CPC sample question # 3

Preoperative Diagnosis: Benign prostatic hypertrophy with urinary obstructive symptoms

Postoperative Diagnosis: Benign prostatic hypertrophy with urinary obstruction

Procedure: Transurethral resection and vaporization of the prostate. Insertion of suprapubic catheter.

Anesthesia: General.

Description of procedure: With the patient in the dorsal lithotomy position after   successful induction of general endotracheal anesthesia, the patient’s penis and perineum were prepped and draped in the usual sterile fashion. A #24 French resectoscope sheath with a Timberlake obturator was inserted into the urethra. The bladder was then filled with irrigating solution.

Next a  #16 suprapubic catheter was placed into the bladder via a small stab wound 1 inch above the pubic bone. Correct placement of the catheter was verified with the resectoscope lens. The balloon was then inflated with sterile water and connected to an outlet tube for continuous irrigation. Resection was then begun going first from the 3 o’clock to the 6 0’clock position, and then from the 6 o’clock to the 9 o’clock position. Resection was followed by electric current vaporization using the Bugbee electrode, again from the 3 o’clock to 6 o’clock position, and then from the 6 o’clock to the 9 o’clock position, effectively removing all hyper-trophied prostate tissue. It should be noted that at this point examination of the bladder neck revealed signs of contracture. Therefore it was considered prudent to release the contracture by making an incision on either side of the bladder neck.

The prostate chips were thoroughly evacuated with the Ellis evacuator. After verifying adequate hemostasis, the bladder was emptied of irrigating solution. A #24 Frence 3 way Foley catheter irrigation was inserted and the balloon was blown up to 40 cc. The balloon was then deflated and removed and the 3 way Foley catheter irrigation was hooked up to continuous irrigation. A sterile compression dressing was applied to the suprapubic incision. The patient tolerated the procedure well and was taken to the Recovery Room in satisfactory condition.