John J Bauer, MD, FACS John J. Bauer, M.D.
www.flinturology.com

Urology Services, Inc.
G-1121 West Hill Rd.
Flint, Michigan 48507
Tel: 810.232.8888
Fax: 810.232.9190
Email: jbauer@flinturology.com
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Counseling and Pre-Op Note

Patient Name:

Age:

Date:

Procedure: Transurethral Resection of the Prostate

Indications:

Patient is a male with irrative or obstructive voiding symptoms secondary to bladder outlet obstruction from benign prostate enlargement, prostate cancer, chronic gross hematuria or bladder neck dysfunction. The patient has had a sufficient trial of pharmacological therapy that has failed to relieve his symptoms.

Alternatives:

Alternatives to the procedure are watchful waiting, chronic urethral or suprapubic bladder drainage, continued oral therapy with alpha-blocking agents or 5-alpha reductase inhibitors (Hytrin, Cardura, tamsulosin, finasteride), incision of prostate, laser therapy, thermotherapy, microwave therapy, ultrasound therapy or open surgery.

Risks/Complications:

The risks and complications of the procedure where extensively discussed with the patient. The general risks of this procedure include, but are not limited to bleeding, transfusion, infection, wound infection/dehiscence, pain, scaring of tissues, failure of the procedure, potential injury to other surrounding structures, deep venous thrombosis, pulmonary embolus, myocardial infarction, heart failure, stroke, death or a long-term stay in the Intensive Care Unit (ICU). Additionally, mentioned were the possible serious complications of the anesthesia to include cracked teeth, airway damage, aspiration, pneumonia, spinal head-ache, nerve damage, spinal canal bleeding and malignant hyperthermia. Your anesthesiologist will discuss the risks and complications in more depth separately. Additional procedures may be necessary.

The specific risks of this procedure include, but are not limited to: injury to or perforation of prostate capsule or bladder, ureteral injury or obstruction, additional procedures to correct injury (stent, percutaneous renal drainage), urinary tract infection, pyelonephritis, irrative voiding symptoms, incontinence, gross hematuria, clot retention, may require prolonged catheterization or recatheterization, retrograde ejaculation, inability to void due to bladder dysfunction, bladder neck contracture, metabolic and electrolyte abnormalities and erectile dysfunction. May require an incision of the urethra using an Otis urethrotome if the urethra can not be dilated to fit the scope, this may cause prolonged bleeding, penile pain and catheterization

You understand the procedure, general and specific risks as discussed and agree to proceed with the procedure. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely.

Physician's Signature: ________________________________ Date: __________________

Patient Signature: __________________________________ Date: __________________

Witness: __________________________________