PREOPERATIVE DIAGNOSIS: Benign prostatic hypertrophy with obstruction and urinary retention.
POSTOPERATIVE DIAGNOSIS: Benign prostatic hypertrophy with obstruction and urinary retention.
PROCEDURES PERFORMED:
1. Cystoscopy.
2. Transurethral resection of prostate.
SURGEON: John Doe, MD
ANESTHESIA: General inhalational.
FINDINGS: Obstructing trilobar prostatic hypertrophy.
SPECIMENS: Prostate.
DRAINS: A 24-French 3-way Foley.
COMPLICATIONS: None.
DISPOSITION: Stable.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old Hispanic male with BPH with obstruction and urinary retention. He has failed previous voiding attempts despite maximum medical therapy. His preoperative urodynamics showed evidence of obstruction and also detrusor dysfunction. He presents for cystoscopy and transurethral resection of prostate. Risks and benefits of the procedure were explained in detail to the patient, including bleeding, infection, damage to the urethra, bladder, prostate, and rectum, failure to diagnose and treat all disease, recurrence of disease, need for further procedures, urinary incontinence, persistent or recurrent urinary retention, impotence, and medical complications including but not limited to heart attack, stroke, and death. The patient expressed understanding and wished to proceed.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and after adequate anesthesia was placed in the dorsal lithotomy position on the OR table. His genital and perineal regions were prepped and draped in a sterile fashion. The 24-French resectoscope was manipulated easily through the patient’s urethra, which appeared normal, into the bladder. There was trilobar obstructing prostatic hypertrophy. The 24-French cutting loop was then placed on the resectoscope. The landmarks were identified, including the bladder neck, the ureteral orifices, the verumontanum, and the external sphincter.
We began the resection at the bladder neck at 6 o’clock and resected back to the verumontanum and proceeded counterclockwise from 6 o’clock to 3 o’clock and then from 3 o’clock to 12 o’clock resecting the left lobe of the prostate. All chips were evacuated from the bladder, and excellent hemostasis was achieved using the loop and rollerball electrode. We then resected the right lobe of the prostate in identical fashion. Again, all chips were evacuated, and excellent hemostasis was achieved. The bladder was not perforated. The ureteral orifices continued to efflux clear urine throughout the case. The sphincter was not injured.
The scope was removed after ensuring excellent hemostasis, and a 24-French 3-way Foley catheter was inserted and balloon inflated to 40 mL. The urine was clear. Continuous bladder irrigation with normal saline was begun. The patient tolerated the procedure well. There were no complications. He was awakened and transported to the postanesthesia care unit in stable condition.
