Successful TURP Surgery for Benign Prostatic Hyperplasia in a 61 Y.O. Male with Multiple Comorbidities

After a detailed consultation with Dr. Abhik Debnath (Consultant Laparoscopic Urologist), a comprehensive evaluation was performed to determine the most appropriate treatment approach for the patient presenting with poor urine flow and acute urinary retention requiring catheterisation.

Considering the patient's benign prostatic enlargement, urinary obstruction, acute urinary retention, and associated medical conditions including coronary artery disease, diabetes mellitus, hypertension, dyslipidemia, and hypothyroidism, a thorough preoperative assessment was undertaken. His blood sugar was poorly controlled, with an HbA1c of 9.6% and random blood glucose levels ranging from 300–500 mg/dL, and was therefore optimised with insulin therapy before surgery.

The patient also had a multidrug-resistant organism (MDRO) infection. Antibiotic treatment was administered based on the susceptibility results. His regular antiplatelet therapy was stopped 5 days before surgery to reduce the risk of bleeding, as clinically appropriate.

Following the necessary investigations, medical optimisation, and pre-anaesthetic assessment, it was determined that Transurethral Resection of the Prostate (TURP) under spinal anaesthesia was the appropriate treatment strategy. The procedure was planned to remove the obstructing prostate tissue, improve urinary flow, relieve bladder outlet obstruction, and reduce dependence on urinary catheterisation.

The patient and his family members were counselled regarding the diagnosis, planned procedure, anaesthesia, potential risks and benefits, expected postoperative recovery, catheter care, medication management, and the importance of follow-up.

Following the decision, the patient was scheduled for Transurethral Resection of the Prostate (TURP) in Hyderabad at PACE Hospitals, under the supervision of the Urology Department.

The following steps were carried out during the procedure:

• Patient Preparation and Anaesthesia: After obtaining informed consent and completing the pre-anaesthetic evaluation, the patient was taken to the operating room. Standard aseptic precautions were maintained, and spinal anaesthesia was administered. The patient was positioned appropriately for the procedure.

• Insertion of the Resectoscope: A specialised endoscopic instrument called a resectoscope was introduced through the urinary opening and advanced through the urethra to reach the prostate. The procedure was performed without any external surgical incision.

• Identification of the Obstructing Prostate Tissue: The enlarged prostate tissue responsible for the bladder outlet obstruction was identified. The obstructing tissue was assessed carefully before resection.

• Resection of Prostate Tissue: The obstructing prostate tissue was gradually removed using an electrical cutting loop. The resected tissue was collected and sent for histopathological examination as appropriate.

• Control of Bleeding: Bleeding points within the resected area were carefully controlled to achieve adequate haemostasis and reduce the risk of postoperative bleeding.

• Catheter Placement and Completion: A Foley urinary catheter was placed to facilitate urine drainage following the procedure. The procedure was completed successfully without intraoperative complications, and the patient was shifted to the postoperative recovery area in a stable condition.

The patient had an uneventful postoperative recovery and remained hemodynamically stable throughout the hospital stay. He was closely monitored for urine output, urinary bleeding, pain, hydration status, blood sugar levels, and overall recovery, considering his underlying medical conditions. Appropriate treatment was provided to prevent infection, relieve pain and discomfort, protect the stomach, prevent constipation, and support recovery. The Foley catheter remained in place at the time of discharge, and the patient was advised to return for follow-up and catheter removal after 5 days.

Upon discharge, the patient was prescribed medicines to prevent postoperative infection, relieve pain, control fever when required, protect the stomach from medication-related irritation, facilitate urinary symptoms, and prevent constipation. His regular medicines for diabetes, blood pressure, cholesterol, and thyroid disease were continued as advised. He was also instructed to resume antiplatelet therapy after 3 weeks, as recommended by the treating team.

The patient was advised to maintain adequate hydration, with approximately 2 litres of fluid per day, and follow a diabetic-friendly, balanced diet. 

Catheter-care instructions were provided while the Foley catheter remained in place. After catheter removal, scheduled voiding, double voiding, and pelvic floor exercises were to be introduced as advised by the treating team.

He was instructed to avoid tea, coffee, spicy foods, weightlifting, forward bending, straining during bowel movements, and prolonged travel by bus, auto, or two-wheeler during the initial recovery period. Mild suprapubic discomfort, occasional blood or cloudy urine, or mild burning during urination may occur temporarily and generally improve within 7–10 days.

The patient was advised to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, severe pain, vomiting, difficulty passing urine, reduced urine output, heavy bleeding, blood clots in the urine, dizziness, or worsening urinary symptoms.

The patient was advised to return for a follow-up visit with the Urologist after 5 days.

This case highlights the successful management of benign prostatic enlargement with acute urinary retention using Transurethral Resection of the Prostate (TURP). The procedure was completed without complications, and the patient was discharged in a stable condition with the Foley catheter in situ. Appropriate postoperative care, adequate hydration, Kegel exercises, scheduled voiding, double voiding, and regular follow-up were advised to support recovery and improve bladder control.

Yes. Some patients may temporarily experience urinary frequency, urgency, a mild burning sensation, or changes in urinary control after TURP. These symptoms usually improve as the urinary passage and bladder recover. Persistent or worsening symptoms should be evaluated by the urologist.

Double voiding means urinating normally, waiting for a short time, and then trying to urinate again. This can help empty any urine that remains in the bladder after the first attempt. It may be useful during recovery in patients who have difficulty completely emptying their bladder.

Kegel exercises strengthen the pelvic floor muscles that help control urine. They may help improve bladder control and reduce temporary urine leakage or dribbling after prostate surgery. Patients should perform them using the technique and schedule recommended by their urologist.

Yes, an enlarged prostate can cause kidney problems. When the prostate grows, it blocks the flow of urine. This blockage traps urine in the bladder, creating back pressure that can damage or fail the kidneys over time if left untreated.

A patient should seek immediate medical attention for inability to pass urine, heavy or persistent bleeding, large blood clots, severe or worsening pain, fever, repeated vomiting, markedly reduced urine output, dizziness, or other rapidly worsening symptoms. These symptoms may indicate a complication requiring prompt assessment.