L I Okeke1. 1. Department of Surgery, College of Medicine, University of lbadan and University College Hospital, Ibadan, Nigeria. liokeke@yahoo.com
Abstract
BACKGROUND: Caudal block regional anaesthesia has been used over the years for out-patient procedures, and in transurethral resection of the prostate gland in Nigeria since 1995. In a preliminary study involving 10 selected patients undergoing TURP, spontaneous voiding resumed on the operative day, and their discharge on the same day did not in any way lead to any adverse events. This larger series further confirms the safety of transurethral resection of the prostate gland as a day case procedure. METHOD: One hundred and eighty patients with obstructing benign prostatic enlargement on urethral catheter drainage with prostate glands weighing 60g or less on ultrasound assessment, were subjected to transurethral resection of the prostate gland (TURP) as day-cases under caudal block regional anesthesia using 2% xylocaine with 1 in 80,000 adrenaline. Hemostasis was secured until effluent of the irrigation fluid from the bladder was totally free of any visible trace of blood. A catheter was not inserted postoperatively. The patients were discharged on the same day after they had satisfactorily voided. RESULTS: These patients resumed spontaneous voiding postoperatively before discharge on the operative day. Their discharge on the same day did not in any way lead to any adverse events. CONCLUSIONS: With a better understanding of the anatomy of the innervations and blood supply of the prostate gland, and proper patient selection, this larger series has confirmed that day-case TURP without postoperative catheterization can now be safely added to the list of day case procedures.
BACKGROUND: Caudal block regional anaesthesia has been used over the years for out-patient procedures, and in transurethral resection of the prostate gland in Nigeria since 1995. In a preliminary study involving 10 selected patients undergoing TURP, spontaneous voiding resumed on the operative day, and their discharge on the same day did not in any way lead to any adverse events. This larger series further confirms the safety of transurethral resection of the prostate gland as a day case procedure. METHOD: One hundred and eighty patients with obstructing benign prostatic enlargement on urethral catheter drainage with prostate glands weighing 60g or less on ultrasound assessment, were subjected to transurethral resection of the prostate gland (TURP) as day-cases under caudal block regional anesthesia using 2% xylocaine with 1 in 80,000 adrenaline. Hemostasis was secured until effluent of the irrigation fluid from the bladder was totally free of any visible trace of blood. A catheter was not inserted postoperatively. The patients were discharged on the same day after they had satisfactorily voided. RESULTS: These patients resumed spontaneous voiding postoperatively before discharge on the operative day. Their discharge on the same day did not in any way lead to any adverse events. CONCLUSIONS: With a better understanding of the anatomy of the innervations and blood supply of the prostate gland, and proper patient selection, this larger series has confirmed that day-case TURP without postoperative catheterization can now be safely added to the list of day case procedures.