Position: Supine, Lithotomy
Time: 30-60 min (short)

Maintenance Paralytic: Not usually

Creatinine and electrolytes should be checked preoperatively. Very common to have some level of kidney dysfunction.

For GETA, Maintain the patient deep or use paralytic. If the patient moves, the doctor can perforate the bladder.

Intraoperatively, assess for signs of hyponatremia which would indicate that the patient has absorbed a lot of the irrigation fluid (as much as ~ 30ml/min and 6L in 2 hours). This is far more common in TURPs.

Minimal blood loss.

Remember, these cases have very little indication of the end of the procedure (ie. sewing up). It would be a good idea to use an anesthetic technique that can be quickly reversed (ie NO2 + gas) and/or regular communication with the MD to assess time left in the procedure.

Postoperatively, if the patient complains of pain in the suprapubic region or general abdominal pain, assessment should be immediate to determine if theres been a bladder perforation. Suprapubic pain is associated with extraperitoneal perforation, whereas generalized abdominal pain is associated with intraperitoneal pain.

This procedure is done using a flexible scope or a rigid scope, which is inserted into the urethra. Flexible scopes are usually done to do a biopsy/diagnostic procedure. Flexible scopes do not require bladder distention and are often times done under local anesthetic (LA). Rigid scopes are used under general anesthesia or Spinal anesthesia.

Rigid scopes require greater bladder distention using large volume of fluids. This opens the possibilities of large amounts of fluid absorption – something that needs to be monitored intraoperatively.

For spinal anesthesia: T10-L2 supplies bladder pain, S2-S4 supplies urethra, prostate, bladder neck and mucosa

Be careful with patients that have spinal cord injuries. The bladder distention associated with a rigid scope can cause autonomic hyperreflexia. In these patients, its better to do GA or spinal anesthesia.