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Published by 12jerob

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Published by: 12jerob on Apr 24, 2010
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A.Describestructures andfunction of themale reproductivesystem.
Identify theindications andcontraindicationsof TURP.
II. TURP (Transurethral Resection of Prostate)A.Anatomic and Physiologic Overview
In the male, several organs serve as parts of both the urinary tract and thereproductive system. Disorders in the male reproductive organs may interfere withthe functions of one or both of these systems. As a result, diseases of the malereproductive system are usually treated by a urologist. The structures in the malereproductive system include the testes, the vas deferens (ductus deferens) andseminal vesicles, the penis, and certain accessory glands, such as the prostateglands and Cowper’s gland (bulbourethral gland). 
TURP is a surgical procedure involving the removal of prostate tissue using aresectoscope inserted through the urethra.
C.Purpose/Indication of TURP
TURP has been long considered the “gold standard” surgical treatment for obstructing BPH specifically when the major glandular enlargement exists in themedial lobe that directly surrounds the urethra. A relatively small amount of tissuemust require resection so that excess bleeding will not occur and the time required tocomplete the surgery will not be prolonged. TURP may be performed with the patientunder general or spinal anesthesia.A resectoscope is passed through the urethra. Tiny pieces of tissue are cutaway, and the bleeding points are sealed by cauterization. The bladder and urethraare continuously irrigated during the procedure, allowing visualization of theresection. Repeated irrigation and drainage of these fluids ensure that resectedtissue and debris are removed from the bladder. Sterile, isotonic solution is selectedhowever, normal saline is avoided because of its suboptimal conductivity properties.Also, hypotonic solution such as water must never be used.
Some relative contraindications include unstable cardiopulmonary status and5 min5 min10 min-Visual Aide-PowerpointPresentation-PowerpointPresentation-Video-LectureDiscussion“Q-A” activity
In thisactivity, thereporters shall askthe studentlearners randomlywith questionsrelevant to their discussed topics.
Discuss thedifferentcomplicationsaffecting TURPa history of uncorrectable bleeding disorders. Patients with a recent myocardialinfarction or coronary artery stent placement should not have elective TURP surgeryfor a least 1 month because of the increased risk of cardiovascular events and other complications. A reasonable minimum delay of 3 months is suggested, but waiting atleast 6 months after any significant myocardial event is optimal before performing anelective TURP.Patients who cannot be safely taken off blood thinners such as Plavix wouldalso not be candidates for elective TURP surgery. If surgery is needed, they may betreated with a Greenlight or vaporization laser surgery instead.Patients with myasthenia gravis, multiple sclerosis, or Parkinson disease inwhom the external sphincter is dysfunctional and/or the bladder is severelyhypertonic should not have a TURP because intractable incontinence invariablywould result. Patients who have had major pelvic fractures that involved damage tothe external urinary sphincter also should not undergo a TURP for similar reasons.Patients who have recently completed definitive radiation therapy for prostatecancer are not candidates for TURP because of the unacceptably high rate of urinaryincontinence reported. If a TURP is absolutely necessary, it should be delayed atleast 6 months after definitive radiation therapy. Alternatives to TURP in such asituation include drainage with a Foley or suprapubic catheter, intermittent self-catheterization, and various other less-invasive prostatic surgical procedures.Patients with prostate cancer who are considering brachytherapy (radioactiveseed implantation) or cryotherapy as part of their definitive treatment should notundergo a TURP because the resected tissue would be necessary for optimalneedle, probe, and seed placement. The patient would also have an increased riskfor incontinence.An active urinary tract infection is another contraindication for TURP surgery.Usually, the surgery can be rescheduled following a course of appropriate antibiotics.
TURP Syndrome
Patient can develop water intoxication, known astransurethral resection (TUR) syndrome, as a result of excessive irrigatingsolution being absorbed during surgery. It is characterized byhyponatremia, hypervolemia, hemolysis and acute renal failure. Cerebraledema may result, which creates a medical emergency. Clinicalmanifestations include agitation, acute delirium, bradycardia, tachypnea,and vomiting.
 – Persistent incontinence after TURP affects 1% to 2%.15 min-SocializedDiscussion-Visual Aide-Powerpoint
postoperativepatients.Clients with overactive detrusor contractions (overactive bladder), voidingfrequency, and sensory urgency initially may note an increase in thefrequency of urinary leakage or de novo incontinence. Pharmacotherapycombined with pelvic muscle rehabilitation and fluid and dietary controlmay be required to control overactive bladder that has been “unmasked”by removal of obstructive prostatic tissue.
Retrograde ejaculation
– Because the verumontanum is destroyed duringmost prostate surgery, antegrade (forward) ejaculation cannot occur.Instead, semen goes into the bladder during ejaculation and is voided withthe next urination, creating cloudy urine. This effect is harmless, but sexualfunction may be impaired unless the client is advised of this anticipatedeffect and reassured that it is expected to alter fertility potential but notlibido or erectile function.
- Because patients undergoing prostatectomy have ahigh incidence of deep vein thrombosis (DVT) and pulmonary embolism,the physician may prescribe prophylactic (preventive) low-dose heparintherapy. The nurse assesses the patient frequently after surgery for manifestations of DVT and applies elastic compression stockings to reducethe risk for DVT and pulmonary embolism.
Excessive bleeding 
- The immediate dangers after a prostatectomy arebleeding and hemorrhagic shock. This risk is increased with BPH becausea hyperplastic prostate gland is very vascular. Bleeding may occur fromthe prostatic bed. Bleeding may also result in the formation of clots, whichthen obstruct urine flow. The drainage normally begins as reddish-pink andthen clears to a light pink within 24 hours after surgery. Bright-red bleedingwith increased viscosity and numerous clots usually indicates arterialbleeding. Venous blood appears darker and less viscous. Arterialhemorrhage usually requires surgical intervention (e.g., suturing of bleeders or transurethral coagulation of bleeding vessels), whereasvenous bleeding may be controlled by applying prescribed traction to thecatheter so that the balloon holding the catheter in place applies pressureto the prostatic fossa. The surgeon applies traction by securely taping thecatheter to the patient’s thigh.
Urinary tract infections and epididymis are possiblecomplications after prostatectomy. It is mostly due to poor irrigation or Presentation

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