SARAH M LLOYD & STUART LLOYD

(This article was originally published in the Journal of One-Day Surgery Vol. 24 No. 1, 2014. It was Number 8 in the 'How i Do It' series, updated in 2020)

Patient Selection

• Benign prostatic hyperplasia or carcinoma of prostate.
• Any size prostate.
• Not contraindicated if known large middle lobe enlargement or a raised PSA suspicious of cancer.
• Typically an elderly population with significant co-morbidities, but most will be acceptable including many ASA 3.

Anaesthetic Techniques

• Most patients have a general anesthetic with spontaneous ventilation through a LMA. This facilitates rapid recovery and early ambulation.
• Some are managed using a spinal technique; due to its shorter duration of block, hyperbaric 2% prilocaine is now the drug of choice for this.
• All patients receive IV gentamicin 2mg/Kg.
• Patients receive 1 litre of IV normal saline solution during surgery and 1 further litre over the 2 hours following.

Surgical Technique

• A transurethral resection (TUR) technique using saline irrigation, which is not modified for day surgery.
• Continuous activation of the loop is best to optimize the cutting potential. Intermittent activation is also an alternative.
• 18 French gauge, Coude tip 3-way catheter with 20ml water to the balloon at the end of surgery. This permits irrigation for 1 to 2 hours if needed.
• The irrigation port of the catheter is spigotted prior to discharge.
• The patient goes home with a catheter for TWOC* at 2 days by either the Day Ward or district nurse / catheter specialist nurse.

Peri-operative Analgesia

• No pre-operative analgesia
• Intra-operative fentanyl and IV paracetamol.
• Postoperative regular paracetamol with codeine if needed.
• Problems managing post-operative pain are uncommon after bipolar surgery.

Take Home Medication

• Paracetamol and codeine as required for 3 days
• No post-operative antibiotics unless concern for infection then oral ciproxfloxacin 500mg bd for 5 days

*TWOC = Trial WithOut Catheter