Advantage of TURB
Transurethral resection of the prostate (TURP) is currently the most popular approach for the surgical treatment of benign prostatic hyperplasia (BPH). It has the advantage of being an endoscopic procedure that avoids an abdominal or perineal incision and is associated with earlier ambulation and faster convalescence than the “open” approaches. It is considered the standard for the surgical treatment of BPH.
It is appropriate for the treatment of small to moderate size (> 75 g) prostatic enlargement and is technically more sophisticated than the open surgical procedures.
With benign prostatic enlargement, the objective is complete removal of the adenomatous tissue to the surgical (false) capsule, but in cases of urethral obstruction due to advanced prostatic cancer, a “channel” TURP is performed to reestablish urethral potency.
Technical
The resectoscope is operated entirely by one hand, leaving the other hand free for insertion of a finger into the rectum to elevate the prostate.
With the patient in lithotomy position, the penile urethra is calibrated with a bougie á boule to ensure that it is sufficient in size to accept a large cystoscope.
The adenoma is resected at the bladder neck around its circumference until the circular fibers, than resect the intravesical median lobe, and next, one of the lateral lobes is chosen for resection.
The resectoscope is placed immediately proximal to the verumontanum
Bleeding is controlled by application of a hemostatic current through the wire cautery loop.
The final part of the procedure involves careful tissue removal from the floor of the prostate and from the prostatic apex near the external sphincter while preserving the verumontanum.
