complications, such as urethral stenosis, bladder neck contracture, bleeding and so on, the causes of which are various, and the preventive measures should be focused on the mastery of anatomical characteristics of the posterior urethra and the prostate electrocutaneous plane under the electrocutaneous microscope, gently operated, and completely The reason for this is that there are many different reasons for this. However, two serious complications, TURS and urinary incontinence, are very difficult to deal with once they occur, which directly affects the surgical effect, and therefore should be highly emphasized in the clinic. TURS is a complication with complex etiology and dangerous condition, and the triggering factors are multifaceted, with perforation of the peritoneum and incision of the venous sinus being the most important factors during the operation. Three cases of TURS in our group occurred because of obvious intraoperative prostatic venous sinus opening or perforation of the peritoneum, which is consistent with most of the results reported in the literature. Because the venous sinus is incised when it is equivalent to the direct high-pressure perfusion of water rapidly into the vascular circulation, the lower the pressure of the flushing fluid, the better, and the distance between its device and the operating table should be grasped at 40cm-60cm is appropriate. And the perforation of the membrane by the prostate peripheral gap water absorption, i.e., extravascular route absorption, the absorption threshold is much lower than the threshold of its absorption through the blood vessels, even if the pressure is lower may produce a large amount of absorption of the flushing fluid, therefore, try to avoid perforation of the membrane and the venous sinus was cut is particularly important during the operation. At the same time, it is worthwhile to pay attention to the hypotonic rinsing solution, especially distilled water, which is more likely to cause water absorption and cell swelling and rupture, and even cause hemolysis, which may lead to acute renal failure, and should try to use a better osmolality rinsing solution, avoiding the use of distilled water. This group has recently occurred in a case of original diabetic nephropathy, azotemia based on this reason induced acute renal failure, TURP operation vital signs are stable, less bleeding, no obvious venous sinus opening or perforation of the peritoneum, the end of the operation to check the blood sodium, low for 133, 4 mmol / L, blood potassium is normal, but the blood specimen suggests a heavy degree of hemolysis only to be taken seriously. In addition, the occurrence of TURS and the size of the prostate volume and surgical time, in principle, should grasp the size of the prostate within 80g, time within 60-90min, but according to the patient’s specific circumstances, the patient’s original physical condition should not be ignored. In this group, there is a case of surgery time is only 50min, in the operation but a serious TURS, which is closely related to the patient’s advanced age, the original poor physical condition, another 11 cases of severe BPH patients surgery time up to 1,5-2 hours, 3 cases up to 2-3 hours without TURS, the main reason is related to the patient’s original physical condition is better and effective preventive measures. The main preventive countermeasures: (1) comprehensive preoperative assessment and adequate correction of the patient’s co-morbid cardiopulmonary and cerebrovascular diseases, in order to improve the patient’s ability to tolerate surgical anesthesia; (2) the establishment of peripheral venous cannulae connected to the three-way switch for peripheral venous pressure monitoring during the operation to determine the circulatory load, which is a simple method that provides a very powerful help in the prevention of TURS. We believe that with peripheral venous pressure monitoring, especially with the joint application of fast and easy biochemical monitor (Abbott i-STAT type) to monitor the changes of blood sodium and potassium, the operation time can be mastered in 90-120min, and its monitoring results confirm that it is relatively safe; (3) Pay attention to the intraoperative identification of the cut surface tissues and the depth of the gland resection and the pressure, and don’t ask to cut to the peritoneum earlier to avoid the premature perforation of the peritoneum. Premature perforation of the peritoneum, in the process of cutting a considerable number of patients can see brown or brownish-yellow, small rice grains to sorghum rice grain size prostate stones were flushed out, which indicates that the depth of cutting has been close to the peritoneum, at this time, it is best to make only a flat cut or shallow cut to the peritoneum of the prostate, such as deeper cuts may be cut through the peritoneum; (4) for the large BPH, the use of TVP to excise a large portion of the prostate proliferation of tissues, at this time, the blood vessels are coagulated, and then the vasculature of the prostate. The blood vessels are coagulated, and then the prostate fossa trauma, prostate tip and bladder neck can be quickly trimmed by TURP, which can not only shorten the operation time, but also avoid cutting through the peritoneum and venous sinus, which can reduce the bleeding and the absorption of the douche solution, and effectively prevent the occurrence of TURS. Urinary incontinence is an important complication after TURP, and its causes are multifactorial. bladder dysfunction is one of the main causes of temporary urinary incontinence after prostatectomy, and also accounts for a certain proportion of patients with permanent incontinence. nunzio reported that 68% of patients with prostatectomy had preoperative urethral instability, and 31% of patients with urethral instability still existed after surgery. klan et al reported that 53% of patients with post-TURP incontinence were due to perineal instability, 47% had sphincter injury, and half of these had perineal instability. The main causes of temporary urinary incontinence are bladder dysfunction, localized inflammatory edema stimulation of the fossa affecting the sphincter closure mechanism, or surgical injury to part of the external sphincter. Five cases of temporary urinary incontinence in our group were related to this. The main cause of permanent urinary incontinence is the injury of posterior urethral transverse muscle sphincter, TURP surgery, the smooth muscle sphincter in the urethral wall of the ring has been damaged to varying degrees, postoperative urination is mainly controlled by the external sphincter, which is to protect the external sphincter is the key to preventing permanent urinary incontinence. The main preventive countermeasures: (1) to master the intraoperative identification of the luminal anatomical markers of the posterior urethral sphincter, the method is to retract the electrodiagnostic scope to the urethral bulb, through repeated alternation of rapid opening and closing of the douche solution, the normal closure of the external sphincter can be observed, at this time, the electrodiagnostic scope and then gently pushed forward to stimulate the urethra, the external sphincter contraction can be seen, and pay attention to the spermathecae and the distance between the neck of the bladder, so that accurate positioning of the external sphincter. The position of the sphincter can be accurately localized. (2) When electrocuting the apical glands close to the caruncle, the end-point cutting method should be used from the beginning to the end. When electrocuting the apical glands beyond the caruncle on both sides or on the distal side of the caruncle, it is strictly forbidden to make the cut too long and too deep in the horizontal direction, and small thin layers of tissues should be cut in an arc from the perineum diagonally to the direction of the urethra, to ensure that it is resected in the prostatic glands and the integrity of the caruncle and external sphincter is well protected. However, there are reports in the literature that the seminal caruncle can be resected during TURP, and it is emphasized that there is a clear depressed border between the prostate and the external sphincter, and keeping the electrodesiccator sheath above the depressed border, there is no need to be particularly concerned about the external sphincter injury. (3) During electrocision, the scope should be moved backward and withdrawn to the bulbous urethra on the distal side of the seminal caruncle to observe whether the apical glands remain and whether they are open in a subcircular shape, but do not pursue the apical membranous urethra to be completely open in a circular shape, which may result in excessive depth of cuts on both sides and injure the external sphincter muscle. Pan Bainian [9] believes that if the cut length is 2,0cm, and the downward deep cut is 0,6cm, it is possible to injure the external sphincter, causing urinary incontinence. (4) At the end of the electrocutaneous cutting of the prostate fossa two external posterior part often have bleeding, generally in the indwelling urethral tube after compression will be self-stopping, should be avoided in this excessive electrocoagulation hemostasis, in order to protect the urethral control nerve, in the bladder neck cutting should not be too deep, to the exposure of the ring fibers can be, in order to try to protect the internal sphincter of the urethra, so as to avoid the stress urinary incontinence and the occurrence of the contracture of the bladder neck. (5) Preoperative urodynamic examination should be performed routinely to clarify whether there is an unstable bladder, as the basis for postoperative efficacy judgment and guidance of treatment.