Trans-Urethral Resection of the Prostate
Airway:
Access:
Pain:
Position:
Time:
Blood loss: 2-4ml/min of resection, usually ~500ml.
Special: TURP Syndrome occurs in 1-8% of patients
TURP:
- Resection of the prostate in small strips under direct vision using a resectoscope inserted into the urethra
Nerve supply via prostatic plexus- Pain from T11-L2
- Sympathetic fibres from T11-L2
- Parasympathetic fibres from S2-4
Including bladder stretch.
- Requires continuous irrigation to allow visualisation and remove debris
Blood loss may be substantial and under-appreciated. - Performed in older men who are usually comorbid
~80% will have other medical disease.
Considerations
- D
- Anaesthetic technique
- Spinal
- Good post-operative analgesia
- Reduces stress response
- Allows monitoring of conscious state due to TURP syndrome
- Allows identification of capsular tears
If spinal block to ⩽T10 then pain will indicate peritoneal stimulation from blood/irrigation fluid.
- Spinal
- TURP Syndrome
- Anaesthetic technique
Preparation
Induction
Intraoperative
Surgical Stages
- Capsular performation may result in significant bleeding
- Bleeding
Can be substantial.- Risk factors:
- Extensive resection
- Large prostate
- Infection
- Surgery ⩾ 1 hour
- IDC preoperatively
- Urokinase is released from the prostate during resection
Conxider 15-25mg/kg of TXA to reduce volume of haemorrhage.
- Risk factors:
- TURP Syndrome
Abandon surgery if suspected.
Emergence
Postoperative
- Myocardial ischaemia in up to 25% of patients
- TURP Syndrome
- Clot retention
References
- O’Donnell, Aidan M., and Irwin T.H. Foo. ‘Anaesthesia for Transurethral Resection of the Prostate’. Continuing Education in Anaesthesia Critical Care & Pain 9, no. 3 (June 2009): 92–96. https://doi.org/10.1093/bjaceaccp/mkp012.