How to Prevent Extravasation During TURP

The risk of extravasation during TURP isn't as great as it was in the past.

Benign prostatic hyperplasia, or BPH, is a condition in which the prostate gland is moderately to severely enlarged. Its symptoms include increased urination at night, heightened frequency of and urgency for urination and difficulty urinating. MayoClinic.com explains that some 90 percent of cases of BPH are treated with transurethral resection of the prostate, or TURP. In this procedure, the surgeon trims away excess prostate tissue, thus alleviating the pressure the tissue caused on the urethra. One of the risks of TURP is extravasation, or the leakage of fluid into surrounding tissues.

Instructions

1. Irrigate the area being resected with 1.5 percent glycine. Use glycine rather than sterile saline, which is the irrigant most commonly used. For TURP, saline is undesirable because it can prevent coagulation as well as effective cutting.

2. Administer intravenous diuretics along with saline -- normal or hypertonic -- if the patient develops hypernatremia during the procedure.

3. Repair the leakage operatively, with either open surgery or laparoscopy, if the extravasation persists.

Tips & Warnings

• In the event of bladder perforation, it is possible to repair the leakage with catheter drainage. If the leakage is significant, however, the patient may require placement of a drain in the retropubic area.

References

• Mayo Clinic
• The Free Dictionary
• Google Books; "Civetta, Taylor and Kirby's Critical Care"; Andrea Gabrielli, A. Joseph Layon, Mihae Yu; 2008