Complications

Local:

• Hemorrhage
  • Reactionary hemorrhage is a major risk following prostatectomy whatever the surgical approach.
    • If bladder is not draining adequately, this may indicate that a clot is blocking the eye of the catheter, so bladder should be promptly washed out using strict aseptic technique.
    • If the blood is not adequately washed out clot retention will ensue.
    • The catheter should be changed by the surgeon if needed.
    • Only rarely is it necessary to return the patient to the operating room to rescuer the homeostasis.
    • Secondary hemorrhage tends to occur around the 10th postoperative day usually due to infection.
    • Advice to rest and to have a high fluid intake.
    • It is usually minor in degree but if clot retention occurs, a catheter  or nasogastric tube will have to be passed and the bladder washed out.
• Perforation of the bladder or the prostatic capsule can occur at the time of transurethral surgery.
  • This usually
  • occurs from a combination of inexperience in association with a large prostate or heavy blood loss.
  • If the field of vision becomes obscured by heavy blood loss, it is often prudent to achieve adequate homeostasis and abandon the operation, swallowing one’s pride on the understanding that a second attempt may be necessary.
  • A large perforation with marked extravasations may require  the insertion of a suprapubic drain.
• Rectal perforation is extremely rare.
• Sepsis:-
  • Bacteraemia is common even in sterile urine and occurs in over 50% with infected urine, prolonged catheterization or chronic retention.
  • Septicemia can occur in these patients shortly after operation or when the catheter is removed.
  • In men at high risk, the use of prophylactic antibiotics is recommended.
  • Infection whether in the bladder, epididmis, or the kidneys should be treated with appropriate antibiotic.
  • Wound infection following open prostatectomy is common if a urethral catheter has been in situ for a number of days before the operation.
  • The most worrying aspect of infection is the early rigor progress to frank septicemia with profound hypotension.

  A blood culture should be taken and antibiotic given parenterally, e.g. amoxicillin  plus cefuroxime or gentamicine.

• Incontinence is inevitable if the external sphincter mechanism is damaged.
• The bladder neck is rendered incompetent by any prostatectomy and, therefore, an intact distal sphincter mechanism is essential for continence.
• Damage to the sphincter may occur at open prostatectomy and following transurethral surgery if the resection extends beyond the verumontanum.
• If pelvic floor physiotherapy is ineffective, then the only satisfactory treatment is the fitting of an artificial urinary sphincter.
• In some patients, detrusor instability contributes to the incontinence than the use of anti-cholinergic or imipramine or duloxetine may help.
• Retrograde ejaculation and impotence
  • Impotence in man with good sexual function before surgery is uncommon, but retrograde ejaculation occurs commonly (>50) because of disruption to the bladder neck mechanism.
• Urethral Stricture This may be secondary to prolonged catheterization, the use of an unnecessarily large catheter, clumsy instrumentation or the presence of the resectoscope in the urethra for too long a period.
  • These stricture arise either just inside the meatus or in the bulbar urethra.
  • An early stricture can usually be managed by simple bouginage but, later  on, it may necessary to cut densely fibrotic stricture with the optical urethrotome.
• Bladder Neck Contracture Occasionally, a dense fibrotic stenosis of the bladder neck occurs following overaggressive resection of a small prostate.
  • It may be due to the overuse of coagulating diathermy.
  • Transurethral incision of the of the scar tissue is necessary.
• Reoperation It is now well known that, after 8 years, 15-18% of men with BPH will undergo repeat TURP(the rate after open prostatectomy is about 5%).
  • The reasons include a technically imperfect primary procedure and a speculative repeat operation in men with symptoms who are cystoscoped after operation.

General complications

• Death is very rare.
• Cardiovascular Pulmonary atelectasis, pneumonia, myocardial infarction, congestive cardiac failure and deep venous thrombosis are all potentially life-threatening conditions that can affect the elderly and frail group of men.
• Water intoxication:-The absorption of water into the circulation at the time of transurethral resection can give rise to congestive cardiac failure, hyponatraemia and haemolysis.
• Accompanying this, there is frequently confusion and other cerebral events often mimicking a stroke.
• The incidence of this condition has been reduced since the introduction of isotonic saline for postoperative irrigation.
• The treatment consists of fluid restriction.