[Prostate resectoscopy] Transurethral plasma resection of the prostate

Transurethral resection of the prostate is a surgical method that requires the removal of prostate tumors or stones. The indications include prostate stones, benign prostatic hyperplasia, prostate stones, bladder neck obstruction, prostatitis and prostate cancer. The surgical steps include body position, inspection instruments, urethrocystoscopy, insertion of resectoscope to find important landmarks, cutting out the anterior groove, cutting lateral grooves, resection of the lateral lobe entity, resection of the middle lobe, end of resection, and emptying the gland Tissue strips, test urine flow, stop bleeding, and insert balloon catheters.

1. Anatomical parts of the prostate

Prostatic hyperplasia, also known as benign prostatic hypertrophy, is one of the common diseases in elderly men. Men over the age of 35 may experience varying degrees of prostate hyperplasia, with clinical symptoms appearing after the age of 50. As age increases, the incidence rate gradually increases, according to reports The incidence rate among elderly people over 80 years old is as high as 95%.

2. Treatment of Prostatic Hyperplasia

The treatments for prostatic hyperplasia mainly include drug treatment, surgical treatment, cryotherapy, microwave therapy, intraprostatic injection therapy, etc. When medical treatment fails to produce satisfactory results, surgical treatment is the best choice for benign prostatic hyperplasia.

Transurethral plasma resection of the prostate (TURP) has the advantages of non-invasive, less bleeding, less pain, and quick recovery.

Prostatic resection generates a type of radiofrequency energy through a two-stage circuit, converting the conductive medium around the resected tissue into plasma, breaking the organic molecular bonds in the tissue to be removed, destroying and vaporizing the tissue to achieve therapeutic effects.

Plasma electrocution：

Bipolar mode, no negative plate required

Temperature is 40-70℃, heat damage is light

Significant reduction in damage to surrounding tissue

0.9% normal saline (isotonic)

Less prone to electroresection syndrome

The operation time can be extended and the operation is thorough

Few complications

Quick recovery and short hospital stay

Traditional electrocution：

Unipolar mode, requires negative plate

Temperature can reach 400℃, causing severe thermal damage

The surrounding tissue is severely damaged and the amount of bleeding is significantly increased.

5% mannitol (hypertonic)

prone to electroresection syndrome

Time control: 1 hour, there is a possibility of another operation

Many complications

Slow recovery and long hospital stay

3. Transurethral resection of the prostate syndrome (TURS)

TURS is caused by a large amount and rapid absorption of the flushing solution (usually 5% mannitol electrosurgical solution) through the surgical wound during electroresection, and is characterized by dilutional hyponatremia and hypervolemia. clinical syndrome. Commonly known as "water intoxication". The main clinical manifestations are functional abnormalities of the circulatory system and nervous system, such as irritability, apathy, yawning, nausea, vomiting, dyspnea, hypotension, oliguria, convulsions and coma, and severe cases can cause death.

4. Basic supplies: vaporization bag, dressing bag, large bowl, gloves, arthroscopy cover, c-p patch, gastroscopy glue, 20# three-chamber balloon catheter 1, drainage bag, Y-shaped flushing strip, 50ml syringe, alcohol, 3000ml isotonic solution, 6 rubber bands, urine catheter label, water bucket.

Special supplies: endoscopic camera system, cold light source, transurethral bipolar plasma, resectoscope and supporting equipment.

5. Cooperation with surgery

(1) Anesthesia cooperation: Surgery generally uses combined epistaxis and spinal anesthesia. The circulating nurse and the anesthetist will coordinate the posture and establish a venous channel with an indwelling needle in the patient's left upper limb to ensure smooth intraoperative infusion.

(2) Reasonable positioning: After the anesthesia plane is generated, take the bladder lithotomy position, raise the buttocks by 15-30°, bend the knees at 90-100°, abduct the legs at 80-90°, and put soft pads on the popliteal fossa. , to prevent compression of the common peroneal nerve and popliteal artery, and abduct the bilateral upper limbs less than 90°.

(3)Intraoperative operation cooperation: The perineum is routinely disinfected and draped, connected to the imaging system, and the light guide beam and camera are isolated with sterile protective sleeves. Use the "Y" type tube to connect the perfusion fluid, turn on the power of the cold light source, adjust the brightness, and turn on the switch next to the power supply behind the plasma generator. The generator will perform self-test and connect the PK cable. When the PK cable is connected to the plasma generator The default values are displayed (prostate 200 100, bladder tumor 160 80). Finally, connect the resection ring and the doctor steps on the foot switch to operate.

(4)After the operation, insert 30ml of normal saline into the balloon of the three-lumen catheter, perform antitension traction, and use a rubber band to pull the catheter on the foot so that the water bladder of the catheter compresses the prostate fossa to achieve compression and bleeding and isotonicity. Fluid continues to flush.

Intraoperative care

1. Closely monitor vital signs. Because most of these patients are elderly and are accompanied by a variety of senile diseases, such as hypertension, diabetes, etc., electrocardiogram, blood pressure, respiration, heart rate, and oxygen saturation should be closely monitored during the operation to detect in time. Deal with it early.

2. Pay attention to keeping the patient warm. Due to the exposure of the surgical field and the large amount of irrigation fluid entering the body, the patient may easily catch a cold. Therefore, the temperature of the operating room must be adjusted before surgery, generally at 22-25°C, the humidity at 50-60%, and the bladder irrigation fluid It can be heated to 20-30℃, and a small cotton quilt covers the patient's upper body.

3. Master the infusion pressure and infusion speed. Generally, the distance between the irrigation fluid and the bladder is about 60cm, so that the field of vision can be clear. The irrigation fluid should be replaced in time during the operation to prevent air bubbles from entering the bladder and affecting the field of vision. Most of the patients are elderly and have poor compensatory adjustment ability of the body. The infusion should not be too fast during the operation. Changes in the patient's lips, conjunctiva, respiratory consciousness and other changes should be closely observed.

Postoperative care

Prevent the occurrence of orthostatic hypotension. Changes in the patient's body position after surgery can lead to redistribution of blood throughout the body and fluctuations in blood pressure. Therefore, when returning to the supine position, the flattening of the limbs should be done gently. You can first put down one lower limb and give it a massage. , wait for 3 minutes, then put down the other limb, massage it and lay it flat, so that the blood volume can have a compensatory process and avoid the occurrence of orthostatic hypotension.

Transurethral resection of the prostate is a surgical method with high safety, few complications, and accurate efficacy. It is recognized as the "gold" standard for the treatment of prostatic hyperplasia. Transurethral bipolar plasma resection of the prostate has the characteristics of "cold cutting", thermal penetration, low thermal damage effect, rapid coagulation, and intraoperative flushing with normal saline. It is safer and more effective than conventional resection of the prostate in the treatment of benign prostatic hyperplasia, with shorter hospital stays and lower costs for patients.