Transurethral resection of prostate adenoma: features of the operation

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Transurethral resection (TURP) of the prostate or prostate gland is performed to remove overgrown tissue. Most often, surgery is performed for adenoma, a benign tumor. TUR of the prostate is currently considered the gold standard for the treatment of this disease, as it gives good results and in most cases allows you to get rid of the tumor forever.

Indications for surgery

Benign prostate tumors are extremely common. Half of males over 50 years of age and 75% of people over 70 years of age encounter it (data from A.A. Bogdanov). Prostate adenoma is the most common reason for transurethral resection. It is performed when the volume of the prostate gland is no more than 80 cm³, as well as when the patient is young or if he wishes to preserve the organ.

The operation is performed for the following symptoms associated with the disease:

• Urinary tract obstruction - narrowing of the lumen of the ureter, bladder neck, which makes urination impossible or difficult.
• Frequent and painful urge to urinate
• Diverticula of the bladder wall (sagging organ tissue with the formation of additional cavities), causing concern.
• Urinary incontinence, urination at night.
• Persistent infections of the urogenital tract.
• The volume of urine that remains in the bladder after urination exceeds 50 cm³.

TUR is also carried out if carcinoma is suspected - malignant degeneration of tissue. In this case, preservation of the organ is possible only if the patient is in good general health and the disease is at an early stage.

Contraindications

The operation is not performed in the following cases:

1. Terminal adenoma or carcinoma that has affected a large volume of the prostate and/or adjacent organs.
2. Varicocele is varicose veins of the scrotum.
3. Ankylosis of the hip joint is immobility resulting from tissue fusion.
4. Any inflammation in the active stage, including caries.
5. Blood clotting disorder.
6. Diseases of the cardiovascular system.

Progress of the operation

Transurethral resection of the prostate lasts on average 1.5 hours. Epidural anesthesia (injection into the spine) is usually used as anesthesia. The patient remains conscious, but does not feel half of the body below the injection site. At the patient's request, general anesthesia can be used.

The patient is placed on the operating table on his back, with his legs spread to the side. His genitals are treated with an antiseptic, and he himself is covered with sterile linen. A gel is applied to the urethra. After this, the preparatory period ends and the actual operation begins.

A resectoscope is inserted into the urethra - an instrument consisting of two tubes through which fluid circulates and a working element. During TUR, an electric loop is used as the last one. It goes directly to the prostate. Due to the action of electric current, the affected tissues are “cut off”.

During the intervention, blood vessels are damaged, which interferes with the surgeon's visual control. Therefore, during TUR, an irrigation fluid is used, which is supplied through one of the proctoscope channels and removed through the other. It washes the prostate and creates conditions for good visualization.

The cut tissues (the so-called “shavings”) are sucked out using a pump. After this, the integrity of the vessels is monitored, if necessary, the doctor performs hemostasis (stopping bleeding), and the resectoscope is removed.

A Faley catheter ending in a balloon is inserted into the urethra. Due to its work, liquid is injected into the former location of the tumor - the adenoma bed is tamponed.

This is necessary to stop bleeding from small vessels. The bladder is constantly flushed.

This measure serves to prevent the collapse of the walls of the organ and to prevent clogging of the channel for the outflow of urine with blood clots.

The duration of hospitalization after TUR is from 3-4 to 7 days. It is important to monitor the patient’s urination during this entire time and the first few days after discharge. With delay and difficulty, bladder overflow occurs, which is extremely unfavorable because it creates conditions for infection.

Complications

During the postoperative period, the patient may experience a number of undesirable consequences:

• Nosocomial infection. Although the intervention itself is carried out under sterile conditions, it is possible to become infected with hospital microflora during a hospital stay (the risk is almost 30% with TUR). These microorganisms are highly resistant to antibiotics and antiseptics, and therefore getting rid of such an infection can be long and difficult. For prevention and treatment, it is necessary to use the latest generation of antibiotics and constantly monitor the effectiveness of therapy.
• Retrograde ejaculation is the reflux of seminal fluid into the bladder. The risk of such a complication reaches 70%. It does not pose any health risks or unpleasant symptoms, however, complete retrograde ejaculation makes conception impossible, and a small volume of sperm (1-2 ml) can cause a decrease in a man’s self-esteem. Treatment is carried out conservatively or surgically.
• Urethral stricture is a pathological narrowing of the urethra. This condition is very dangerous because... as a result, there is stagnation of urine in the bladder, which increases the risk of developing infections, as well as expansion of the organ cavity and renal pelvis. Treatment can be minimally invasive - bougienage (dilatation of the urethra by inserting bougies - probes of different diameters) into the canal or surgical, associated with plastic surgery of the urethra.
• Impotence. This is a rare complication, occurring in less than 1% of cases. Treatment of erectile dysfunction can be carried out by conservative methods - taking drugs that improve blood supply to the penis, and surgically.
• Urinary incontinence. In mild cases, patients can benefit from physical exercises aimed at strengthening the pelvic floor muscles and transurethral administration of gel. A radical method is to place a bladder sphincter implant.

Recovery period

During hospitalization, a catheter is placed in the patient's ureter, which makes it possible to monitor his condition. The absence of blood in the urine is a good sign and grounds for discharge. The patient usually does not feel any post-operative pain, but the catheter may cause discomfort and a feeling of fullness in the bladder. Doctor M.A. Ryabov, who performed more than 600 such operations, notes: “You need to understand that there is nothing outside, but inside there is a wound that heals under constant contact with urine.”

Sometimes minor spasms develop, which are easily relieved with special medications. There may also be difficulty urinating. A doctor in a medical facility can teach the patient special exercises to facilitate this process. Otherwise, the catheter is reinserted into the ureter. Once it is removed, most often the problem no longer occurs.

Important! At first, the bladder becomes very irritated, so you need to follow a certain diet. For several hours after surgery, you are only allowed to drink water in small sips. During the entire recovery period (1.5-2 months), it is forbidden to eat salted, smoked, fried and fatty foods.

At home, the patient will have to follow certain rules for 7 weeks after transurethral resection of the prostate:

1. Refusal of sexual life;
2. Limitation of physical activity;
3. Avoiding constipation;
4. Drinking large amounts of fluid to stimulate the bladder;
5. Abstinence from alcohol;
6. It is advisable not to drive vehicles or equipment.

The operation is considered successful only in 80% of cases. In this case, we are talking about the subjective feelings of patients regarding the reduction of unpleasant symptoms. Sometimes you just need to wait to see the effect; in other cases, more radical therapy will help to cope with the problems.

If the operation was performed for a malignant neoplasm, the patient will receive additional treatment aimed at completely destroying the tumor.

This may be chemotherapy or radiotherapy. In such cases, the recovery period is longer and more difficult.

The patient should prepare himself for possible additional complications while taking medications or radiation.

Patient reviews

Most often, patients encounter problems with the prostate gland in old age. It is difficult for them to pay for treatment in an expensive clinic, so they usually go to a clinic at their place of residence. Unfortunately, as they note, the quality of services of this kind is not always the best. This is one of the reasons why patients try to delay the moment of surgical intervention.

Important! In their reviews, men who have undergone TUR of prostate adenoma are strongly advised not to delay the operation. Many of them have learned from their own experience that the consequences of a tumor and stagnation of urine in the bladder can lead to much worse consequences than resection.

Hospitalization of several days, as a rule, is not enough for a complete recovery of the patient, especially the elderly. Relatives of such patients write that in the postoperative period they had to hire nurses or independently care for their relative.

Patients and their relatives are advised to choose an institution based on the qualifications of the surgeon, and not on high technology. This can be done by studying reviews of those who have undergone prostate resection and coming for a personal consultation.

Price

The cost of transurethral resection of the prostate is 80,000 – 160,000 rubles.

In this case, we are talking about a full set of services, including hospitalization and all consumables.

In some government agencies, in the absence of a compulsory medical insurance policy, the service can be obtained for a fee. In this case, prices are the most affordable. They usually start from 40,000 rubles.

If desired, the patient can receive free help. It is provided by both public medical institutions and some private clinics that work with compulsory medical insurance policies.

Transurethral resection of the prostate returns the patient to a normal, fulfilling life. It is a minimally invasive method of intervention, is easily tolerated and, despite the difficult recovery period, is the optimal method of treating prostate adenoma.

Video: transurethral resection of the prostate - medical animation

Source: https://operaciya.info/urologia/tur-prostaty/

Transurethral resection of prostate adenoma

This technique was first used back in 1909. And since then, transurethral resection of prostate adenoma has been considered the “gold standard” in the treatment of benign prostatic hyperplasia.

This operation became the first effective minimally invasive technique in the treatment of prostate adenoma in our time. Until now, it is widely used as a reliable treatment for benign prostatic hyperplasia. This technique can significantly improve the quality of life of men.

Many patients seeking transurethral resection of prostate adenoma have been taking various medications for a long time to improve urination.

In the vast majority of cases, this treatment option is ineffective.

Typically, surgery is recommended for men who have been treated with medications (alpha blockers, 5-alpha reductase inhibitors), if these drugs do not have a noticeable effect.

During transurethral resection of prostate adenoma

Transurethral resection of prostate adenoma requires a position in which the patient lies on his back. An endoscopic device, a resectoscope, is inserted into the urethra. Through it, a resection electric loop is brought to the prostate. It is with its help that adenoma tissues that compress the lumen of the urethra are removed. When the prostate adenoma operation is completed, the resectoscope is removed and the bladder is catheterized. This helps to avoid complications such as acute urinary retention.

The surgeon and anesthesiologist will monitor the patient's condition, checking whether the heartbeat, breathing and blood pressure are normal until the anesthesia wears off. After this, the patient is transported from the operating room to the recovery room. The operation takes 1-1.5 hours.

After transurethral resection of prostate adenoma

After removal of the prostate adenoma, it will not be long before the doctor allows you to eat and drink. In particular, you can eat in the evening of the same day, and in the morning physical activity is even allowed.

Transurethral resection of prostate adenoma does not lead to severe pain. But, if unpleasant, painful sensations occur, they should be reported to doctors immediately. In this case, medications will be prescribed to help make the postoperative period easier.

The catheter from the bladder will be removed within 1-3 days. All this time it will ensure normal healing of the postoperative wound. Blood and clots in the urine are normal in the first few days.

This drawing shows how a catheter is positioned through the urethra into the bladder.

It will only take a few days until the urine acquires a more natural color and the catheter is removed. After this, doctors recommend drinking as much fluid as possible. The norm is 2-3 l/day. This way, blood, clots, and fragments of the prostate remaining in the bladder will come out faster naturally.

In most cases, patients who have undergone an operation such as TUR of prostate adenoma are prescribed antibiotics. They protect against infections that could cause serious complications.

Complications arising after transurethral resection of prostate adenoma

Improvement in disease symptoms according to the IPSS scale (improvement in maximum urine flow rate) is observed in 90-100% of patients after prostate adenoma surgery.

Complications during surgery

• Bleeding requiring correction with drugs - 1-2%
• Damage to the prostate capsule

Source: http://laparo-urology.ru/transuretralnaya-rezekciya-adenomy-prostaty

How is transurethral resection of prostate adenoma performed?

Medical statistics show that half of the world's male population is faced with the problem of a benign tumor in the prostate gland.

Today, prostate adenoma is increasingly called benign hyperplasia (BPH). The older a person gets, the higher the risk of getting sick.

An overfilled bladder leads to cystitis. And squeezing the urethra leads to pain and burning. There is a high probability of sand and stones appearing. Over time, if the adenoma is not treated, it becomes many times larger, causing even more serious complications. To prevent this process, effective treatment is needed. Modern doctors use prostate adenoma tour for this purpose.

What is TOUR?

Tour of prostate adenoma is a surgical intervention on the male gland, which stands for transurethral resection. Today, transurethral resection of prostate adenoma is the most used and effective treatment method. The essence of the procedure is to remove hyperplastic adenoma tissue.

The prognosis of the operation is favorable and allows the patient to forget forever about problems in the reproductive system and the ineffectiveness of the urination process. There are no special recommendations for the operation; it can be practiced for any size and weight of the gland.

When is surgery necessary?

Surgery for prostate adenoma is prescribed for benign tumors, fibrosis and chronic inflammation. In this case, the patient must have the following symptoms:

1. Constant desire to go to the toilet “in a small way.” The passage of urine is accompanied by heaviness in the pubic area and severe cutting pain. The pain is diffuse in nature, spreading towards the spinal column and testicles. In advanced cases, urinary incontinence is possible; it is released involuntarily, drip-wise. The urge increases up to 10 times, especially at night.
2. Urinary retention.
3. The appearance of bloody or purulent inclusions in the urine. The presence of blood in the urine indicates bleeding due to damage to the vasculature. Pus is a sign of inflammation.
4. The appearance of residual urine. It is formed due to the fact that urine cannot flow out through the urethral canal, which is narrowed or completely compressed by the prostate adenoma. It accumulates in the bubble, stretching its walls. Long-term disruption of fluid outflow can trigger the process of stone formation in the kidneys.

When choosing a treatment method, the doctor relies on the above symptoms, but this does not mean that a transurethral resection operation will be accurately prescribed. Usually treatment begins with conservative methods and in 80 - 85% of cases it helps.

Source: https://prostatitaid.ru/adenoma-prostaty/lechenie-adenomy/transuretralnaya-rezektsiya.html

Transurethral resection of the prostate (TUR): Features, Indications, Contraindications, Preoperative preparation, Fundamentals of the technique, Progress of the operation, Options for TUR, Difficulties of the operation, Postoperative period

Transurethral resection of the prostate is one of the main types of surgical operations on the prostate gland. The entire organ or only part of the area that interferes with free urination is removed.

Benign prostatic hyperplasia (BPH) or adenoma is the most common disease in men after a certain age. The proliferation of gland tissue occurs mainly in the part that borders the bladder, which mechanically prevents normal urination.

Transurethral resections (TUR) for the treatment of BPH are used in 90% of patients. Recently, new, less traumatic methods of treating urinary disorders have been developed and introduced: cryodestruction, thermotherapy, laser and ultrasound ablation, vaporization, introduction of stents and balloons to expand the lumen of the narrowing of the urethra in combination with medications.

Nevertheless, it is believed (operation TUR of the prostate) that this is the “gold standard” of modern medicine for the treatment of adenoma.

Let's take a closer look:

• transurethral resection, what is it;
• what preparation is given to the patient;
• surgical technique, its main points;
• possible complications;
• rehabilitation after the procedure.

Peculiarities

The TUR operation of the prostate is a special type of intracavitary surgical intervention using an endoscope, without disturbing the skin. In this case, excision (resection) of tissue and stopping bleeding from damaged vessels occurs using a specially designed instrument under the influence of high-frequency electric current.

The instrument, a resectoscope, is passed through the lumen of the urinary canal into the organ cavity.

The history of this surgical method dates back more than a century of practical experience. TUR for prostate surgery has a number of advantages over traditional, open-cavity operations to remove adenoma hyperplasia:

• less trauma and reduced incidence of postoperative complications;
• reducing the patient’s stay in the clinic and his rehabilitation period;
• restoration of normal urination, in the most severe forms of the disease;
• no scar.

Nowadays, all endoscopic manipulations are carried out using improved designs of instruments and optics, improving the quality of the image on the screen and simplifying the orientation and work of the surgeon.

However, we should not forget that transurethral resection of prostate adenoma is one of the most complex operations in endosurgery, requiring precision manipulation, extensive knowledge and experience from the doctor in the procedure. A surgeon is considered experienced if he has independently performed at least a hundred similar interventions.

Indications

Transurethral resection of the prostate gland is possible and indicated at any stage of treatment for benign hyperplasia of the organ thanks to the introduction of new techniques.

This is a continuous washing of the bladder cavity with simultaneous removal of removed tissue, as well as a technique of practically “bloodless” resection with preliminary stopping of bleeding by exposing and coagulating large vessels in the gland.

The procedure is recommended for:

• high degree of danger or contraindications to open adenomectomy;
• gland volume less than 80 cm³ (with a mass of up to 80 g);
• reproductive age of the patient;
• the feasibility of preserving sexual function;
• if there is a suspicion of malignancy of tissue degeneration in the organ;
• excess body weight and concomitant disorders of other organs and systems;
• during operations on the genitourinary organs or laser therapy of BPH previously undergone;
• with remnants of prostate tissue after incomplete removal;
• ineffective drug treatment of BPH;
• chronic form of the disease with stones.

Contraindications

TUR is contraindicated only if there are general restrictions on any operation. This is, as a rule, an inoperable condition of the patient, acute diseases of the genitourinary system, the inability to insert an instrument through the urethra, uncontrolled diseases of the patient’s blood coagulation system.

Preoperative preparation

Carrying out a TUR requires a detailed clinical and urological examination of the patient, which includes:

• general and specific biochemical analyzes of physiological fluids;
• determination of blood clotting;
• prostate-specific antigen (PSA) to rule out prostate cancer;
• transrectal and transabdominal ultrasound of the gland;
• urine culture for microflora with determination of antibiotic resistance;
• excretory urography (according to indications);
• analysis of gland secretion;
• study of the state of kidney function;
• urocystoscopy.

Basics of the technique

It is well known that electrosurgery (including transurethral resection) requires tissue electrical conductivity to perform the procedure. The prostate also contains electrolytes.

Electrotomy (cutting) occurs under the heating of tissue created by a special surgical device connected to an electrical network. The intracellular fluid boils, an explosion occurs, death, destruction and detachment of cells in the area affected by the electric arc.

Coagulation of blood vessels requires less heating of the device and a different operating mode. Slow drainage of the tissues of blood vessels leads to their narrowing, twisting, blockage and stopping bleeding.

To prevent stimulation of nerve endings and the occurrence of uncontrolled movements of the patient during surgery under the influence of electric current, in TUR the active electrode is the loop of the resectoscope, and the passive electrode is a special plate that directs the energy after passing through the body tissue back to the device. Burns and thermal damage to surrounding tissues are excluded due to the difference in electrode sizes. The passive electrode plate is much larger in area than the cutting loop.

During the operation, the patient is reliably protected from the effects of electric current, reliable grounding of the device, and a special insulating coating on the surface of the operating table.

 Hair at the site of contact with the skin of the passive electrode must be completely removed, the plate is additionally secured with a rubber bandage.

All personnel undergo special training to work with power tools.

Progress of the operation

Prostate surgery is performed using a resectoscope. This is the main instrument; it is a metal tube with a Teflon or ceramic tip (beak), an obturator, an optical telescope, a loop, a curette, and a coagulator.

A resectoscope is used for constant washing of the bladder cavity to remove removed particles of gland tissue. The extension of the active element (wire loop, coagulator or curette) and operation of the instrument is carried out by the surgeon’s finger. The telescope allows you to see and illuminate the internal working field and objects using special lamps.

Anesthesia methods are selected individually in each case, depending on the patient’s age, the condition of his body, the duration of the operation, and the size of the BPH. More often, the spinal (conductor, epidural) method of pain relief is used. To prevent the development of bacterial complications, antibiotic injections are used.

The patient's position during the operation is fixed on his back with his legs elevated and bent at the knees.

TOUR OPTIONS

Transurethral resection is a generalized concept of a treatment method as a whole. There are several options for the procedure.

1. Pseudo-TOUR. A small part of the hyperplastic prostate (no more than 10-15 g) is removed from the base or body of the gland, which facilitates the outflow of urine.
2. Partial TOUR. A cone-shaped canal is created in the prostate with excision of the bulk of the gland. Some tissue remains at the edges of the organ.
3. Total prostatectomy, in which up to 100% of the organ tissue is removed. As with open cavity surgery.
4. With the radical technique, the entire organ with capsule is removed. More often, this procedure is performed in the treatment of the initial stage of malignant degeneration of the prostate.

Difficulties of the operation

Inserting a resectoscope through the urethra can be difficult. This is due to the presence of natural narrowings of the lumen and bends, as well as pathological processes.

To prevent complications, several days before the operation, the urethra is bougiened with special metal curved bougies. Such a procedure can cause the formation of perforation, false passages, bleeding, microtrauma of the urethral mucosa, scars and strictures later.

An alternative is to pass a resectoscope treated with a special gel along the urethra under constant visual control using an optical obturator.

There should be no tissue fragments or blood clots left in the lumen of the bladder cavity, which could subsequently clog the urethral catheter.

Postoperative period

Immediately after a TUR of the prostate, for 2-3 days, the patient is fitted with a catheter to flush the bladder from possible blood clots and remove urine. Additionally, according to indications, antibiotic therapy, infusions and plenty of fluids are prescribed.

Meals should be small and balanced. Canned food, pickles, semi-finished products, sausages, products with dyes and artificial flavors should be excluded from the diet.

After removal of the catheter, patients often complain of difficulty urinating and a persistent burning sensation. These are typical post-operative symptoms and usually subside 1-2 weeks after the procedure. The patient's condition can be alleviated by using rectal painkillers and anti-inflammatory suppositories.

In case of early postoperative bleeding, the doctor prescribes medications or performs additional endoscopic coagulation of blood vessels.

Due to the fact that TUR of the prostate has its own complications and failures, advantages and disadvantages, research is constantly being conducted to introduce new minimally invasive methods for removing BPH.

Sources

1. Guidelines for transurethral resection of endoscopic electrosurgery for benign prostatic hyperplasia / Martov A.G., Lopatkin N.A. – M.: Triada-X Publishing House, 114 pp., 2006.

Author

Gorodneva Nina Valerievna

Source: https://uran.help/surgery/transuretralnaya-rezektsiya-prostaty.html

How is transurethral resection of prostate adenoma performed?

Transurethral resection of the prostate (TUR or TURP) is the most commonly used operation for advanced cases of prostate adenoma. The operation is carried out in a way that is quite gentle for the patient, however, despite this, it requires some preparatory and relatively long rehabilitation periods. In some cases, it can cause various complications.

The essence of the operation

Transurethral resection of the prostate is a minimally invasive (performed without an incision) operation to remove diseased prostate tissue.

It is performed using a resectoscope - a cylindrical instrument equipped with an electric loop, a light source, a camera and a fluid supply and pumping system.

Due to the action of an electric current, the affected tissue is cut off, the camera allows you to control the progress of the operation and not touch healthy areas, the liquid supply and pumping system allows you to wash the operation site for a better image on the camera and disinfection of the intervention area.

TUR removal of prostate adenoma is performed through the urinary tract, which, due to the absence of an incision, reduces the risk of infection and bleeding in the postoperative period, and also reduces the duration of hospitalization and rehabilitation.

However, there are more modern methods that involve the use of a laser, which can further reduce rehabilitation and protect the patient from possible complications. In addition, it is worth knowing that early resectoscopes were monopolar, which could cause additional complications.

Bipolar transurethral resection of the prostate is considered much safer.

During TUR of the prostate, epidural anesthesia is used, i.e. an anesthetic is injected into the spine, sensitivity of the lower part of the body disappears, however, the patient remains conscious. This method is safer than general anesthesia used for prostatectomy because it does not cause complications that can result from general anesthesia.

During a TUR of prostate adenoma, it is possible to preserve the removed parts for histological analysis, which makes it possible to more accurately determine the possibility of the onset of an asymptomatic stage of oncology. With some types of laser prostate removal this is not possible.

Indications

Indications for TUR of prostate adenoma:

• frequent urge to urinate, weak stream, feeling of incomplete emptying;
• pain or burning during urination or ejaculation;
• presence of blood in urine or semen;
• stones in the bladder or prostate;
• relapses or the emergence of new infections of the urogenital tract are possible;
• diverticula of the bladder wall (formation of additional cavities in the organ);
• contraindications for prostatectomy, previous operations on the gastrointestinal tract or pelvic organs;
• TUR for prostatitis can be performed in advanced cases of the chronic form of the disease.

Contraindications

Prostate TURP surgery is not performed in the following cases:

• with immobility of the hip joints due to tuberculosis, arthritis or injury;
• acute inflammation in the pelvic organs;
• end-stage adenoma or carcinoma;
• varicocele;
• bleeding disorders;
• pathologies of the cardiovascular system.

Preparation

Planned transurethral resection of prostate hyperplasia involves a short preparatory period. 1.5-2 weeks before it you need to stop taking anticoagulants. To select an anesthetic, you need to undergo standard tests - blood, urine, electrocardiography, ultrasound of the pelvic organs and chest x-ray.

Antibiotics may also be prescribed, starting 2 days before surgery and lasting 7-10 days after surgery.

1 day before the operation you need to give up your last meal and drink, and do not consume anything on the day of the procedure.

Carrying out

The procedure for TURP of the prostate gland is as follows:

1. The patient is placed on the operating table, legs are raised and spread apart.
2. The TUR operation for prostate adenoma is performed under local anesthesia; for this, the patient is given anesthesia between the 4th and 5th vertebrae. If desired, general anesthesia can be used, however, it causes more complications during the rehabilitation period, so it is recommended to avoid it.
3. The area is disinfected.
4. A special gel is injected into the urethra.
5. A resectoscope is inserted into the urethra and gradual removal of the affected tissue begins.
6. The technique of transurethral resection of the prostate involves the use of an irrigation fluid during the operation, which will wash away blood and particles of the prostate for better imaging and control over the progress of the intervention.
7. Hemostasis (stopping bleeding) of the damaged vessels is carried out and the resectoscope is removed.
8. A catheter is installed in the urethra.
9. The operation lasts about 1.5 hours.

Rehabilitation

The length of stay in the hospital after a TUR is usually 3-7 days. During this time, the process of urination is observed.

Blood may be found in the urine; this is not considered a complication; the symptom goes away on its own within a short time. The possibility of infection is also controlled.

In addition, a number of simple exercises are recommended to prevent thrombosis; they should be performed every 3-4 hours, the rest of the time observing bed rest.

After this period, the catheter is removed from the urinary canal and the patient undergoes outpatient rehabilitation.

After 3-4 weeks, urination should completely normalize; for this, it is recommended to maintain a drinking regime and consume at least 3 liters of water daily.

However, it is not recommended to drink in the evening and at night (after 20 hours). It is acceptable to drink non-carbonated water, juices, fruit drinks and tea. Coffee and alcohol are prohibited.

Salty, fatty and spicy foods are excluded from the diet, as well as foods that increase gas formation and the risk of constipation.

Various groups of medications and periodic examinations may be prescribed.

Possible complications

Possible complications of TURP of the prostate include:

1. Infection with hospital microflora. This complication is observed in 30% of cases.
2. Subsequent narrowing of the urethra for several years and sclerosis of the bladder neck. It is observed in 4-5% of cases and requires repeated surgery.
3. Retrograde ejaculation (ejaculation occurs not outward, but into the bladder) and associated infertility. Observed in 70% of cases.
4. Impotence is observed in 1% of cases.
5. Urinary incontinence, which can be treated with simple exercises.

Source: https://prostatity-net.ru/prostata/lechenie/transuretralnaya-rezekciya-predstatelnoj-zhelezy.html

Operation transurethral resection (TUR) of the prostate: indications, progress, rehabilitation at the MEDSI clinic

Benign prostate tumor is a common pathology, affecting more than half of men over the age of 50. The disease is successfully treated today. The most modern technique is transurethral resection (TUR) of prostate adenoma.

The technique is especially relevant for young patients. This is due to the fact that TUR of the prostate is an operation that allows you to preserve the organ and all its functions. The intervention is carried out at MEDSI by experienced specialists. Our doctors are fluent in modern techniques of minimally invasive surgery.

What is a TOUR of the prostate?

Transurethral resection of the prostate gland is an intervention that is performed to quickly remove overgrown organ tissue. As a rule, surgery is performed for a benign prostate tumor. At the moment, the technique is rightfully considered the gold standard of treatment.

This is due to the fact that in most cases, after surgery, the tumor disappears forever. In addition, the intervention is minimally invasive, has a short rehabilitation period, and a minimal number of contraindications and side effects.

After surgery, patients recover quickly and can return to their normal lifestyle within a few days. In the future, they are not limited to physical and sexual activity.

Indications for surgery

TUR operation for prostate adenoma is performed in the following pathological conditions of the patient:

• Urinary incontinence
• Large volume (more than 50 cm3) of residual urine (retained in the bladder after voiding)
• Frequent urination at night
• Obstruction of the urinary tract, making it difficult to urinate due to narrowing of the bladder neck or lumen of the ureter
• Painful urge to urinate
• Frequent urge to urinate
• Causing discomfort sagging bladder tissue with the formation of cavities

TUR surgery is often prescribed for patients who regularly suffer from genitourinary tract infections. Intervention is also carried out in cases of suspected malignant degeneration of prostate tissue.

Important! In this case, it is possible to save the organ only with early diagnosis and the general satisfactory state of health of the man. Your doctor will tell you about all the indications for a TUR of the prostate. He will determine whether intervention is required in your case.

Despite the fact that the TUR operation is widely used in urology, it is not performed on everyone. In some cases, other (including medication) methods are used.

Benefits of prostate tour

The main advantage of TUR is that the intervention is minimally invasive. It is performed without tissue incisions.

Thereby:

• Reduces the risk of infection
• Reduces patient rehabilitation time
• Risks of complications are eliminated

The TUR operation for an adenoma is performed without opening the bladder cavity. The integrity of the organ guarantees the rapid restoration of the urination process. If after an open operation the catheter is removed only after a few weeks, then after a TUR - after a couple of days.

TUR (prostate gland) is compared by some to laser removal of the organ. But these are completely different interventions! When exposed to laser, the organ is exposed to heat.

This delays the recovery of the urination process, for example. In addition, during laser surgery, a specialist cannot simultaneously collect material for histology (biopsy).

For this reason, the asymptomatic stage of cancer development may be missed, which will significantly complicate its further treatment.

Intervention technique

The intervention lasts 60-90 minutes. Anesthesia is usually administered by injection into the spine (epidural anesthesia). With this anesthesia, the patient is conscious. During the operation he cannot feel the lower half of his body. If necessary (including if the person being operated on wishes), the intervention is performed under general anesthesia (rather rarely).

Tour of the prostate gland: progress of the operation

Preparation

TOUR is performed on the operating table. The patient is placed on his back, and his legs are spread apart. After this, the genitals are carefully treated with an antiseptic. The patient is covered with sterile linen.

The operation itself

A special instrument is inserted into the patient's urethra. It is called a “resectoscope” and consists of 2 tubes and a working element (electric loop) connected to the prostate. Cutting off the affected organ tissue is ensured by the action of electric current.

End of intervention

The final stage of the operation is to control the integrity of all vessels. The surgeon also stops the bleeding. Only after this the operating instrument is removed from the patient’s urethra.

After completing all the main manipulations, the doctor inserts a catheter with a balloon, which injects a special fluid and tampons the intervention site. The procedure allows you to quickly stop bleeding from all small vessels.

In addition, the bladder is flushed through the catheter. This eliminates the risk of postoperative complications.

Transurethral resection of the prostate: consequences

Important! Despite the fact that upon completion of the intervention the bleeding stops, the risk of bleeding persists for up to 3-4 days. For this reason, the catheter remains in the urethra for the period recommended by the surgeon.

The patient remains in the hospital for about a week. All this time, specialists monitor the urination process.

If the patient experiences difficulty or any delay in urination, additional therapeutic measures are taken.

It is very important to restore the process of urination, since if the outflow of urine is difficult and the bladder is full, the risks of developing an infectious process increase.

Preparation for transurethral resection

The operation of TUR of the prostate gland does not require complex preliminary preparation. The doctor will tell you about all the features.

There are also general recommendations:

• 12 hours before the intervention you should refuse water and food.
• A week before surgery, stop taking aspirin and other medications that can thin the blood. Be sure to tell your doctor about all the medications that are currently prescribed for you. This will reduce the likelihood of surgical and postoperative complications, the risks of worsening the condition
• On the eve of the intervention, you should not be subjected to physical and emotional stress.

Important! Before TUR, the patient must undergo a comprehensive diagnosis.

It includes:

• Taking blood and urine tests
• Ultrasound
• ECG
• X-ray examination of the lungs
• Transrectal examination, etc.

Your doctor will issue a referral for testing. He will also inform you when the results of all tests will be ready. This will allow you to plan the date of the intervention and calmly prepare for it.

Complications

Correctly performed by an experienced surgeon, TUR of an adenoma rarely leads to complications.

However, the following consequences of the intervention may occur:

• Infection . The risk of such a complication with TUR is 30%. Typically, the process of spread of infection begins in the hospital after the intervention and is associated with certain hospital microflora. Microorganisms in hospitals have increased resistance to antiseptics and antibiotics. For this reason, the process of eliminating the infection is often delayed. The latest generation antibiotics are prescribed for prevention and treatment
• Strictures of the urethra . A condition such as narrowing of the urethra is considered very dangerous. This is because it leads to stagnation of urine and increases the risk of infection. Strictures are treated by dilating the urethra. Probes are inserted into the canal. Surgery can also be performed - canal plastic surgery.
• Urinary incontinence . Treatment of such a complication may involve prescribing the patient a number of physical exercises to increase the strength of the pelvic day muscles
• Retrograde ejaculation . This complication occurs quite often (in 70% of cases) and consists of the reflux of seminal fluid into the bladder. There is no threat to the health or life of the patient. Treatment of complications is carried out both conservatively and surgically.
• Impotence . This complication occurs only in 1% of cases. Treatment is carried out mainly by conservative methods. Surgery is prescribed only if therapy does not give the desired result for a long time

If you are at risk of any complications, your doctor will definitely warn you about them and tell you about preventive measures.

Postoperative period in the hospital

The patient remains in the hospital for 1-3 days after surgery. There are no restrictions on food consumption during the rehabilitation period.

Immediately after the intervention, a catheter is installed to ensure the outflow of urine. The duration of use of the catheter is determined individually and depends on the patient’s condition, his individual characteristics, the complexity of the intervention and other factors. Typically, the maximum period for using a catheter is 3 days.

During the day after surgery, there may be blood in the urine. Over time, the urine clears.

The first day should be kept in bed. The patient is prohibited from standing up or undergoing physical activity. In order to prevent blood clots, some patients are recommended to perform simple exercises.

Complete rehabilitation after TUR operation usually lasts 3 weeks. After discharge from the hospital, the patient remains at home.

Recovery period

The operation is considered successful if recovery occurs quickly enough and without complications.

Important! Rehabilitation may be delayed if the intervention was carried out for a malignant tumor. The patient is additionally prescribed treatment aimed at reducing the risk of tumor recurrence and metastasis in other organs. Typically, therapy is carried out through irradiation and the introduction of chemicals into the blood.

Surgery TUR of the prostate gland: postoperative period at home

To ensure the fastest possible rehabilitation, the patient should:

• Strictly observe the drinking regime
• Introduce teas, juices and fruit drinks into your diet
• Stick to a diet
• To refuse from bad habits

Surgery TUR of the prostate gland: limitations of the postoperative period

Restrictions in the postoperative period concern not only nutrition and fluid intake, but also:

• Driving a car. You can get behind the wheel no less than a month after discharge from the hospital
• Sexual life. You can return to it a month after the intervention
• Physical activity. They resolve one month after surgery TUR of the prostate gland

The doctor will tell you about all restrictions. He will also determine the desired lifestyle of the patient during the rehabilitation period. If you follow all the recommendations, recovery will take place as quickly as possible and without the risk of complications.

Contraindications

The TUR operation in urology has a number of contraindications and is not performed if:

• Serious pathologies of the cardiovascular system
• Bleeding disorders
• Adenoma in the terminal stage
• Varicocele
• Carcinoma that has affected large volumes of the organ
• Stiffness of the hip joint
• Active inflammatory processes in the body

The doctor will tell you about all contraindications. He will determine whether the TUR technique is suitable for you or whether another operation is necessary.

Advantages of a prostate tour at MEDSI

• Experienced highly qualified doctors
• Competent junior and nursing staff
• Patient management by one specialist
• Comprehensive programs. The price of TUR operation for prostate adenoma is fixed. The cost includes the intervention itself and the patient’s hospital stay.
• High-quality preparation for intervention. Thanks to it, all risks of complications and side effects are reduced
• 24-hour medical care
• Comfortable accommodation in wards with all amenities
• Use of modern drugs
• Using the latest equipment
• Five meals a day, taking into account all medical indications
• Possibility to visit the patient at any time
• Possibility of placing non-resident relatives and friends in the MEDSI sanatorium in Otradnoye

To get a doctor’s consultation before surgery and undergo a full examination, just call +7 (495) 7-800-500 and make an appointment. Our specialists will always answer any of your questions, give you the estimated cost of services, conditions of hospital stay and tell you about all the intricacies of the upcoming intervention.

Source: https://medsi.ru/articles/operatsiya-transuretralnaya-rezektsiya-tur-prostaty-pokazaniya-khod-reabilitatsiya/