Soriano, Lilet Quiñonez,

Rizalyn

Ragasa, Don Hanes

Introduction

Benign prostatic hyperplasia is a common condition that affects millions of men. It

could make it hard for men to urinate.An operation may be needed to relieve these
symptoms.

Etiology

Benign prostatic hyperplasia (BPH) is a common condition with of older men. This
can cause pressure on the urethra and can block the bladder outlet making it hard to
start and maintain the urinary stream. Men with this problem feel like they have to
urinate frequently but are unable to empty their bladder completely.

Rationale

Benign Disease
An operation called transurethral resection of the prostate (TURP) relieves symptoms
of BPH by removing the prostate tissue that is blocking the urethra. No incision is
needed. Instead a tube (resectoscope) is passed through the penis to the level of the
prostate, and tissue is either removed or destroyed, so that urine can freely pass from
the body.

Indication

TURP is indicated in patients with persistent, progressive, or bothersome symptoms

of urinary obstruction due to prostatic hypertrophy that are refractory to medical
therapy. While this is the most common indication, 70% of men undergoing the
procedure have multiple indications. Patients with prostates larger than 45 grams, who
present with acute urinary retention or who require operating times in excess of 90
minutes, are at increased risk of postoperative complications.

Definition

Transurethral resection of the prostate (TURP) is the most common type of surgical
procedure for benign prostatic hyperplasia (BPH) .The surgical and optical instrument
is introduced directly through the urethra to the prostate, which can then be viewed
directly. This procedure, which requires no incision, may be used for glands of
varying size and is deal for patients who have small glands and for those who are
considered poor surgical risks.

Application

This procedure is usually done under general, epidural or spinal anesthesia. After the
penis is anesthesized, a scope is inserted in the urethra until the prostate is seen. The
excess prostatic tissue that is blocking the urethra is then taken out using a
resectoscope, a special instrument used to take the prostate tissue out. The procedure
is commonly referred to as reaming out or roto-rooter. When the surgeon is satisfied
that the pressure is taken off the urethra and enough prostate tissue is taken out, a
catheter tube is placed in the bladder to allow easy urination for the postoperative
period.
Diagnostic study

1. The PSA blood test determines whether you have cancer of the prostate. The test
measures how much of a protein essential to human reproduction, PSA (prostate-
specific antigen), is in your blood. PSA turns your gelatinous pre-semen into a liquid,
thus supporting ejaculation. If your PSA is below 4, most doctors agree that you
needn't be tested again for a year. During annual tests, remember that it is normal for
your reading to go up by a few tenths of a point every year. In general, only a drastic
increase in PSA (an increase of at least 0.75 points or 20 percent) is considered a
reason to worry. This test is recommended on an annual basis for all men over 50
(and for men above 45 if there is a family history of prostate problems).

2. A digital rectal examination (DRE) is a quick and safe screening technique in

which a doctor inserts a gloved, lubricated finger into the rectum to feel the size and
shape of the prostate. The prostate should feel soft, smooth, and even. The doctor
checks for lumps or hard, irregular areas of the prostate that may indicate the presence
of prostate cancer. The entire prostate

Pre operative care

Before your surgery, a nurse will ask you questions about your health and your
surgery. These questions may be asked during pre-admission testing, in your hospital
room, or in the Ambulatory Surgery Unit. On the day of your surgery, a nurse will
talk with you either in the Ambulatory Surgery Unit or in your hospital room. Your
vital signs (blood pressure, pulse, temperature and breathing rate) will be taken at this
time. Blood tests will be done, if needed. The nurse may put a needle into your vein
(IV or Intravenous) to give you fluid. Dentures or partial plates, contact lenses,
eyeglasses, hearing aids, and any other prostheses must be removed before going to
surgery. Nail polish, make-up, jewelries, and hair clips also will be removed. Your
family will be allowed to stay with you until you go to the Pre-operative Holding
Area. The nurse will answer any questions and tell your family where to wait while
you are in surgery. You will leave the Ambulatory Surgery Unit (ASU) or your
hospital room on a cart. It is common to stop in the Pre-Operative Holding Area
before going to surgery. While there, your anaesthesiologists may talk with you. An
IV will be started, if you do not already have one. Your hair will be covered with a
paper hat, like the operating room staff wears.

Intra operative care

During Surgery All staff in the operating room wears special scrub clothes, caps, and
masks. You will notice that the room has bright lights and is quite cool. Many
pieces of special equipment and tables are set up with supplies and instruments. A
scrub nurse or operating room technician gets the instruments and supplies ready for
your surgery. The staff will explain what will happen to you before they are done. A
nurse will be there to greet you and check your identification (ID) bracelet. You will
be asked about allergies. Then you will be made comfortable on the operating room
table. A safety strap will be put over your knees so you stay on the table. You will be
covered with an extra blanket if you are cold and your arms may be tucked in at your
sides or put on an arm board. During your surgery your vital signs will be closely
checked. Three leads used to monitor your heart will be put on your chest. They will
be connected to a monitor that counts your heart rate. As the monitor counts your
heart rate it makes a beeping noise. Your heart beat also may be seen on a screen. A
small clip (pulse oximeter) is placed on your finger to measure your pulse and the
amount of oxygen in your blood. The time it takes for your surgery is estimated.
Your surgery may take a longer or shorter time than you and your family was told. If
your surgery takes longer than you were told, it does not mean that anything is wrong.
Your family will be told how you are doing. After your surgery is over, the surgeon
or an assistant will call or come to the waiting area to talk to your family.

Positioning for TURP

Lithotomy Position

The position is frequently used and has many obvious benefits from the doctor's
perspective. Most notably the position provides good visual and physical access to the
perineal region. The position is used for procedures ranging from simple pelvic exams
to surgeries and procedures involving, but not limited to reproductive organs, urology,
and gastrointestinal systems.

Instrument :

1. Cystoscope (tubelike instrument) is inserted into the penis through the urethra to
reach the prostate gland.

2. Foley catheter (artificial tube to remove urine from the body) is placed to help drain
the bladder after surgery. The urine will initially appear very bloody, but will clear
with time.

3. A bladder irrigation solution may be attached to the catheter to continuously flush

the catheter, thus keeping it from becoming clogged with blood or tissue. The
bleeding will gradually decrease, and the catheter will be removed within 1-3 days.

Post operative care

After your surgery you will be moved on a cart and taken to the Post Anesthesia
Care Unit (PACU). As you come out of anesthesia, a PACU nurse will watch you
closely and will take your vital signs frequently.Your pulse and the amount of oxygen
in your blood will be checked. If you need oxygen after your anesthesia, you will feel
a tube on your face. When you first wake, up you may feel cold and you may
shiver.This is normal if you have had general anesthesia. There will be other patients
and a lot of activity and noise in the PACU. The nurse will try to wake you up during
your time in PACU. If you have pain, ask your nurse to give you pain medicine.
When you are awake and your vital signs are normal, you will be taken to the
Ambulatory Surgery Unit (ASU) or to your hospital room. Your vital signs, IV fluids
and any drainage tubes and dressings will be checked. At this time, your family will
be allowed to visit. When the patient awakens in the recovery room after the
procedure, he already has a catheter in his penis, and is receiving pain medication via
the IV line inserted prior to surgery.The initial recovery period lasts approximately
one week, and includes some pain and discomfort from the urinary catheter.