Reducing the occurrence of complications after prostate electrosurgery should focus on active prevention, early observation, and early detection. Effective management measures can not only reduce the generation of poor prognosis for patients, but also make them less painful and reduce unnecessary economic expenses.
1. TURP syndrome.
TURP syndrome (dilutional hyponatremia) is an absorption complication that is prone to occur intraoperatively and postoperatively, mainly due to the massive absorption of irrigation fluid into human blood through cut and open veins within a short period of time during electrodesection, resulting in disturbance of the internal environment such as blood volume, electrolytes and plasma osmolality. It manifests as nausea, vomiting, abdominal distension, hypertension, etc., and even respiratory distress, cyanosis, visual loss and coma.
Treatment measures.
① Reduce the absorption of flushing solution, choose isotonic or slightly hypotonic solution without conductive ions, e.g., 5% glucose solution, etc. Ensure unobstructed drainage after surgery to prevent increased bladder pressure due to poor drainage, thus increasing the absorption of flushing solution.
② Monitor TURP symptoms. For patients with electrodes >90 minutes or prostate perineal cut, monitor central venous pressure and blood gas, urine volume and heart condition. For patients with nausea, vomiting, hypotension or hypertension and impaired consciousness in the early postoperative period, electrolytes and plasma osmolality should be monitored promptly.
2. Bleeding.
The outer envelope of the prostate and the prostate itself are very rich in blood flow and prone to bleeding after surgery. Causes of bleeding.
① Intraoperative hemostasis is not complete;
② early tissue scabs fall off;
(3) Increased intra-abdominal pressure;
④ Postoperative infection of the prostatic fossa, etc. Bleeding often causes blockage of the drainage tube, and if not treated promptly, the patient will undergo another transcystic blood clot removal.
Treatment measures.
① Keep the bladder flush unobstructed. If the postoperative flush is bright red and foamy in color and the blood is thick, it suggests severe bleeding. In case of uncontrollable active bleeding, report to the physician promptly and stop the bleeding surgically if necessary. Vital signs should be monitored while keeping drainage unobstructed to prevent the occurrence of Link.
② Avoid the increase of intra-abdominal pressure. Before the operation, patients should be advised to quit smoking and alcohol, and be actively matched with doctors to treat respiratory tract inflammation to prevent constipation, give clean enema one night before the operation, tap the patient’s back after the operation to promote sputum excretion, and perform nebulized aspiration if necessary; after the recovery of intestinal peristaltic function, coarse fiber food should be eaten, and laxatives should be routinely applied after eating. After extubation, patients should be told not to sit for a long time, not to ride a bicycle, not to take a bath, and not to perform heavy labor and excessive exercise to avoid rebleeding of the trauma.
3. Blockage of ducts.
It is mainly because the cut prostate tissue fragments are not completely flushed and sucked to block the urethra, the postoperative flushing and drainage tube is not draining well, and the blood clot forms to block the urethra. After surgery, the flushing speed should be adjusted according to the color of the flushing fluid, such as the flushing speed can be in a straight line when there is a lot of bleeding. Timely flushing prevents blood from forming blood clots, strengthens the drainage tube extrusion, and discharges the fine blood clots out of the body in time.
If the tube is found to be blocked, the bladder should be flushed and pumped back repeatedly under pressure with a syringe at this time to draw out the blood clots or tissue fragments around the drainage tube until the flushing fluid is clarified. When there are many blood clots, urokinase 2000u dissolved in 20ml of saline can be used, injected into the bladder by the drainage tube or urinary catheter and kept for 15-20 minutes, after the blood clot is dissolved, the bladder is repeatedly flushed with saline to suck out the broken blood clots.
4. Bladder spasm.
Most often occurs within 3 days after surgery, with 24 hours being the most severe. Common causes.
① Surgical dissection bleeding, pain;
② stimulation of the urethra and bladder neck after catheter traction and water bladder compression;
③ Blockage of the drainage tube;
④ Inappropriate flushing fluid temperature, mental stress and increased intra-abdominal pressure;
⑤ Severe preoperative urinary tract infection is also a cause of postoperative bladder spasm. The duration of spasm varies, the patient feels distension and pain on the pubic bone, there is a sense of urgent urination, the continuous drip of irrigation fluid reflux, the flushing fluid blood color deepens, or even full blood, and there is bloody fluid outflow from the urethral orifice at times.
Treatment measures.
① Active analgesia and hemostasis.
② Timely adjustment of Foley,tube traction strength, general traction time is 4-6 hours.
③ The temperature of the postoperative flushing fluid should be maintained between 2O-30℃, especially in winter to reduce the stimulation of the bladder by cold.
④ Eliminate tension factors and relax the patient’s whole body.
⑤ Preoperative active prevention of urinary tract infection is also an effective method to reduce postoperative bladder spasm.
5. Pulmonary infection.
Postoperative patients bed braking, long-term bed rest can lead to pulmonary atelectasis, pneumonia, the patient should be given to perform semi-recumbent position. Elderly patients generally have low resistance, so they should be given anti-infective and immunity-enhancing drugs, ultrasonic nebulized inhalation and back tapping.
6, lower limb venous thrombosis.
Prostate electrosurgery are middle-aged and elderly male patients, preoperative often have a history of smoking, hypertension, hyperlipidemia, diabetes, preoperative oral lipid-lowering drugs should be taken according to the lipid situation, postoperative hemostatic drugs used can increase the formation of thrombosis. Therefore, postoperative hemostatic drugs should be reasonably applied. Postoperative patients should be braked in bed, and the passive activities and massage of lower limbs should be performed regularly, which can well prevent the formation of lower limb venous thrombosis.
7. Pulmonary embolism.
Patients should not get out of bed immediately after removing the tube to prevent pulmonary embolism due to free venous thrombosis of the lower limbs. The patient should be allowed to sit on the bed or beside the bed first. Gradually leave the bed and walk.
8. Urinary incontinence.
Often due to too long an indwelling urinary catheter or excessive traction and compression or bleeding in the urethra of the urethra balloon, and lead to postoperative infection, infection is a common cause of temporary incontinence, other such as damage to the external urethral sphincter during electrodesection or excessive removal of bladder neck tissue can also cause urinary incontinence.
Treatment measures.
① Prevention of urinary tract infections. Use antibiotics reasonably and pay attention to aseptic operation when changing flushing fluid and urine bags. After anal venting, encourage patients to drink more water, more than 2,500-3,500ml per item, to achieve the purpose of “internal flushing”.
② Exercise the pelvic floor muscles after extubation. The patient was asked to contract the anal sphincter like a sudden interruption of urination and keep the abdominal muscles relaxed, 20 times each time. 3-5 times for each purpose.
9. Posterior urethral stricture.
Postoperative bleeding, prolonged postoperative tube placement, urinary tract infection and difficulty in urination after extubation are considered to be the main causes of postoperative posterior urethral stricture after TURP .
Treatment measures.
① Keep bladder flushing and drainage unobstructed and continuous bladder flushing.
② Correctly place the catheter. Insert and remove the catheter with appropriate force to prevent edema and bleeding of the urethral mucosa caused by improper pulling force. Keep the urethral system absolutely airtight to reduce urinary tract infection and cross-infection.
③ Timing of catheter removal is appropriate. Removing the urinary catheter when the bladder is full can restore the patient’s natural urination earlier. And improve the success rate of natural defecation .