Successful TURP Relieved Urinary Obstruction in a 73 Y.O. Male with Benign Prostatic Enlargement

A 73-year-old male patient with a body mass index (BMI) of 20 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of reduced urine flow for the past three months. His urinary symptoms had progressively worsened, and he developed acute urinary retention requiring urinary catheterization.

The patient had no documented significant medical comorbidities, previous urological procedures, major surgeries, or chronic illnesses. The patient had no reported history of diabetes mellitus, hypertension, chronic kidney disease, cardiac disease, respiratory illness, neurological disorders, or known medication allergies.

On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. General physical examination showed no pallor, jaundice, cyanosis, clubbing, lymph node enlargement, or swelling.

Abdominal examination revealed a soft and non-distended abdomen without significant tenderness. There were no clinical signs of active urinary tract infection or dehydration. Cardiovascular, respiratory, and neurological examinations were within normal limits.

Upon admission to PACE Hospitals, following a detailed clinical assessment, the Urology team evaluated the patient for reduced urine flow, lower urinary tract symptoms, and acute urinary retention requiring urinary catheterisation.

Ultrasound and transrectal ultrasound examinations were performed to assess the prostate gland, bladder outlet, and urinary tract. Based on the patient’s symptoms, clinical findings, and diagnostic investigations, he was diagnosed with benign prostatic enlargement associated with lower urinary tract symptoms and acute urinary retention.

Benign prostatic enlargement, also known as benign prostatic hyperplasia, is a non-cancerous enlargement of the prostate gland. As the prostate increases in size, it may compress the urethra and obstruct the normal passage of urine. This can cause reduced urine flow, difficulty starting urination, straining, incomplete bladder emptying, increased urinary frequency, urgency, night-time urination, and urinary retention.

Routine investigations, including complete blood picture, serum electrolytes, kidney and liver function tests, urine examination, urine culture, coagulation profile, blood grouping, blood sugar testing, viral screening, and pre-anaesthetic assessment, were performed to evaluate the patient’s overall fitness for surgery. The findings were within acceptable limits and supported proceeding with surgical treatment.

Based on the confirmed diagnosis, the patient was advised to undergo Benign Prostatic Enlargement Treatment in Hyderabad, India, under the expert care of the Urology Department.

After a detailed consultation with Consultant Laparoscopic Urologists Dr. Abhik Debnath, Dr. K. Ravichandra, and Senior Consultant Urologist Dr. Vishwambhar Nath, a comprehensive evaluation was performed to determine the most appropriate treatment approach.

Considering the patient’s reduced urine flow, lower urinary tract symptoms, acute urinary retention requiring catheterisation, enlarged 60-gram prostate, and prominent median lobe causing bladder outlet obstruction, the team assessed the severity of the urinary blockage and the possibility of continued catheter dependence.

Routine investigations, including complete blood picture, kidney function tests, urine examination, urine culture and sensitivity, blood sugar, liver function tests, serum electrolytes, and blood clotting tests, showed acceptable parameters for surgery.

Based on the patient’s symptoms, prostate size, imaging findings, catheter-dependent urinary retention, and preoperative investigations, it was determined that Transurethral Resection of the Prostate under spinal anaesthesia was the most appropriate and effective management strategy.

The procedure was selected to remove the obstructing prostate tissue, widen the urinary passage, improve urine flow, help the patient pass urine without a catheter, and reduce the risk of recurrent urinary retention and other urinary complications.

The patient and his family members were counselled regarding the diagnosis, investigation findings, planned surgical procedure, type of anaesthesia, expected recovery, possible risks, catheter care, postoperative urinary symptoms, and the importance of regular follow-up.

Following the decision, the patient was scheduled for Transurethral Resection of the Prostate (TURP) in Hyderabad at PACE Hospitals under the expert care 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. Under strict aseptic precautions, spinal anaesthesia was administered, and the patient was positioned appropriately.

• Insertion of the Resectoscope: A specialised endoscopic instrument called a resectoscope was gently passed through the urinary opening and advanced through the urethra towards the prostate. No external surgical incision was required.

• Identification of the Obstructing Prostate Tissue: The enlarged prostate tissue, including the prominent median lobe causing obstruction at the bladder outlet, was carefully identified.

• Resection of the Prostate Tissue: The obstructing portion of the prostate was gradually removed using an electrical cutting loop. The resected prostate tissue was flushed into the bladder and collected for histopathological examination.

• Control of Bleeding: Bleeding points within the operated area were carefully controlled to reduce the risk of postoperative bleeding.

• Catheter Placement and Completion: A Foley urinary catheter was inserted into the bladder to allow continuous drainage of urine and support healing of the operated area. The procedure was completed successfully without any intraoperative complications.
  

The patient had an uneventful postoperative recovery and remained hemodynamically stable throughout the hospital stay. He was regularly monitored for urine output, bleeding, hydration, kidney function, pain, and overall recovery. Appropriate treatment was provided to prevent infection, relieve pain and discomfort, protect the stomach, prevent constipation, and support recovery. The urinary catheter was removed on the third postoperative day, after which the patient passed urine comfortably with an improved urinary stream. He was gradually started on oral fluids and a normal diet and was discharged in a stable condition with postoperative instructions.

Upon discharge, the patient was prescribed oral medications to help prevent postoperative infection, reduce pain and discomfort, control fever when required, protect the stomach from irritation, prevent constipation, and support recovery following surgery. The patient was also advised to continue his routine medications as recommended. 

The patient was advised to drink adequate fluids, follow a balanced fibre-rich diet, avoid constipation and straining, and perform Kegel exercises as instructed. He was also advised to avoid heavy lifting, strenuous exercise, cycling, prolonged travel, and activities that place pressure on the pelvic region during the initial recovery period.

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, dizziness, or worsening urinary symptoms.

The patient was advised to return for a follow-up visit with the Urologist in Hyderabad at PACE Hospitals after one week.

This case highlights the successful use of TURP to relieve urinary obstruction caused by benign prostatic enlargement. The procedure improved urine flow, allowed successful catheter removal, and supported comfortable urination. Appropriate postoperative care, Kegel exercises, and regular follow-up help promote recovery and improve urinary control.