3. In Summary
The prostate is a gland at the base of the
bladder in men
Sometimes, the prostate may become too
large. Then, less urine flows out of the bladder
opening
Your doctor can remove the inner part of the
prostate to make passing urine easier
This procedure is called a transurethral
resection of the prostate or a TURP
A TURP can remove all or part of the prostate
gland
4. Resulting in
You will be able to pass urine more easily
Your doctor may also take small pieces of
the prostate to test and look for signs of
illness or cancer
5. Perianesthesia Nursing Care of
the TURP Patient
“Pre existing medical
conditions and the effects
of anesthetic agents may
compromise respiratory
function making it
pertinent that deep
breathing and coughing,
position changes and the
use of incentive spirometry
are of utmost importance
to ensure optimal lung
function”(Odom-Forren,
2013, p. 547).
6. General Anesthetic
General anesthesia is
the induction of a state
of unconsciousness with
the absence of pain
sensation over the
entire body, through the
administration of
anesthetic drugs.
7. General Anesthetic
Complications
Pain - 25% of patients still experience pain despite spinal anesthesia
Nausea and vomiting - up to 30% of patients, due to the narcotics
being used
Damage to teeth - most frequently damaged
teeth are the upper maxillary incisors
Hypotension - transient hypotension as sympathetic nerves are
blocked. This usually responds to prompt fluid replacement, usually
starting with crystalloids followed by colloids
Headache - results from CSF leak from the puncture site. This is
treated with bedrest and adequate hydration
Awareness during anaesthesia - up to 0.2% of patients;
Respiratory depression – due to narcotics being used, usually
treated with narcan
Death
8. Spinal Anesthetic
“Spinal anesthetic is
classified as a neuraxial
block and blocks the spinal
nerve roots as they pass
through the cerebral spinal
fluid, resulting in a block of
sensory, motor and
autonomic impulse
transmission. Spinal
anesthetic is a single, small
dose of local anesthetic
administered within the
subarachnoid space”
(Odom-Forren, 2013, p. 327).
9. Spinal Complications
High spinal block – excessive spread of local anesthetic that can
result in upper extremity sensory block , bradycardia/asystole, loss
of consciousness, respiratory distress or apnea.
Hypotension – can be treated by fluid bolus, or vasopressors.
Nausea and vomiting (sometimes due to hypotension).
Urinary retention- often caused by autonomic blockade of the
sacral nerve and can cause patients to exhibit signs of restlessness
and incoherence. A bladder scan can be done to confirm
retention and a urinary catheter can be inserted.
Hypothermia – inhibited peripheral vasoconstriction, transferring
body heat from the core to the periphery.
Neurological – very rare, from traumatic needle placement,
hematoma, or bleeding. Causing pain, paralysis, sensory and motor
changes. Recovery is poor and more severe infectious
complications such as meningitis, and abcess can occur.
Spinal Hematoma - rare but serious. Symptoms are low back pain,
motor changes, bowel & bladder dysfunction. If surgical treatment
is delayed more than 8 hours recovery is poor (Odom-Ferron, 2013,
p. 330-331).
10. Spinal Monitoring
Monitoring the patient
recovering from spinal
anesthetic requires
regular checks of
dermatones ( with ice),
sensory and motor
function, respiratory,
cardiovascular and
neurological systems
frequently to assess for
complications.
11. Post Anesthesia Care
Pain control
Foley catheter with continuous bladder irrigation
(CBI)
Monitoring CBI for color & presence of blood clots
Intake and output
Sequential compression devices (SCD)
Incentive spirometer
Vital signs
Physical assessment
Early ambulation
12. Complications of TURP
Infection. Urinary tract infection is the most common.
Passing the semen into the bladder instead of out through
the urethra
Loss of sperm fertility. If you plan on having children, talk to
your doctor before your procedure.
Problem with urine control which is rarely long-lasting.
Need for another TURP procedure, either because the signs
never improved or simply return over time as the prostate
continues to get bigger.
Problem with erection which is rare.
Bleeding or small blood clots
A hole in the bladder
Reduced sexual activity
13. An Unusual Case…
Patients who undergo a TURP are not
anticoagulated because the urine is bloody
after surgery
A patient who develops a DVT (deep vein
thrombosis) is usually treated with an
anticoagulant such as
Coumadin or Xaralto
In this case a patient would
not be able to be treated this
way…
14. What’s a DVT?
When a blood clot forms in one of the deep
veins in your body (usually your legs)
Leg pain or swelling can be an indication but
may occur without symptoms
DVT can develop
when a patient doesn’t
move for a long time
This is a serious condition
because a clot can 0
break off an cause a
pulmonary embolism
15. Signs & Symptoms of DVT
Pale skin or your skin feels cold to touch
Swelling of legs or change in size of one leg
No feeling in your leg or foot
Tingling sensation in your leg or foot that does not go
away
Trouble breathing
Chest pain
Coughing up blood
Pain when walking
Blood in your stool or urine
Bleeding from anywhere in your body that will not
stop
17. Preventing DVT
Do not sit for long periods of time. Get up and
move around every 1 to 2 hours, unless you
are sleeping or on bedrest
Stretch your legs or wiggle your toes during
long trips and change position often
Drink 6 to 8 glasses of water each day
Do not drink beer, wine, and mixed drinks
(alcohol)
Do not smoke
If you are overweight, you should lose weight
18. References
Mayo Clinic Staff. (2015). Deep Vein Thrombosis (DVT).
Retrieved from http://www.mayoclinic.org/diseases-
conditions/deep-vein-thrombosis/basics/definition/con-
20031922
Odom-Forren, J. (2013). Drain’s Perianesthesia Nursing: A
Critical Care Approach. 6th Edition. St. Louis, Missouri:
Saunders.
Personal Communication, March 29, 2015, Dr. A. Iocca.
Urology Care Foundation. (2013). BPH: Surgical
Management (Benign Prostatic Hyperplasia/Enlarged
Prostate). Retrieved from http://www.urologyhealth.org
/urology/index.cfm?article=31