Consent: TURP — Much Important Before and After Surgery

This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

The transurethral resection of the prostate (TURP) is a common urological operation, performed for lower urinary tract symptoms unresponsive to medical therapy and for prostatic bladder outflow obstruction such as recurrent acute urinary retention or recurrent urinary tract infections.

The procedure is always performed under general anaesthesia (or spinal anaesthesia). The patient is positioned supine with the legs in lithotomy or Lloyd-Davies supports.

Complications

Intraoperative

Complication	Description of Complication	Potential Ways to Reduce Risk
Bleeding	Damage to the lining of urethra or bladder can cause bleeding	Careful and meticulous handling of resectoscope avoiding  damage
Damage to surrounding structures	Damage can occur to the urethra, bladder, or ureters during the procedure	Ensure a good visual field throughout the procedure
Damage to external urethral sphincter or the bladder neck	Damage to external urethral sphincter may lead temporary or permanent incontinence	Prevent damage to the external urethral sphincter by resecting only proximal to the verumontanum
Anaesthetic Risk	Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications	Forms a part of the anaesthetist assessment before the operation

Early

Complication	Description of Complication	Potential Ways to Reduce Risk
Pain	Dysuria from the instrumentation used and slight urethral dilation from the scope	Use of instillagel into the urethra and simple analgesia post-operatively
Infection	Infection can be introduced by the instrumentation, however the overall risk is very low	Maintain an aseptic technique throughout the procedure
Haematuria	Damage to the intraluminal surfaces of urethra or prostate, with inadequate haemostasias can cause post-operative hematuria, including formation of blood clots and resultant clot retention	Achieve arterial haemostasis by cautery, if necessary using the rolling-ball electrode; place a triple-lumen Foley’s catheter and set-up ongoing post-op saline irrigation
Urinary retention post-catheter removal	Failure to pass urine after the post-operative catheter has been removed, may require a longer period with an indwelling catheter
Incontinence	Relief of the bladder outflow obstruction results in increased voiding pressures, which can result in urinary incontinence
TURP syndrome	Presents classically with mental confusion, vomiting, hypertension and bradycardia. Occurs with hyponatraemia secondary to absorption of irrigation via the exposed venous channels in the prostate	Reduce operating time to less than an hour and careful use of irrigation solutions rich in glycine
Blood clots	DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest.	The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate
Stroke, MI, Kidney Failure, Death	Although small, this is always a risk in any major surgery

Late

Complication	Description of Complication	Potential Ways to Reduce Risk
Stricture	Recurrent procedures can lead to the development of urethral strictures
Sexual dysfunction	Rare, however some patients may develop retrograde ejaculation or erectile dysfunction post-operatively