Transurethral Prostatectomy

Transurethral Prostatectomy

Transurethral Prostatectomy is a surgical procedure through which the prostate is removed. The prostate is a gland which may only be found in male individuals; it is situated in the lower abdomen, below the bladder. The urethra runs through it before entering the penis. The external sphincter, a muscle ring situated below the prostate gland, controls the urinary flow. As the individual advances in age, the prostate may start to enlarge. This may not be true in the case of all men, however in some cases the prostate enlargement may become severe, exercising pressure on the urethra and slowing the flow of urine. The individual may experience a loss of the urinary stream strength and may have difficulties starting to urinate.

The vast majority of men suffer from prostate enlargement. However, just an average of 15% of them suffer from dysfunctions so severe that they require surgical intervention. The most frequent affections which require surgical procedures such as Transurethral Prostatectomy are urinary stream dysfunctions (manifested through difficulty starting the flow of urine and weak stream; in many cases the bladder does not empty completely and the need to urinate may persist even after urination). It is possible for complete urethral blockage to occur and the bladder muscle may enlarge to suit the increased force required for emptying the bladder; this may cause irritability in the bladder, and may result in frequent urination. Overactive bladder is a condition which may give the feeling of needing to urinate urgently, and may cause leakage prior to reaching the toilet.

In some cases, the bladder muscle stretches and becomes under-active, leading to inability to completely empty the bladder allowing urine to remain inside even after excretion. This may cause further complications such as stones and infections. In very rare situations, kidney failure or kidney damage are possible, due to the backpressure being exerted on the kidneys. Prompt surgical intervention (such as Transurethral Prostatectomy) is required.

Transurethral Prostatectomy Description

Many of the above medical conditions may be successfully treated through Transurethral Prostatectomy – in other words, the surgical removal of part of the prostate, allowing the blockage to be eliminated. A part of the prostatic tissue will remain in place. In most cases however, this procedure is performed in order to correct the urination problems rather than to deal with medical complications.

Prior to the Transurethral Prostatectomy, a cystoscopy is performed. This is a procedure which allows the telescopic visualization of the urethra, the prostate and the bladder in order to allow the surgeons to decide what the best procedure is. It is also possible for the cystoscopy to reveal no problems with the patient’s prostate – in this case, the surgical procedure is cancelled and the operation will no longer be performed. In most cases, the Transurethral Prostatectomy is performed by employing the use of a resectoscope. The instrument is inserted into the bladder through the urethra. It is composed of a telescope, to allow the surgeon to visualize the patient’s prostate, and a cutting device which will be used to cut the part of the prostate causing the blockage into small pieces and remove it.

In rare situations, the prostate gland may have become too large to allow a transurethral resection or the patient’s bladder or urethra may be too small to allow passage for the resectoscope. In such situations, the best alternative available is an open prostatectomy surgical procedure – the removal of the prostate through an incision performed in the lower abdomen. Typically, all discomfort is eliminated after the procedure has completed and most complications can be easily treated. However, as with all surgical procedures, a number of complications may appear. These include excessive bleeding, late bleeding, infections, urinary retention, urinary incontinence, bladder muscle weakness, rectal injury, scarring of the urethra or bladder, testicle pain, retrograde ejaculation, erectile dysfunctions, and in severe cases, death may occur after surgery. The risk of complications is increased in obese patients and in individuals who habitually use tobacco.

Transurethral Prostatectomy Related Medication

Prior to undergoing a Transurethral Prostatectomy surgical operation, the patient will be required to cease taking any medication with blood thinning effects in order to reduce the risk of bleeding complications during surgery. The patient should stop taking any such pharmaceutical or herbal products at least 14 days before the scheduled date of the operation. In case such products have been taken less than two weeks before the operation, the doctors may advise the postponing of the intervention in order to ensure that the patient is exposed to minimum risks.

Right before the Transurethral Prostatectomy operation, the patient is administered prophylactic doses of antibiotics in order to reduce the chances of infections. This is a standard procedure for all surgical operations. The antibiotic medicine to be used, as well as the exact dosage will be determined by the health care professional based on a number of factors which vary from one individual to another, and the medicine will be administered by a trained health care professional in the preparation room before the patient is transported into the operation room.

The Transurethral Prostatectomy will commence only after the patient has been put under regional anesthesia. This is commonly performed using an epidural anesthetic. The drug is injected into the patient’s spinal cord region through a needle, causing the patient to lose feeling in the legs and the waist area for up to several hours. In some cases, general anesthesia may be preferred; the patient is administered a general anesthetic which will allow them to sleep without feeling anything for the entire duration of the surgical procedure. The general anesthetic is commonly administered through an intra-venous injection prior to the operation.

The most commonly employed anesthetic agents for Transurethral Prostatectomy operations are amide-based local anesthetics (such as Bupivicaine, Dibucaine, Levobupivacaine, Lidocaine, Mepivacaine or Prilocaine). For general anesthesia, there are two types of anesthetic agents which may be used: opioids (Fentanyl, Sufentanil, Remifentanil, Alfentanil) and non-opioid agents. There are several types of medicines which may be employed as non-opioid anesthetic agents, including barbiturates, benzodiazepines, Propofol, Etomidate and Ketamine.