TURP Complications Management
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Questions and Answers

What is a common complication during or after a TURP procedure?

  • Infection
  • Urinary incontinence
  • Bladder perforation
  • Hemorrhage (correct)

    • What percentage of patients historically required transfusion during or after TURP?

  • 5%
  • 2%
  • 8% (correct)
  • 10%

    • What technique is mentioned as a method to minimize intraoperative hemorrhage during TURP?

  • Laser therapy
  • Cold knife resection
  • Electrocautery
  • Bipolar electrosurgical technique (correct)

    • What is a common management approach for delayed hemorrhage after TURP?

    <p>Placement of a large-bore catheter</p> Signup and view all the answers

    When does delayed hemorrhage typically present after a TURP procedure?

    <p>Within 4 weeks</p> Signup and view all the answers

    What may indicate the need for a Penrose drain placement during or after TURP?

    <p>Suprapubic tension or distention</p> Signup and view all the answers

    What is done to create space for the Penrose drain during a TURP procedure?

    <p>A transverse suprapubic skin incision</p> Signup and view all the answers

    What is a typical outcome observed within 24 to 48 hours after managing bleeding in TURP?

    <p>Clear urine return</p> Signup and view all the answers

    What is one reason TURP is considered effective in decreasing bladder outlet resistance?

    <p>The bladder neck is resected and completely open.</p> Signup and view all the answers

    What should be considered if the prostate is small during TURP?

    <p>Alternative techniques such as TUIP should be considered.</p> Signup and view all the answers

    What is a common issue following TURP despite it being generally uncommon?

    <p>Urinary incontinence.</p> Signup and view all the answers

    Which type of bladder contraction may lead to urinary urgency and incontinence after TURP?

    <p>Detrusor overactivity.</p> Signup and view all the answers

    What condition can occur due to overly aggressive apical resection during TURP?

    <p>Intrinsic sphincter dysfunction.</p> Signup and view all the answers

    What factor may lead to a temporary increase in urge incontinence after surgery?

    <p>Decreased bladder outlet resistance.</p> Signup and view all the answers

    How long can patients experience urge incontinence after treatment for bladder outlet obstruction?

    <p>Several months.</p> Signup and view all the answers

    Why is retrograde ejaculation viewed as an inevitability rather than a complication of TURP?

    <p>It is a common side effect.</p> Signup and view all the answers

    Study Notes

    TURP Complications

    • Hemorrhage is a common major complication during or after Transurethral Resection of the Prostate (TURP).
    • About 8% of patients from older studies required blood transfusions during or post-TURP.
    • Bipolar electrosurgical techniques have reduced the incidence of intraoperative hemorrhage.
    • Delayed hemorrhage occurs within the first four weeks post-procedure and is often patient-related rather than technique-related.

    Management of Hemorrhage

    • Management of delayed hemorrhage typically does not require reoperation.
    • A large-bore catheter (24 Fr or greater) is placed for clot retention and hand irrigation with a catheter tip syringe.
    • Continuous bladder irrigation can be initiated after clot evacuation and the return of clear urine.
    • Bleeding usually resolves within 24 to 48 hours, followed by a voiding trial.

    Fluid Extravasation

    • Extravasation of irrigating fluid into periprostatic tissue may occur, more so with aggressive resection techniques.
    • Inspection of the suprapubic region is critical during and immediately post-TURP for signs of distention.
    • If distention occurs, a Penrose drain may be placed through a 2-cm transverse suprapubic incision to allow drainage of bloody fluid.

    Retrograde Ejaculation

    • Retrograde ejaculation is considered an inevitable outcome rather than a complication of TURP.
    • The main effectiveness of TURP in reducing bladder outlet resistance is due to the complete opening of the bladder neck post-procedure.
    • Caution is warranted in smaller prostates to prevent bladder neck contractures, potentially utilizing other techniques like Transurethral Incision of the Prostate (TUIP).

    Urinary Incontinence

    • Urinary incontinence is rare following TURP.
    • Two causes of post-TURP incontinence include:
      • Detrusor overactivity (DO) resulting from long-term bladder outlet obstruction, leading to urgency and urge incontinence.
      • Intrinsic sphincter dysfunction from aggressive resection or individual variances in sphincter function.
    • Temporary urge incontinence may occur after alleviating bladder outlet resistance but typically decreases as the bladder's condition improves, which may take several months.

    Surgical Technique Considerations

    • Limiting resection to the proximal aspect of the verumontanum can help prevent permanent intrinsic sphincter dysfunction.
    • Awareness of the risks of aggressive techniques and patient-specific factors is crucial in TURP to minimize complications.

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    Description

    This quiz addresses the complications associated with Transurethral Resection of the Prostate (TURP), focusing on hemorrhage risks and management strategies. Explore the impact of newer techniques like bipolar electrosurgical methods on reducing these complications. Test your knowledge on the frequency of transfusions and evolving procedural practices.

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