PROCEDURE AT A GLANCE
PERIOP BRIEFING
Transurethral resection of the prostate
INDICATIONS FOR PROCEDURE hips are positioned in a way that prevents excessive
flexion, rotation, and abduction.
• Transurethral resection of the prostate (TURP) • This position should be maintained for the shortest
is indicated to treat moderate to severe urinary amount of time possible, with repositioning
problems associated with benign prostatic intervals if possible.3
hypertrophy.
Prostatic tissue
• It also is indicated to prevent or treat
is removed
complications associated with an obstructed urine
flow from such conditions as persistent urinary Prostate
Resectoscope
tract infections, kidney or bladder damage, or
bladder stones.1
•
PREPARING FOR PROCEDURE
• The perioperative RN should assemble basic
instrumentation for cystoscopy; a resectoscope, a
foroblique scope, cutting loops, a sheath, and an
obturator; a high-frequency cord; a short bridge;
a Toomey syringe or bladder evacuator; sound
dilators; an indwelling urinary catheter; a urologic
drape with rectal sheath; and a continuous bladder To perform TURP, the surgeon will insert a resectoscope into
irrigation and urinary drainage system. the urethra to remove the prostatic tissue.
• The patient’s entire pubic area, including the
perineum, should be prepped.2
BASIC WORKFLOW FOR PROCEDURE
To perform TURP, the surgeon will
1. dilate the urethra with sound dilators;
2. perform cystoscopy to determine the size of the
obstruction and evaluate the bladder;
3. place a resectoscope sheath with obturator into
the urethra;
4. remove the obturator and insert the
resectoscope, along with the foroblique scope
and cutting loop, into the sheath;
5. attach the light cord, irrigation tubing, and
high-frequency cord;
6. open the stopcock on the sheath and control
A resectoscope will be needed to perform TURP. the irrigation to distend the bladder and allow
inspection of the prostatic urethra and bladder
trigone;
PATIENT POSITIONING 7. electrodissect the prostate, alternating cutting
and coagulating;
• The patient is placed in the lithotomy position.2 8. drain the bladder, which will wash out any
• The leg holders should be at an even height. remaining prostatic tissue;
• Care must be taken to ensure that the patient’s 9. consider use of a bladder evacuator or Toomey
doi: 10.1002/aorn.13337
© AORN, Inc, 2021 February 2021 Vol 113 No 2 • Periop Briefing | P13
18780369, 2021, 2, Downloaded from https://aornjournal.onlinelibrary.wiley.com/doi/10.1002/aorn.13337 by Centennial College, Wiley Online Library on [12/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
PERIOP BRIEFING
PROSTATE RESECTION
syringe to manually irrigate the bladder and POSTOPERATIVE RECOVERY COURSE
remove any additional prostatic tissue;
10. inspect the prostatic fossa for bleeding; • The patient will be hospitalized for up to two days.
11. remove the resectoscope; • The urinary catheter will remain in place for at
12. insert a urinary catheter and inflate the balloon, least one day.
which is pulled in traction against the bladder • Blood in the urine is typical after TURP; if it is
neck to control venous bleeding; and thick or is getting worse, or if it is blocking urine
13. consider initiating continuous bladder flow, the patient should contact the surgeon.
irrigation with normal saline to remove clots • Urinating will be painful; the pain typically
and catheter obstructions.2 improves within eight weeks.
• The patient also may feel urinary urgency or
frequency.
PROCEDURAL VARIATIONS • The patient should avoid heavy lifting and sex for
• One alternative to TURP is holmium laser four to six weeks.1
enucleation of the prostate.
o With this approach, a laser is attached to the
resectoscope.
• Another option is transurethral laser resection of
the prostate.
o With this approach, a cystoscope with a laser
attached is used.
• These approaches may be more appropriate for
men with large prostates, older men not healthy
enough to undergo TURP, and men taking blood
thinners.4
POSSIBLE COMPLICATIONS
Complications associated with TURP include
• TURP syndrome,
After TURP, a urinary catheter will remain in place for
• urinary tract infection,
wat least one day. Photo by Andrii Pohranychnyi via Getty
• dry orgasm, Images.
• erectile dysfunction,
• heavy bleeding,
• incontinence, and This Procedure at a Glance article is adapted from
the AORN eGuidelines+.
• urethra or bladder neck stricture.1
REFER ENCES
1. Transurethral resection of the prostate (TURP). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/turp/about/
pac-20384880. Published November 26, 2019. Accessed December 9, 2020.
2. Korey Marley HP. Genitourinary surgery. In: Rothrock JC, ed. Alexander’s Care of the Patient in Surgery. 16th ed. St. Louis,
MO: Elsevier Mosby; 2019:455-528.
3. Guideline for positioning the patient. Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2021:643-718.
4. Transurethral resection of the prostate (TURP). NHS Inform. https://www.nhsinform.scot/tests-and-treatments/surgical-
procedures/transurethral-resection-of-the-prostate-turp. Updated February 14, 2020. Accessed December 9, 2020.
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