la resection trans-urethrale de la prostate

Transurethral resection of the prostate (TURP)

Prostate transurethral resection (TURP) is still widely used and is still considered the gold standard surgical technique for the treatment of benign prostatic hyperplasia (BPH). Until recently, this transurethral resection and open adenomectomy were the only surgical alternatives for the treatment of BPH.

Transurethral resection of the prostate (TURP) is an operation that requires approximately one hour and takes place in an operating room under general or spinal anesthesia (spinal anesthesia). This technique avoids the use of surgical incisions on the abdominal wall by cutting the excess prostate tissue using an endoscopic resectoscope or resectoscope.

 

resecteur endoscopique ou resectoscop

 

It is a device that has 3 elements.

  1. The liner which is a long cylindrical sheath of small diameter which the surgeon inserts into the urethra of the patient until reaching its prostatic portion;
  2. The large field optics connected to a cold light cable and a camera. The surgeon thus visualizes the surgical field on a monitor and benefits from excellent vision in two dimensions.
  3. The handle of the resector in which the resection handle is inserted. This handle is operated by the hand of the surgeon who moves the handle from back to front. It is connected by a cable to the electrical current which allows the section to cut the tissues, and coagulation to extinguish bleeding.

In order for the electric current to circulate in liquid medium, a solution which conducts electricity (Glycocolle) is irrigated in the urethra and the bladder continuously.
The prostate chips are removed by washing through the shirt and transmitted to the laboratory for analysis.

Retrait de copeaux de prostate par resection transuretrale

 

 

TURP remains the most common form of prostate surgery and generally remains more effective than drug therapies. It relieves urinary obstruction in at least 85-90% of patients, most often in a sustainable manner. However, urinary problems can reappear if the prostate tissue is reformed. This is why the younger the patient is, the greater the risk of unfortunately having to resort to a subsequent surgery.

After surgery, the surgeon remains hospitalized one to two nights. During this period, the urine is drained by a probe placed in the bladder, through the urethra canal. When this probe is removed, the patient resumes spontaneous urination by natural routes. He can resume his usual activities quickly. However, the resolution of post-operative micturition disorders may take a few weeks and in any event, the final result of the intervention is acquired only after a convalescence period of three months.

The usual consequence of TURP is the appearance in most patients of retrograde ejaculation, that is, sperm is excreted to the bladder instead of being driven into the urethra through the penis (In the opposite direction of the normal ejaculation called antegrade). Although the sperm ends up being evacuated with urine and does not cause any damage, the prospect of not feeling a normal ejaculation, and of course the difficulty in these conditions of having children, discourage some men from using To this technique.

On the other hand, between 5 and 10% of patients who have used TURP suffer from complications such as blood loss, impotence, urinary incontinence to a greater or lesser extent, infection or post – anesthesia. Such risks should be taken into account when choosing treatment options.

It should also be noted that approximately 2% of patients undergoing surgery develop a “TURP syndrome” during the procedure or in the immediate postoperative period, characterized by mental confusion, nausea, vomiting, hypertension or visual distortions . This specific syndrome is a complication associated with abnormal absorption in the bloodstream of the irrigation fluid used to keep the surgical field clear during surgery. The irrigation liquid used in the TURP is a solution of glycocolle which allows the conduction of electric current.

The use of saline (used in many other types of operations) is a safer alternative. However, this type of solution can not be used in the classic “monopolar” TURP we have just seen, but it is compatible with the more recent “bipolar” resectors discussed in another article.