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UROLOGY -part 6


Confusion, convulsions and coma. Therefore, it is easy to detect
TURP syndrome when the surgery is done under spinal anaesthesia. If there is a central venous pressure line it 1s easy to detect the rise in CVP. Another sign is distended neck veins. Because of pulmonary oedema there will be tachypnoca and
basal crepitations.

Early detection
Stop surgery
Frusemide IV
Hypertonic saline (1.8% NaCl) – not freely available
TURP syndrome can occur during or after surgery in about 1% of the patients. Anyway, the mortality is about 50%.

Complications of prostatectomy
Bleeding – Primary

Primary bleeding: occurs at the time of prostatectomy.
Diathermy coagulation and fluid/blood replacement will be helpful.

Reactionary bleeding:
During the first 24 hours.
There will be – Tach ycardia
Intense thirst
Cold and clammy extremities
If the external irrigation catheter is not blocked the bleeding will be obvious. However, torrential bleeding can result in clot retention.
Clot retention
External irrigation is not functioning
There is Severe suprapubic pain and features of internal

Rapid infusion of normal saline.
Pethidine 75mg IM
Flush the catheter with a bladder syringe.
If there is no response, change the catheter.
Some patients need a return to theatre and arrest of bleeding.
Tranexamic acid is useful.

Secondary bleeding:
Bleeding within the first two weeks of surgery.
It is usually secondary to infection.
The features and the treatment will be the same as above.

Perforation of the bladder

Perforation of the capsule of the prostate
The fluid gets accumulated in the scrotum, penis, lower part of the abdomen and the upper thigh.

At the time of induction prophylactic antibiotics should be started. eg: Gentamicin 80 mg IV.
Otherwise, prostatectomy can result in septicaemia, wound
infection, epididymoorchitis and bacterial endocarditis.
Impotence (erectile dysfunction)
Retrograde ejaculation when the bladder neck is incised, there
is damage to the internal şphincter urethrae.
Urinary incontinence is due to damage to the external sphincter urethrae. It improves with time with pelvic floor exercise.
Urinary fistula
It generally responds to catheter drainage of the bladder.
Bladder neck stenosis
Urethral strictures
After 10 years; 8%. especially after TURP.

Wound related complications of open prostatectomy
Wound infection
Incisional hernia
Urinary fistula
Keloid and hypertrophic Scars

General complications
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)
Myocardial infarction (MID
Hypostatic pneumonia

Preoperative preparation of prostatectomy
Steam inhalation and chest physiotherapy.
Oral hygiene.
Investigations to assess the fitness for surgery and anaesthesia.
Pre-anaesthetic medication.
A shower.
Overnight fasting.

Postoperative care

Continue read… Part 7

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