Post-Operative Management of TURP Patients
The most effective post-operative TURP appointment should include a comprehensive evaluation of urinary continence, assessment for complications, and monitoring for recurrence of symptoms, with particular attention to catheter removal timing and management of potential TURP syndrome.
Key Components of Post-TURP Follow-up
Timing of Follow-up
- Initial post-operative visit: 2-4 weeks after surgery
- Secondary follow-up: 3 months post-procedure
- Long-term follow-up: 6-12 months after surgery
Clinical Assessment
1. Urinary Function Evaluation
Assess continence status:
- Document any stress urinary incontinence (SUI), urgency incontinence, or mixed symptoms
- Evaluate pad usage (number per day)
- Determine if incontinence is improving or worsening since catheter removal 1
- Ask specifically about sexual arousal incontinence and climacturia, which can occur in up to 30% of patients 1
Voiding parameters:
- Urinary flow rate (Qmax)
- Post-void residual volume measurement
- Frequency of urination (day and night)
- Presence of hesitancy, straining, or incomplete emptying
2. Complication Screening
Immediate complications:
Delayed complications:
- Urethral stricture (poor stream, straining) 4
- Bladder neck contracture
- Retrograde ejaculation (inform patient this is expected)
- Erectile dysfunction
3. Laboratory Testing
- Urinalysis and urine culture if symptomatic
- Serum electrolytes if TURP syndrome is suspected (sodium < 130 mmol/L) 2
- PSA measurement (optional, typically at 3-6 months post-procedure)
Management Decisions
1. Catheter Management
- If catheter is still in place:
- Assess for appropriate removal timing
- Evaluate urine clarity and volume
- Consider trial without catheter if urine is clear and patient is stable
2. Incontinence Management
For mild incontinence:
- Initiate pelvic floor muscle exercises 1
- Consider scheduled voiding
- Reassure about expected improvement over 3-6 months
For persistent/severe incontinence:
- Consider urodynamic evaluation
- Evaluate for surgical options if no improvement after 6 months 1
3. Infection Management
- Evaluate need for antibiotics based on symptoms and urinalysis
- Consider antibiotic stewardship principles - avoid prophylactic antibiotics unless indicated by pre-operative catheter or pyuria 5
Special Considerations
Anticoagulation Management
- If patient was on anticoagulation:
- Confirm appropriate resumption of therapy
- Monitor for delayed bleeding
- Be alert for secondary hemorrhage which may occur up to 28 days post-procedure 6
Elderly Patients
- Higher risk of catheter dependency post-TURP if:
- Age ≥90 years
- Pre-operative PVR >1500 mL
- Poor performance status (WHO ≥3) 3
TURP Syndrome Monitoring
- Be vigilant for delayed presentation of TURP syndrome (can occur up to 24 hours post-procedure)
- Key symptoms: confusion, bradycardia, hypertension, hypoxemia 7
- Management includes hypertonic saline (3% NaCl) for severe hyponatremia 2
Documentation Requirements
- Current urinary symptoms and their severity
- Physical examination findings
- Management plan with clear follow-up instructions
- Patient education provided regarding expected recovery timeline
- Recommendations for when to seek urgent care
Patient Education
- Normal post-TURP recovery expectations
- Potential for temporary worsening of symptoms before improvement
- Activity restrictions (avoid heavy lifting for 2-4 weeks)
- Sexual function expectations (including retrograde ejaculation)
- When to seek emergency care (severe bleeding, inability to void, fever)
By following this structured approach to post-TURP follow-up, you can effectively monitor recovery, identify complications early, and optimize patient outcomes while reducing the risk of long-term sequelae.