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Chapter 139 - Transurethral resection of the prostate

from Section 26 - Urologic Surgery

Published online by Cambridge University Press:  05 September 2013

By
Muta M. Issa  and
Adam B. Shrewsberry
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Transurethral resection of the prostate (TURP), developed in the 1920s, remains the gold standard surgical treatment for benign prostatic hyperplasia (BPH) throughout the world. Over the years, the procedure has undergone significant modifications that improved its efficacy and safety. The most significant recent improvement is bipolar TURP. Conventional monopolar TURP employs hypo-osmolar fluids for irrigation during the procedure. As a result, patients are at risk of developing perioperative dilutional hyponatremia and TUR syndrome, which is a severe form of serum electrolyte and osmolar derangement. Since the new bipolar TURP system utilizes normal saline for irrigation, these risks and complications are completely eliminated. Bipolar TURP thus allows for safer resection.

Indications for transurethral resection of the prostate

Transurethral resection of the prostate is the treatment of choice in patients with moderate to severe BPH symptoms and significant compromise to their quality of life who:

  • Are unable to tolerate or do not respond to other forms of management (e.g., watchful waiting, medical therapy and/or minimally invasive thermal therapy).

  • Are experiencing urinary retention thought to be secondary to BPH.

  • Have recurrent urinary infection secondary to BPH.

  • Have bladder stones secondary to BPH.

  • Have renal failure secondary to BPH.

  • Have recurrent bleeding (gross hematuria) secondary to BPH.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 790 - 793
Publisher: Cambridge University Press
Print publication year: 2013

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References

Issa, MM, Marshall, FF.Contemporary Diagnosis and Management of Diseases of the Prostate. 3rd edn. Newtown, PA: Handbooks in Healthcare; 2005, pp. 103–12.Google Scholar
Issa, MM.Technological advances in transurethral resection of the prostate – bipolar versus monopolar TURP. J Endourol 2008; 8: 1587–95.CrossRefGoogle Scholar
Issa, MM, Young, MR, Bullock, AR, Bouet, R, Petros, JA.Dilutional hyponatremia in TURP syndrome – a historical event in the 21st century. Urology 2004; 64: 298–301.CrossRefGoogle ScholarPubMed
McVary, KT, Roehrborn, CG, Avins, AL et al. American Urological Association Guideline: Management of Benign Prostatic Hyperplasia. Linthicum, MD: American Urological Association, 2010. .Google Scholar
Wasson, JH, Reda, DJ, Bruskewitz, RC et al. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperation Study Group of Transurethral Resection of the Prostate. N Engl J Med 1995; 332: 75–9.CrossRefGoogle Scholar

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