Successful TURP and Right Orchidectomy for BPE with LUTS in 70 Y.O. Male

Chief Complaints

A 70-year-old male patient with a body mass index (BMI) of 21.2 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of lower urinary tract symptoms (LUTS) for the past 3 months and right-sided testicular swelling for the past 15 days.

The patient was a known case of hypertension (HTN) and was on regular treatment. There was no documented history of diabetes mellitus or other significant chronic illnesses. No prior major surgical history was noted.

On examination, the patient was conscious, coherent, and oriented, and was hemodynamically stable. General physical examination was within normal limits. Cardiovascular and respiratory system examinations were normal. Abdominal examination revealed a soft, non-tender abdomen with no palpable masses. Local examination showed an abnormal right-sided scrotal swelling, while the left testis was normal.

Upon admission to PACE Hospitals, the patient underwent a comprehensive evaluation by the Urology team, including a detailed clinical examination and review of medical history. He presented with complaints of lower urinary tract symptoms (LUTS) for 3 months and right-sided testicular swelling for 15 days.

Clinical examination revealed right-sided scrotal swelling, suggestive of underlying pathology. Ultrasonography (USG KUB and scrotum) demonstrated benign prostatic enlargement (BPE) with significant post-void residual urine and findings suggestive of right epididymo-orchitis (EDO), indicating bladder outlet obstruction secondary to an enlarged prostate.

Laboratory investigations were reviewed in detail. Complete blood picture showed hemoglobin, total leukocyte count, and platelet count within normal limits, with mild lymphocytosis. Renal function tests, including serum creatinine, were within normal limits. Liver function tests were largely within normal range, except for mildly elevated Serum Glutamic Oxaloacetic Transaminase (SGOT) levels. Prostate-specific antigen (PSA) was within normal limits. Urine microscopy was unremarkable with no pyuria or significant bacteriuria; however, urine culture showed growth of coagulase-negative Staphylococcus with a defined antibiotic sensitivity pattern. Two-dimensional echocardiography revealed normal cardiac chamber size and good left and right ventricular function, with mild valvular regurgitation and Grade I diastolic dysfunction.

Based on the diagnosis and clinical findings, the patient was advised to undergo Benign Prostatic Enlargement (BPE) Treatment in Hyderabad, India, along with Right epididymo-orchitis (EDO) under the expert care of the Urology Department.

After a detailed consultation with Dr. K Ravichandra, Consultant Urologist, a comprehensive evaluation was conducted to determine the optimal diagnostic and therapeutic approach for the patient presenting with lower urinary tract symptoms for 3 months and right testicular swelling for 15 days. Based on detailed clinical evaluation and imaging studies, surgical intervention was deemed necessary.

It was determined that the patient had benign prostatic enlargement with significant urinary obstruction, along with right epididymo-orchitis not responding to medical management. Transurethral resection of the prostate (TURP) and right orchidectomy were identified as the most effective interventions to relieve obstruction, remove the affected testis, and restore normal urinary function. 

The patient and his family members were informed about his condition, the procedures, their associated risks, and the potential benefits, including relief of urinary symptoms, resolution of infection, and improvement in overall quality of life. 

Following the decision, the patient was scheduled to undergo Right Orchidectomy and TURP Surgery in Hyderabad at PACE Hospitals, under the expert care of the urology department.

The procedure involved the following steps:

• Preoperative Preparation: The patient was positioned in the lithotomy position for the TURP procedure, and spinal anesthesia was administered. The perineum, scrotum, and lower abdomen were prepared and draped in a sterile fashion. Prophylactic antibiotics were given, and instruments for TURP, scrotal surgery, and suprapubic catheter placement were prepared.

• Transurethral Resection of the Prostate (TURP): A resectoscope was inserted via the urethra to access the prostate. The grade 3 medial lobe and grade 2 lateral lobe causing obstruction were identified. Obstructive tissue was carefully resected using electrocautery loops, achieving a near-complete resection. Continuous irrigation maintained a clear field, and hemostasis was secured. The urethral lumen and bladder neck were confirmed to be patent.

• Right Orchidectomy: A scrotal incision was made on the right side. The spermatic cord was isolated, ligated, and divided, and the right testis, along with the epididymis, was removed. Hemostasis was ensured, and the scrotal incision was closed in layers.

• Left Vasectomy: A small incision was made on the left side of the scrotum. The vas deferens was identified, ligated, and divided. The incision was closed with absorbable sutures, completing the sterilization procedure.

• Suprapubic Catheter (SPC) Placement: A small incision was made just above the pubic symphysis. A tract was created into the bladder, the suprapubic catheter was inserted and secured, and proper positioning and drainage were confirmed. All surgical sites were dressed, and the patient was monitored postoperatively.

After surgery, the patient was closely monitored to ensure stability and an uncomplicated recovery. His postoperative course was uneventful. During his hospital stay, he received antibiotics to prevent infection, analgesics for pain control, and medications to support urinary function. The patient was discharged in stable condition with appropriate follow-up instructions.

Upon discharge, the patient was prescribed treatment to prevent infection, support urinary function, and manage pain. Medications were also provided to protect the stomach lining and relieve constipation, given for the appropriate duration to ensure a smooth recovery at home.

The patient was advised to avoid straining during bowel movements to prevent complications and ensure proper healing.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms like fever, blood in urine, or painful urination.

The patient was advised to return for a follow-up visit with the Urologist in Hyderabad at PACE Hospitals after 5 days for suprapubic catheter (SPC) removal.

This case highlights the management of benign prostatic enlargement with lower urinary tract symptoms and testicular swelling. Surgical intervention involving transurethral resection of the prostate and orchiectomy was performed successfully without complications. Postoperative recovery was stable, and follow-up care was recommended to monitor healing and urinary function.