Irrigation free transurethral resection of prostate [TURP]

ABSTRACT

To assess the safety and feasibility of irrigation free TURP in our routine practice. This study was carried out at Department of Urology, Karachi Medical and Dental College and Abbasi Shaheed Hospital, from March 2009 to February 2010. In this interventional study our inclusion criteria was benign disease and prostate weight up to 70 grams. Patients having more than two systemic medical illness like Diabetes, Hypertension [HTN], Ischemic heart disease [IHD], Cerebro-vascular accident [CVA] and Parkinsonism, were excluded from study. Patients remains on anti coagulant medications, patients with present or persistent urinary tract infections were also excluded. Patients who had surgical trauma, incidentally invent urethral stricture and vesical stones were also excluded. All cases were operated by one qualified, experienced surgeon. The decision of irrigation free TURP was taken on the basis of satisfactory hemostasis and good peri operative blood pressure control. Irrigation free TURP was ordered in post operative notes and such cases were closely observed for next 24 hours. After initial advice of irrigation free group if the patient needed irrigation because of haematuria, different patient's and operative variables were reviewed. There were total 50 patients aged 52-84 years with prostate weight ranging from 35 to 70 grams. Mean weight of prostate was 50.12 grams. Our 27% patients were hypertensive, 20% were diabetic and 17% patients had two comorbid conditions. Out of 50 patients 39 that is 78% cases remained irrigation free and followed the routine post operative course and were discharged. Patients who developed haematuria and had irrigation were 22%, seven had about two liters irrigation fluid over 6 hours and 4 patients had larger amount of fluid for 24 hours. In those patients who needed irrigation, seventy six percent were hypertensive, forty two percent were diabetic and twenty percent had two comorbid conditions. History of urinary infection was positive in ninety percent cases. Size of prostate and duration of surgery had no major impact on post operative period in this study. Seventy percent of the patients who needed irrigation had low blood pressure during surgery and became hypertensive in post operative phase. Post TURP Irrigation is an important step that helps in avoiding clot retention in early post operative phase. It increases the work load and treatment cost. In selected patients who have moderate gland, no major co morbidities and no infection, irrigation free TURP can be practised under close observation