This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'Grade I benign prostate with outflow obstruction is best treated with - \nSelect and explain. \nA. Retropubic prostatectomy, B. Transurethral resection, C. Transvesical prostatectomy, D. Androgen therapy', 'role': 'user'}, {'content': 'Answer: B \nExplanation: • MC indication for surgery is symptoms interfering with quality of life\xa0(bothersome symptoms and symptoms of BOO).\n• TURP (Gold standard) :\n−− Cystoscopic removal of strips of prostatic tissue using diathermy loop. Two techniques; NESBIT technique (preferred maver mayer technique)\n−− Best irrigant fluid is 1.5% glycine\xa0(Electrolyte solutions like NaCl are not compatible with electrocautery, so not used).\n−− Glycine is composed of glycolic acid and ammonium, which can cause CNS (visual) toxicity.\nTURIS: TUR in saline using bipolar cautery\n• Verumontanum is the single most important anatomical landmark in TURP.\n• Verumontanum lies immediately proximal to external sphincter and serve as the distal landmark for prostate resection to prevent injury to the external sphincter.\n• Verumontanum: Distal landmark for prostate resection.\n• Verumontanum: Landmark for proximal limit of external sphincter.\n−− Risks of TURP: Retrograde ejaculation (75%)Q, impotence (5–10%)\xa0and incontinence (< 1%).\n−− Complications: Bleeding, urethral stricture or bladder neck contracture, perforation of the prostate capsule with extravasation, and if severe, TUR syndrome.\nTUR syndrome (Dilutional hyponatremia or water intoxication)\n• TUR syndrome (Dilutional hyponatremia or water intoxication)\xa0resulting from a hypervolemic, hyponatremic state due to absorption of the hypotonic irrigating solution.\n• Clinical Features: Nausea, vomiting, confusion, hypertension, bradycardia, and visual disturbances.\n• The risk increases with resection times > 90 minutes or gland size > 75 gm.\n• Treatment includes diuresis (furosemide) and in severe cases, hypertonic saline (3%) administration.\nLate Complications of TURP\n• Bladder neck stenosis (4%) > Urethral stricture (3.6%)\n• Bladder neck stenosis is seen more often with small (< 30 gm) fibrotic prostates.\n• Transurethral incision of the prostate (TUIP):\n−− For posterior commissure hyperplasia (elevated bladder neck), involves two incisions using the Collins knife at the 5- and 7-o’clock positions.\n−− The incisions are started just distal to the ureteral orifices and are extended outward to the verumontanum.\n• TUIP lowers the incidence of bladder neck contracture when compared to TURP, so TUIP should be strongly considered in patients with smaller gland in place of TURP.\n• TUIP is used for smaller (20 gm) prostate, young patients.\n• Decreased incidence of retrograde ejaculation as compared to TURP.\n• Open simple prostatectomy: Glands > 75 gm, concomitant bladder diverticulum or a bladder stone or if dorsal lithotomy positioning is not possible.\n−− Suprapubic prostatectomy: Performed transvesically (Frayer’s)\xa0and operation of choice in dealing with concomitant bladder pathology (Bladder stones or diverticulum).\n−− Retropubic prostatectomy (Millin’s): Transverse incision is made in surgical capsule of prostate and enucleation is done.\n−− Perineal prostatectomy (Youngs): Abandoned now\n• Carcinoma prostate originates in peripheral zone of prostate, so prostatectomy for BPH confers no protection for subsequent cancer.', 'role': 'assistant'}]