TRANSURETHRAL

RESECTION OF
THE PROSTATE
Anatomy and Physiology
of the male
reproductive System
 Description of TURP
• -primary approach to surgical
resection of the prostate and in
the past has been used as the
primary intervention for any
patient with clinical BPH.
• -surgical procedure is under
endoscopic control
• -A rigid cytoscope is inserted into
the urethra and bladder, and the
prostatic urethra is localized.
 TURP description cont…

-Obstructive prostatic tissue is

removed by resectoscope.
-A glycine or sorbitol solution is
irrigated through the
resectoscope during the
procedure, removing blood and
tissue from the operative field.
RESECTOSCOPE
Actual photo of a
TURP
Actual photo of a
TURP
 Advantages of
TURP
Avoidance of abdominal incision
•
•Causes less pain
•rapid removal of prostatic tissue
at the time of surgery
•it can be combined with some
other procedures such as
removing small bladder stones
•many years of data to support
its use with a thorough
understanding of its
advantages, risks and outcomes
•widespread use throughout
hospitals in most countries by
urologists
•shorter hospitalization and
recovery period
 Disadvantages of
TURP
•Inability to pass urine
after the procedure
•Requires a high skilled
surgeon to perform the
surgery
 Cont. disadv.

•surgical operation
•Stricture, obstruction
and urethral trauma may
occur
•Delayed bleeding may
occur
 Indications of
TURP
– -Obstructive uropathy
related to benign
prostatic hypertrophy
(BPH)
– -Acute urinary retention
related to prostatic
hypertrophy
 Indications cont.……
-Recurrent urinary
infections or febrile
urinary infection related
to benign prostatic
hypertrophy
-Recurrent bleeding from
the prostate
 Indications cont.……
-Bladder stones with prostate
enlargement
-Increased pressure on the
ureters and kidneys
(hydronephrosis) from urinary
retention
NURSING MANAGEMENT OF THE
PATIENT UNDRGOING TURP
Preoperative Care
 Preoperative Care

1.Preoperative
assessment
2.Proper explanation of
surgical procedure
3.Proper explanation of
the complications and
risks
Preoperative Care
4.Ensure that informed
consent has been
signed
5.Notify physician for
allergies
6.Notify physician of all
medications taken
7.Notify for history of
bleeding disorders
Intraoperative
Care
Intraoperative
Care
1.Maintain Safety
and Prevent Injury
2.Position in Client
3.Provide
Equipment Safety
 Intraoperative
Care
4.Maintain Surgical Asepsis
5.Assist in Wound Closure
6.Monitoring:
– V/S (Body temperature)
– Malignant Hyperthermia
– Cardiac Respiratory Arrest
• -Allergic Reactions
Procedural Steps: (Nagle &
Bollinger, 1997.
Genitourinary Surgery.)
1. The urethra is lubricated generously
with water soluble jelly and dilated
with van Buren sounds.
2. The smallest resectoscope sheath,
consistent with removal of the
amount of hyperplastic prostate
tissue present in a reasonable period
of time ( 1 to 1 ½ hours or less ), is
chosen.
 Procedural Steps:
3. Resection of prostatic tissue begins
with the middle lobe to the crossing
fibers of the bladder neck. This opens
the prostatic urethra proximally to
facilitate the balance of the resection.
4. Resection of the lateral lobe
component is begun at the anterior
aspect of the prostatic urethra to allow
the lobes to “fall” into the prostatic
urethra. This allows for an easier
resection. The lateral lobes are
resected to their attachment in the
surgical capsule.
 Procedural Steps:
5. The distal resection is limited to the
level of the verumontanum to prevent
injury of the intraprostatic continence
mechanism (sphincter).
6. All prostatic chips are are evacuated
from the bladder with a Toomey
syringe or Ellik evacuator to prevent
catheter obstruction in the early
postoperative period. If a continuous-
flow resectoscope is used, suction is
attached to the outflow. This removes
the need to periodically clear the
bladder of tissue and fluid.
 Procedural Steps:
7. Residual arterial bleeders and
significant venous bleeders in the
prostatic urethra are located and
cauterized.
8. A three-way Foley catheter with a 30 cc
balloon, large enough to accommodate
blood clots that may form during the
postoperative period, is inserted and
generally attached to continuous
irrigation. If the resection is small and
only a small volume of tissue is
removed, a two-way catheter may be
sufficient, or no catheter may be
needed at all.
 Procedural Steps:
9. The Vaportrode and Sled are also
being increasing frequency to
promote hemostatis and ablation.
An adequate prostatic urethral
channel must be created to allow
for voiding.
10.Blood for serum electrolytes,
hemoglobin, and hematocrit is
drawn in the immediated
postoperative period if blood loss
is significant or the operative
time is more than 1 hour.
Procedural Steps:
POST OPERATIONAL Phase:
POST OPERATIONAL Phase: (Phipps
and Marek,1999. Medical-surgical nursing: Concepts & clinical practice)

1.Maintaining patency of
catheter system
2.Monitoring urine appearance
3.Monitoring signs of water
intoxication
4.Avoid enemas and rectal
thermometer use
5.Instruct patient not to void
around catheter
POST OPERATIONAL Phase:
6.Give prescribed
medications
7.After catheter removal
8.Frequently change
dressings
9.Give opportunities to
discuss any concerns
10.Do health teachings to
client
 Post OPERATIONAL Phase:
• Complications/Risks
1. Hemorrhage
2. Transurethral resection
(TUR) syndrome
3. Acute urinary retention
4. Stress urinary incontinence
5. Erectile dysfunction
Sample nursing care of a client
undergoing TURP surgery
 CASE: taken from (Phipps and Marek,1999. Medical-surgical
nursing: Concepts & clinical practice)

• DATA : Mr. Bee is a 67-year-old retired

married automobile mechanic. His
physician has diagnosed benign
prostatic hypertrophy. Mr. Bee has
undergone medical examinations on
an outpatient and has never been
admitted to the hospital. He is slight
obese. On admission his blood
pressure is 140/90 mm Hg. He denies
any history of HP. He takes only OTC
Tylenol for in frequent headaches. He
had TURP performed today.
 Possible Nursing Dx:
• Preoperative nursing care
– Knowledge deficit r/t procedure,
goals, anesthesia, and potential
untoward effects.
POSTOPERATIONAL Care:
 Altered tissue perfusion (peripheral,
prostatic vascular bed) r/t surgical
incision
 Altered tissue perfusion (deep leg
veins) r/t surgical position for
transurethral resection of prostate
 Urinary retention (potential) r/t
surgical resection of prostate
adenoma
 Potential TUR syndrome r/t surgical
resection of benign prostatic adenoma
POSTOPERATIONAL Care:
 Pain r/t prostatic resection
 Pain r/t bladder spasm
 Altered patterns of urinary
elimination r/t surgical
resection of benign prostatic
adenoma
 Risk for fluid volume excess
related to absorption of
irrigating fluid
POSTOPERATIONAL Care:
 Risk for fluid volume excess related to
absorption of irrigating fluid
 Risk for infection/injury (hemorrhage) r/t to
surgical resection of the prostate adenoma
 Risk for stress or urge incontinence r/t catheter
use
 Risk for sexual dysfunction r/t surgical resection
of benign prostatic adenoma
 Knowledge deficit (activity restriction,
prevention of complications) r/t lack of
information
Videos!!!
Videos!!!
 BIBLIOGRAPHY:
• Black, J. & Hawks, J. (2005). Medical-Surgical Nursing:
Clinical Management for Positive Outcomes. 7th ed. USA:
Elsevier Inc.
• Doughty, D. (2000). Urinary and fecal incontinence:
Nursing management. 2nd ed. St. Louis, Missouri: Mosby,
Inc.
• Gray, M. (1992). Genitourinary disorders. St. Louis,
Missouri: Mosby, Inc.
• LeMone, P. & Burke, K.M. (1996). Medical-surgical
nursing:Critical thinking in client care. California: Addison-
Wesly Nursing of the Benjamin/Cumming Publishing
Company, Inc.
• Marieb, E. & Hoehn, K. (2007). Anatomy and physiology.
7th ed. San Francisco, CA, USA: Pearson Education, Inc.
• Nagle, G. & Bollinger, J. (1997). Genitourinary Surgery. St.
Louis, Missouri: Mosby, Inc.
• Phipps, W.J., Sands, J.K., & Marek, J.F. (1999). Medical-
surgical nursing: Concepts & clinical practice. 6th ed. St.
Louis, Missouri: Mosby, Inc.
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