TURP

Please note these are examples, read through the entire op report to ensure your Op report is accurate according to what you actually did

SURGEON: Dr. _

ASSISTANT: _

PREOPERATIVE DIAGNOSIS: Benign prostatic hyperplasia with lower urinary tract symptoms

POSTOPERATIVE DIAGNOSIS: Benign prostatic hyperplasia with lower urinary tract symptoms

PROCEDURE: Cystourethroscopy, transurethral resection of prostate

FINDINGS: Unremarkable bladder, urethra, prostate

ANESTHESIA: General with LMA

INTRAVENOUS FLUIDS: IV crystalloid

ESTIMATED BLOOD LOSS: None

TUBES AND DRAINS: 22 french 3 way foley catheter

SPECIMENS: Prostate chips for pathology

COMPLICATIONS: None

INDICATIONS FOR PROCEDURE:  The patient is a _ yr old who has a history of benign prostatic hyperplasia with lower urinary tract symptoms . I discussed the treatment options with patient who has agreed to have a cystourethroscopy and transurethral resection of the prostate. Prior to the procedure today, the patient's history and physical was obtained and reviewed.  Informed consent was obtained and all questions were satisfactorily answered. The risks and benefits of the procedure including pain, damage to organs including the ureter/kidney/bladder/prostate/urethra, ureter and bladder perforation, bleeding, retrograde ejaculation, infection and complications from anesthesia and other complications were discussed, patient acknowledged and communicated understanding of these risks and wished to proceed with the procedure.

 

OPERATIVE DETAIL:  The patient was transferred to the cystoscopy suite and placed on continuous pulse oximetry and cardiac monitoring by anesthesia.  IV antibiotics including 240mg gentamycin , 2g cefazolin were administered.  IV sedation and general anesthetic were administered.  The patient was placed in the dorsal lithotomy position and prepped and draped in sterile fashion.  Time out was performed confirming patient, procedure, side, all in the room agreed.  SCDs were on and functioning.  A well lubricated 26 french resectoscope sheath with a visual obturator with 30 degree lens was inserted into the urethral meatus and advance and advanced into the bladder. Care was taken to keep the urethra lumen in center of view to minimize trauma to the urethra. In the urethra there were no urethral strictures, no mucosal lesions, no tumors, no polyps. The verumontanum was identified easily and the prostate was observed to be severely enlarged and showed trilobar obstruction. Upon entering the bladder, the bladder was drained. Urine appeared clear and was not sent for culture. The bladder was then partially filled and evaluated in a panendoscopic fashion. Both ureteral orifices were able to be identified and were far from the bladder neck and median lobe. In the bladder there were nomucosal lesions, no trabeculations, no diverticulum, no stones and no tumors. Once the primary survey was complete, the visual obturator was replaced with resectoscope sheath with a working element using a bipolar loop . The verumontanum was identified and marked with the bipolar loop to ensure we did not work distal to the verumontanum, ensuring external sphincter remains damage free. The external sphincter was protected throughout the whole procedure. The bipolar resectoscope was held proximal to the external sphincter and the verumontanum at all times. Attention was first directed at the median lobe, which was resected at the 5 and 7 o'clock position until adequate visualization was achieved. Then, attention went to the right lateral lobe, which was resected in a counterclockwise fashion from the 12 o'clock position to the 7 o'clock position, and then attention went to the left lateral lobe, which was resected in a clockwise fashion from the 12 o'clock position to the 5 o'clock position. Once an adequate channel was resected, the verumontanum was again identified and held proximal to the verumontanum at all times, confirming repeatedly no resection distal to the verumontanum. The bladder was then drained. The bladder was re-distended and a large working channel was identified. The anterior lobe was then resected adequately to maintain a large open channel. The bladder was then drained and re-distended and using the Elik evacuator all prostate chips were removed and sent for pathology and all bleeders were hemostatically identified and coagulated using the bipolar loop . Once hemostasis was achieved with the bladder undistended, the bladder was then distended. The cystoscope was removed. The external sphincter was protected throughout the whole procedure. Once the resectoscope was removed, the patient was able to Crede without any difficulty. Then, a 22 -French 3-way Foley catheter was placed into the urethral meatus and advanced to the bladder without any complication with 30 mL of sterile water placed in the balloon port after confirming no blood was present that could potentially clog the balloon port. Light pink urine was expressed and CBI was connected at a slow drip . The bladder was drained, all parts of the cystoscopic sheath, cystoscope and instruments were intact and removed from the patient. The amount of fluid drained from the bladder was the expected amount given the amount of fluid irrigated into the bladder. The patient's abdomen was palpated and there was no change in physical exam from before the procedure and patient was awakened by anesthesia and transferred to PACU in stable condition. The Foley catheter was set to dependent drainage. The patient tolerated the procedure well. I was present throughout the whole procedure.

 

PLAN:  The patient will be discharged after meeting anesthesia criteria.  Patient was given given prescriptions for norco and miralax . The patient understands if there is any nausea, vomiting, fever, chills, persistent or new pain or symptoms to come back to the Emergency Room for evaluation. The patient knows to expect some gross hematuria over the coming days. Patient will follow up in 1-2 weeks.