Post TURP Balloon Inflation And Traction

• 04 May 2020 11:18:49 AM
• |Endo Urology

Dear Friends,

Comments(7)

• 

  Tikenjit Mazumdar

  04 May 2020 12:33:26 PM

  Sir,after turp, we do all attempts for complete hemostasis...if hemostasis is achieved..most of d time it does.. we put 20 fr 3day cath .we don't put any trction..no irrigation...

  If hemostasis is partial or venous oze is present... then..we put 20fr 3 way cath...inflate ballon upto 40 cc...make sure that cathmove freely...n gentl traction given upto next day morning...morning  ballon deflated to 20cc... irrigation stopped

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  Dr. Anil Takvani

  04 May 2020 12:44:09 PM

  Good.

  How it serves the purpose of haemostasis? 

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  Tikenjit Mazumdar

  04 May 2020 01:08:54 PM

  It cause mechanical compression of prostatic fossa.hence cause hemostasis...

  We usually don't put ballon in prostatic fossa... because it cause more pain..

  
  

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  Dr. Anil Takvani

  04 May 2020 01:18:18 PM

  If you are not putting balloon in prostatic fossa as you mentioned, my quarry is how it can cause mechanical compression in prostatic fossa?

  Thanks

• 

  Tikenjit Mazumdar

  04 May 2020 01:34:24 PM

  Im not sure...but...I think it causes bladder neck compression...exert compresive force

  Not radial force as would be exerted if ballon in prostatic fossa...correct me sir if I'm wrong

• 

  Pankaj N Maheshwari

  04 May 2020 07:00:24 PM

  Mechanism of traction effect:

  1. Pressure over bladder neck by catheter balloon occludes the veins that enter the prostatic capsule through the vesicle-prostatic junction reducing the venous ooze. 
  2. Bladder neck blocked by the balloon would prevent blood from entering the bladder and prevent clot formation in bladder.
  3. Blood is retained in the resected fossa and this helps in formation of clot in the fossa and hence hemostasis. 
  4. Traction CANNOT control arterial bleeding

  Where should the catheter be fixed: thigh or lower abdomen?

  If you fix on the thigh, leg movement is restricted. If he moves the leg, traction could reduce. Reduced leg movement can increase the risk of DVT in these elderly patients. Also the way the urethra gets pulled, there can be injury at the bulbo-penile junction leading to increased risk of stricture. In contrast if the catheter is fixed on supra-pubic area, leg movement if permitted and the urethra remains in the natural 'C' curve reducing the risk of injury. 

  Achieving good homeostasis and reducing the need for traction is paramount importance. Traction increases pain, can increase the risk of stricture and bladder neck obstruction. Even if traction is applied, it should not exceed two hours. 

  With newer procedures, the need for traction is reducing but in procedures like aquabalation this form of hemostasis is still needed. During aquablation, the balloon is described to be positioned in the fossa and they position and fill the balloon to about 60% volume of tissue removed under TRUS control.

  Interestingly, the initial description of the foley balloon in 1937 was as a 'intra-prostatic fossa homeostatic device.' Photograph attached

  

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  Dr. Anil Takvani

  04 May 2020 09:36:31 PM

  Thanks Pankaj Sir,

  
  

  PGs will be benefited as I have watched them fumbling while answering this most common question....Thanks