What to pay attention to in transurethral resection of the prostate
Transurethral resection of the prostate (TURP) is the "gold standard" for the treatment of prostatic hyperplasia in older men.
Routine preoperative preparation
(1) Do not smoke for one week before surgery.
(2) Antibiotic skin test the day before surgery.
(3) Take laxatives to empty the gastrointestinal tract the night before surgery.
(4) Eat a normal diet at noon the day before surgery, and eat a light and easy-to-digest diet the night before surgery.
(5) Fasting after 8 p.m. before surgery.
(6) Do not drink water after 12 p.m. before surgery.
On the day of surgery (before entering the operating room)
(1) Laxative enema in the morning.
(2) Between 7:30 a.m. and 8:30 a.m., the first patient will be studied.
(3) The following items should be brought to the operating room at the same time.
1. Antibiotics.
2. Medical records.
(4) After the patient is pushed into the operating room, the family members wait in the waiting area, and after the operation, the physician in charge will notify the patient's family members to the interview room by radio and inform them of the relevant conditions of the operation.
On the day of surgery (during surgery)
(1) The anesthesia is generally epidural anesthesia, but also combined hard and lumbar anesthesia or tracheal intubation general anesthesia.
(2) It takes 30-50min from anesthesia induction to anesthesia completion.
(3) About 60-100min from the beginning of the operation to the end of the operation.
(4) Postoperative indwelling urinary catheter and continuous bladder irrigation.
On the day of surgery (return to the ward after surgery)
(1) Continue to bladder irrigation after surgery, pay attention to the color of the irrigation solution, and notify the responsible nurse and the physician in charge in time if there is fresh bleeding (please contact the nurse on duty during off-duty hours).
(2) Encourage patients to breathe deeply.
(3) Encourage patients to move their limbs in bed.
(4) Lateral decubitus position.
(5) Return to the ward for 6 hours with a pillow (in the case of epidural anesthesia and hard-waist combined anesthesia).
(6) Strictly abstain from eating and drinking (including drinking water) on the day of surgery.
(7) The patient's thirst can be relieved by moistening the lips and mouth with a cotton swab, but not drinking water.
(8) Family members assist the patient to move the lower limbs once an hour (to avoid venous thrombosis of the lower limbs).
(9) Due to the stimulation of the bladder triangle by the urethral catheter, some patients will have bladder spasm (mainly manifested as a feeling of urination that cannot be suppressed by itself), which can be relieved by intramuscular injection of resorcinol, anal plug diclofenac sodium suppository, oral tolterodine and other drugs.
(10) Gauze is sometimes wrapped around the urethral opening urethral tube to stretch the balloon and compress the bleeding point of the prostate wound, and the urethral opening gauze can be loosened 4-6 hours after returning to the ward (long-term compression can cause urethral necrosis).
First postoperative day
Normal diet (transurethral resection of the prostate has a low level of anesthesia, a short time, and little impact on the gastrointestinal tract, but pay attention to eating small and frequent meals). In general, bladder irrigation can be discontinued, and more water should be drunk (ensure urine output of 2000-300 m/day). Eating fruits, if necessary, can use proprietary Chinese medicines to promote gastrointestinal recovery and soften stools. There will be some blood stains and urethral secretions around the urethral catheter (especially near the urethral meatus), which should be washed with a warm towel in time.
Anti-inflammatory, supportive care
Get out of bed mobilization (the earlier you get out of bed, the faster you will recover after surgery). On the 2nd to 5th day after surgery, eat and drink the same as before.
In general, the longer the indwelling urethral catheter is 3-5 days, the more common the occurrence of urethral infection and urethral stricture, and the less frequent urination, urgency, and hematuria after extubation (personal opinion). The shorter the indwelling catheter time, the less common the occurrence of urinary tract infection and urethral stricture, and the more common the urinary frequency, urgency, and hematuria after extubation.
Precautions after discharge
(1) It takes 3-4 months for the prostate wound to heal completely after surgery, during which hematuria may occur.
(2) Dry stool, sedentary, cycling, and sexual activity can lead to the appearance or aggravation of hematuria.
(3) Oral finasteride (5mg, once a day) can reduce hematuria symptoms.
(4) Oral medication to improve local edema.
(5) Uroflow rate and residual urine volume should be rechecked 1 month after surgery (to confirm the improvement of urination obstruction).
(6) Patients with elevated PSA should continue to undergo PSA re-examination (PSA is an important marker molecule of prostate cancer).
(7) If the symptoms of dysuria reappear after a short period of improvement after surgery, it is necessary to be careful of the possibility of urethral stricture, and if necessary, the urethra is dilated.