What is the standard preoperative and postoperative care for patients undergoing Transurethral Resection of the Prostate (TURP)?

Standard Preoperative and Postoperative Care for TURP

Transurethral Resection of the Prostate (TURP) requires specific preoperative evaluation and postoperative management to minimize complications and optimize outcomes for patients with benign prostatic hyperplasia. 1

Preoperative Care

Patient Evaluation

• Complete medical history, AUA Symptom Index (AUA-SI) score, urinalysis, and post-void residual (PVR) measurement should be performed before considering TURP 1
• Prostate imaging (transrectal or transabdominal ultrasound) is recommended when surgical intervention is planned to determine prostate size and shape 1
• Urine culture should be obtained prior to the procedure to identify and treat any existing bacteriuria 2

Risk Assessment

• Assess for risk factors that may affect surgical outcomes, including advanced age, larger prostate size, and shorter membranous urethral length 2
• Evaluate for comorbidities that may increase risk of DVT, including age >60 years, cancer, prior venous thromboembolism, and prolonged immobility 2

Antibiotic Prophylaxis

• For patients with asymptomatic bacteriuria, targeted antimicrobial therapy should be prescribed rather than empiric therapy 2
• Short-course antibiotic prophylaxis (1-2 doses) should be initiated 30-60 minutes before the procedure 2
• Preoperative antibiotic treatment may have a protective effect against bladder neck contracture formation 3

DVT Prophylaxis

• For low-risk patients, early ambulation is recommended for DVT prophylaxis 2
• For patients at increased risk of DVT, consider graduated compression stockings (GCS), intermittent pneumatic compression (IPC), or pharmacological prophylaxis with low-dose unfractionated heparin (LDUH) or low molecular weight heparin (LMWH) 2

Postoperative Care

Immediate Postoperative Management

• Monitor for signs of transurethral resection (TUR) syndrome, particularly in patients undergoing monopolar TURP 1
• Bipolar TURP has reduced risk of hyponatremia and TUR syndrome compared to monopolar TURP 1
• Observe for hematuria and manage with adequate hydration and bladder irrigation as needed 1

Catheter Management

• Patients should be informed that a urinary catheter will be in place for a short period after surgery 2
• Patients with prior radiation therapy or complex cases may have higher rates of failure of initial voiding trial after catheter removal 4

Pelvic Floor Exercises

• Pelvic floor muscle exercises (PFME) or pelvic floor muscle training (PFMT) should be offered in the immediate post-operative period 2
• PFME/PFMT after catheter removal has been shown to improve time-to-achieving continence 2

Monitoring for Complications

• Common complications (>5% of patients) include sexual dysfunction, irritative voiding symptoms, bladder neck contracture, urinary tract infection, and hematuria 1
• Risk of urinary incontinence is approximately 1% 1
• Smaller prostate volume, positive preoperative urine culture, and urethral stricture are independent predictors for bladder neck contracture development 3

Follow-up Assessment

• PSA levels should be expected to decrease by approximately 70% after TURP, with 90% of patients having a postoperative PSA value of less than 4 ng/mL at 3 months 5
• Evaluate for persistent lower urinary tract symptoms (LUTS), which may occur in some patients following TURP 6
• If LUTS persist beyond 6 months despite conservative therapy, further evaluation and potential surgical intervention may be considered 2

Patient Counseling

• Patients should be informed that incontinence is expected in the short-term but generally improves within 12 months 2
• Counsel patients about potential sexual side effects, including ejaculatory dysfunction and possible worsening of erectile dysfunction 1
• Inform patients about the risk of sexual arousal incontinence and climacturia following the procedure 2

By following these standardized preoperative and postoperative care protocols, clinicians can optimize outcomes and minimize complications for patients undergoing TURP.