Transurethral resection of prostate for treatment of BPH

• Monopolar - use hypotonic irrigation fluid (water). TUR syndrome = excessive fluid absorption from the prostate vascular bed -> hyponatremia. Increased risk with longer procedure, higher irrigation pressure
• Sorbitol/Mannitol still causes hyponatremia, but not hypoosmolarity (which is more dangerous and causes cell lysis)
• Bipolar - use isotonic irrigation (saline) (no TUR syndrome)
• Overall no difference between procedure duration, bleeding, recovery, bladder neck contractures. Only difference is less hyponatremia with bipolar. 

Greenlight

• 532 nm laser
• Settings typically 80-160 W, ~ 100-300,000 J

• Make sure to identify UOs before/during/after
• Do not resect distal to veru (will get the sphincter)
• Dobberfuhl will do DRE during TURP to see which areas can be resected further

Complications

• Bleeding (1%)
• Incontinence (1%)
• Urethral stricture (5%)
• Erectile dysfunction (5-10%) - similar to general population
• Ejaculatory dysfunction (65%)

Discharge

• If PVR < 50% of total bladder volume, usually OK to go
• If prescribed oxybutynin; stop night before catheter removal