What is transurethral prostatectomy?

In an era of rapid economic development, people nowadays have increasing stress in their lives, and the chances of getting many diseases have also increased significantly. There may be many diseases that we have never heard of before, but now we know about them. Do you know about transurethral prostatectomy? It sounds so advanced, and modern medicine can be said to be really advanced.

Transurethral prostatectomy

【Overview】

Benign prostatic hyperplasia is actually a prostate adenoma. The proliferating adenoma compresses the normal prostate tissue into a capsule called the surgical capsule. The fingers of open surgery are separated in this gap. At present, developed countries rarely use traditional open surgery to remove the prostate. Transurethral resection of the prostate (TURP) has become one of the conventional surgical methods. Only a few patients with excessive prostate hyperplasia and estimated weight exceeding 50g will consider open surgical treatment. Since the 1980s, TURP has been carried out in many large and medium-sized cities in my country. This method has the advantages of less impact on patients and quick recovery, but it requires special instruments and equipment, such as resectoscopes, high-frequency electric knives, etc. 

The following equipment and devices should be available for TURP.

(1) Electroresectomy: There are three types of electroresectomy that are commonly used: ① reflux electroresectomy; ② Reuter reflux improved electroresectomy; ③ suprapubic puncture cannula reflux electroresectomy (Figure 1). The reflux tube of the reflux electroresectomy can prevent the bladder wall from being accidentally cut by the resection circle during TURP. The reflux of the flushing fluid must be electrically aspirated to empty the bladder fluid.

The Reuter reflux modified electroresection scope also needs to be sucked with an electric suction device. The shortcomings of this device are that the suction opening is easily blocked by the urethral wall and the prostatic fossa, and the bladder wall is occasionally sucked to the top of the sheath, causing damage during TURP; the double-lumen sheath reduces the effective inner cavity; in order to clean the flushing opening of the sheath during operation, the entire instrument must be withdrawn from the urethra and reinserted; the water inflow speed is faster than the water outflow speed, so the bladder is always in a full state. During high-pressure flushing (the flushing fluid reservoir is higher than 60cm), non-physiological pressure acts on the bladder and prostatic fossa, and there is no alarm system. 

The suprapubic puncture cannula reflux electrosurgical resectoscope has the speed of water inlet and outlet regulated by an electric suction device to adjust the balance. The electrosurgical cutting circle of the resectoscope can also be 1/3 larger than the above two types, and the resection efficiency is correspondingly improved. The observation mirror can also be placed into the bladder through the puncture cannula, and direct visual control can be performed during resection when necessary. Therefore, its advantages are: ① Percutaneous cystoscopy is feasible; ② After the end of TURP, the fluid in the bladder can be emptied retrogradely through the cannula; ③ A plastic catheter can be introduced through the puncture cannula to facilitate continuous flushing of the bladder after surgery; ④ Once the cannula is blocked, the safety alarm tube will overflow with liquid. At this time, the multi-porous internal suction tube can be pulled out to clear the blockage. The disadvantages are: ① If the suction tube is blocked and not discovered in time during the operation, the bladder fluid can overflow to the periphery of the bladder through the bladder puncture and the suction tube; ② If the transurethral catheter drainage is blocked after the operation, the bladder puncture hole will be flushed open by the high-pressure fluid in the bladder, and the fluid can overflow to the periphery of the bladder. Close observation should be made during and after the operation, and timely treatment should be given.

(2) High-frequency generator: The high-frequency generator generates two different types of currents: ① vacuum tube current, which is used for prostatectomy (wave-like); ② spark gap current, which is used for coagulation and hemostasis (saw-like). The resection current requires high energy and sharp resection without affecting deep tissues, will not cause necrosis, and has no coagulation effect. The coagulation current destroys the tissue until it is charred, which will form necrosis several millimeters deep, so it is not suitable for resection. TURP can also use mixed currents, but most people think it is more appropriate to use the resection and coagulation currents separately. The use of mixed currents increases the risk of damaging the prostate capsule exponentially, makes it easy for tissues to stick to the resection coil, and increases the rate of postoperative bladder neck stenosis. With normal electrosurgical current, slight resistance will be felt during excision, and a smooth surface will be produced after excision. Normal electrocoagulation current can immediately stop arterial bleeding, and only after long-term electrocoagulation will a black eschar be produced, and the coagulated tissue will shrink slightly. Extensive and blind electrocoagulation can cause widespread tissue necrosis, and eschar may fall off 10 to 30 days after the operation, resulting in heavy bleeding. To prevent electric burns, the patient's body should not come into contact with metal objects.

(3) Flushing fluid and syringe: Flushing fluid must be a non-conductive, nearly isotonic, non-hemolytic sterile liquid. Foreign countries use 1.5% glycine solution, which is non-sticky but expensive. my country uses 4% mannitol solution or 5% glucose solution. The former is more expensive than the latter. After using the latter, diabetic patients should be given appropriate amounts of insulin to lower blood sugar. The intraoperative dosage of TURP flushing fluid is usually 15~30L. It is best to use non-toxic plastic bags, 5L per bag, and use them after gamma irradiation disinfection. my country currently uses containers of different capacities according to their respective conditions. In order to maintain low pressure, the container should usually be suspended at a height not exceeding 30cm above the bladder plane. 

How about it? Do you know more about transurethral prostatectomy now? In addition, computers are very advanced nowadays. People often acquire knowledge not only from books, but also from the Internet. However, if you have a real disease, you still have to go to the hospital.