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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.