Perioperative Complications

Perioperative complications primarily include bleeding, urinary tract infection, and urinary retention. These occur in approx 7% of patients, sometimes extending the hospital stay by a few days or requiring discharge with an indwelling catheter (3,21).

Bleeding

It is imperative that optimal hemostasis be achieved before TURP is concluded and the patient is transported from the operating room. Methods to manage mild-to-moderate persistent bleeding, such as catheter traction and continuous bladder irrigation, have been described earlier. Despite these maneuvers, persistent or recurrent bleeding can complicate postoperative management, potentially causing obstruction of the urethral catheter and clot retention. Initial management should include aggressive hand irrigation of the bladder to remove clots and changing the catheter to a larger caliber with more eyes, as necessary. If the clots can be completely evacuated, another attempt at traction and continuous bladder irrigation is not unreasonable. Patients with continuous bleeding after TURP that cannot be abated by these techniques should be returned to the operating room for clot evacuation and fulguration of bleeding vessels. Recurrent bleeding can also occur after discharge from the hospital. Often it is transient, obviating the need for medical intervention. On occasion, however, catheterization, irrigation, and cystoscopy with fulguration may be necessary.

Urinary Tract Infection and Urinary Retention

Recently studies have shown that urinary tract infections occur in approx 2% of patients during the postoperative period, although it had been reported to occur in as many as 60% of patients (11,21). As stated above, the use of prophylactic antibiotics during TURP is unquestioned when the patient is managed with continuous or intermittent catheter-ization because bacteriuria can be expected to occur in these situations. Recently, it has been established that all patients undergoing TURP will likely benefit from the use of prophylactic antibiotics administered preoperatively and perioperatively (14). Urinary retention has been reported to occur in approx 7% of patients after TURP (21). This can usually be managed with continuous or intermittent catheterization. The latter is generally preferable because it allows the patient an opportunity to spontaneously void. Nevertheless, most patients eventually regain the ability to void unless there is underlying detrusor dysfunction.

Mortality

Mortality associated with TURP is generally low according to most studies. Over the last several decades, the mortality rates have dropped significantly from over 2% in the 1960s to well below 1% more recently (3,20). Roos et al. compared the mortality rate between open prostatectomy and TURP, finding that it was higher in the TURP group, approx 3% (22). A potential explanation for this difference may be that patients undergoing TURP in this study were more likely to have significant comorbidities. Other studies have found that mortality rates following TURP are no different from those of age-matched controls (23,24). These data suggest that TURP is a safe treatment for the treatment of BPH.

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  • Stefan
    How does clot retention occur after turp?
    8 years ago

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