Question

Jim is a 56-year-old man who has been experiencing urinary symptoms that include a medical history of chronic urinary tract infections that cause dysuria and hematuria with two or three episodes over the last two years, difficulty starting his urinary stream (hesitancy and straining), diminished stream strength (weak flow), and frequent trips to the restroom. Jim’s symptoms have been getting progressively worse, and his urinalysis is positive for blood and white blood cells in the urine. Upon the digital rectal examination in the office, he is found to have an enlarged prostate. The surgeon explains there are several possible causes, including an enlarged prostate, an infection of the prostate, stones in the prostate, or cancer of the prostate.

1. What diagnostic studies are needed to determine the diagnosis?

2. The biopsy report is negative for cancer, and the physician confirms an enlarged prostate. What is Jim’s diagnosis, and what causes his symptoms?

3. What are the possible treatments for Jim’s condition? What type of procedure will most likely be performed?

4. Due to the severity of his symptoms, Jim selects the removal of his prostate, and his surgery is scheduled. What resectoscopes may be used? How will the resected pieces of the tumor be removed?

5. During the procedure, Jim’s leg suddenly jerks. What does that indicate? What procedure might be done to rule out injury?

6. What is TURP syndrome? If Jim should develop this complication, what symptoms would he exhibit?

7. At the end of the procedure, Jim continues with bright red bleeding. What will be done to control the bleeding?

During the procedure, Jim’s leg suddenly jerks. What does that indicate? What procedure might be done to rule out injury?

Answer 1

1.

• Rectal examination - In this test doctor will gently insert a gloved, lubricated finger into anal opening . This allows them to feel for any abnormalities. For example, an enlarged prostate feels like a bulge behind the rectum wall. Prostate cancer may feel like bumps on the normally smooth surface of the prostrate.
• Cystoscopy is used to diagnose, monitor and treat conditions affecting the bladder and urethra. Cystoscopy can also help determine the cause of frequent urinary tract infections.
• Urodynamic testing or urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine.
• Transrectal ultrasonography is a method of creating an image of organs in the pelvis. Most commonly used to perform an ultrasound-guided needle biopsy evaluation of the prostate gland in men with elevated prostate
• Prostate biopsy is a procedure in which small hollow needle-core samples are removed from a man's prostate gland to be examined for the presence of prostate cancer.

2.

benign prostrate hyperplasia is condition occurs when the cells of the prostate gland begin to multiply. These additional cells cause prostate gland to swell, which squeezes the urethra and limits the flow of urine.

Symptoms are dribbling after urination, excessive urination at night, frequent urination, sense of incomplete bladder emptying, urge to urinate and leaking, or weak urinary stream

3.

Wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on

• The size of your prostate
• Your age
• Your overall health
• The amount of discomfort

Due to severity of symptoms, minimally invasive prostate resection is surgery to remove part of theprostate gland. It is done to treat an enlarged prostate. The surgery will improve the flow of urine through the urethra, the tube that carries urine from the bladder outside of body.

4.

Transurethral resection of the prostate is a surgery used to treat urinary problems that are caused by an enlarged prostate.

An instrument called a resectoscope is inserted through the tip of male genetalia and into the tube that carries urine from bladder (urethra). The resectoscope helps your doctor see and trim away excess prostate tissue that's blocking urine flow.

It is generally considered an option for men who have moderate to severe urinary problems that haven't responded to medication.

5.

blood vessel could be accidentally damaged, leading to bleeding that requires a blood transfusion to correct.

6.  

Transurethral Resection of the Prostate (TURP) Syndrome is a rare, potentially life-threatening complication of a transurethral resection of the prostate procedure.

It occurs as a consequence of the absorption of the fluids used to irrigate the bladder during the operation into the prostatic venous sinuses.Symptoms and signs are varied and unpredictable, and result from fluid overload and disturbed electrolyte balance and hyponatraemia.

Central nervous system

• Restlessness
• Headache
• Nausea and vomiting
• Confusion
• Visual disturbances
• Cerebral edema
• Convulsions
• Coma

Cardio-respiratory symptoms

• Bradycardia
• Hypotension or hypertension
• Tachypnoea
• Hypoxia
• Cyanosis
• Pulmonary edema

7.

After having a TURP, it's normal to occasionally notice some blood in urine. Around a week or two after the operation, the amount of blood may increase as the scab on your prostate falls off.

Drinking plenty of fluids will help flush any blood or small blood clots out of your bladder.

If the increased blood in your urine continues for longer than 48 hours, should contact the hospital.