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Home Downloads Others Uro-Surgery

Informed Consent in URO: Transurethral Resection of the Prostate

by medicare nepal
June 15, 2022
in Uro-Surgery
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Informed Consent in URO: Transurethral Resection of the Prostate
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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.

Informed Consent in URO: Transurethral Resection of the Prostate

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.

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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.

Informed Consent in URO: Transurethral Resection of the Prostate

Complications

Intraoperative

ComplicationDescription of ComplicationPotential Ways to Reduce Risk
BleedingDamage to the lining of urethra or bladder can cause bleedingCareful and meticulous handling of resectoscope avoiding  damage
Damage to surrounding structuresDamage can occur to the urethra, bladder, or ureters during the procedureEnsure 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 incontinencePrevent damage to the external urethral sphincter by resecting only proximal to the verumontanum
Anaesthetic RiskIncludes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complicationsForms a part of the anaesthetist assessment before the operation

Early

ComplicationDescription of ComplicationPotential Ways to Reduce Risk
PainDysuria from the instrumentation used and slight urethral dilation from the scopeUse of instillagel into the urethra and simple analgesia post-operatively
InfectionInfection can be introduced by the instrumentation, however the overall risk is very lowMaintain an aseptic technique throughout the procedure
HaematuriaDamage to the intraluminal surfaces of urethra or prostate, with inadequate haemostasias can cause post-operative hematuria, including formation of blood clots and resultant clot retentionAchieve 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 removalFailure to pass urine after the post-operative catheter has been removed, may require a longer period with an indwelling catheter
IncontinenceRelief of the bladder outflow obstruction results in increased voiding pressures, which can result in urinary incontinence
TURP syndromePresents classically with mental confusion, vomiting, hypertension and bradycardia. Occurs with hyponatraemia secondary to absorption of irrigation via the exposed venous channels in the prostateReduce operating time to less than an hour and careful use of irrigation solutions rich in glycine
Blood clotsDVTs 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, DeathAlthough small, this is always a risk in any major surgery

Late

ComplicationDescription of ComplicationPotential Ways to Reduce Risk
StrictureRecurrent procedures can lead to the development of urethral strictures
Sexual dysfunctionRare, however some patients may develop retrograde ejaculation or erectile dysfunction post-operatively
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