TURP TECHNIQUE

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TURP Technique
Eko Indra Pradono

INTRODUCTION
• Transurethral resection of the
prostate (TURP) is a commonly
performed surgical treatment for
benign prosta...

INDICATION
Strong Indications for Surgery
• Recurrent urinary retention
• Acute urinary retention
• Recurrent haematuria r...

INDICATION
Relative Indications
• Morphological changes in bladder or upper urinary tract secondary to bladder outlet
obst...

Contraindications
Absolute :
- Active urinary tract infection
- Uncorrected coagulopathy
Relative :
- Large bladder stone ...

Pre-operative
• Stop any ‘bleeders drugs’
• Informed consent
• No shaving necessary
• Antibiotics

Operating Suite

The re-sterilizable funnel for the collection of
irrigation fluid (views showing its attachment b to the
operating table)

Positioning
POSITIONING

The Sets
• Resectoscope 24-Fr single-flow or 27-Fr/24- Fr
continuous-flow rotatable resectoscope with 12° or 0°
optics.
• ...

TECHNIQUE

TURP Technique Principle
Do safety and efficiently
Work in low pressure
Achieve good hemostasis
Systematic approach of TURP

Main Steps of TURP
1. Identification of landmarks
2. Removal of most of adenoma
3. Bleeding control
4. Tidying up & remova...

Urethrocystoscopy
• Verumontanum
• Kissing lobes
• Bladder neck
• Ureteral orifices
• Bladder trabeculation ; sacculation,...

CUTTING
TECHNIQUE
Nesbit
Barnes
‘Like a canoe’
as wide and deep as the loop, as long as its travel

Varying depths of cut. Shallow (a), normal (b), and deep (c) cuts

Cuttingwithpredeterminedendpoint

TheCutwithPredeterminedStartingPoint

TheExtendedCut

RetrogradeCutting

EntrapmentCutting

HEMOSTATIC

• Smaller vessel may be
controlled by coagulating its
mouth
• Larger vessel is controlled by
applying the loop just to one...

CHIPS EVACUATION
Milo Ellik’s
• Get rid all the air
• Gently
• Inflow valve left open  ‘safety
valve’

Catheter Placement

TURP Methods
NesbitBarnes
Alcock &
Flocks
Mauermayer Blandy

Nesbit’s Method
• Start from 12 o’clock
• Lateral lobe will be resected from the top to the bottom
• Median lobe will be t...

Nesbit’s Method

Nesbit’s Method

Alcock and Flocks’ Method
• Start from 9 and 3 o’clock
• Then, it depends on the situation

Mauermayer’s Method
• Alcock & Flocks’ modification
• Start from median lobe
• Then, resect 9 and 3 o’clock
• This method ...

Blandy
Identification of landmark
Resect middle lobe
Control the Flock Arteries and resect
lateral lobes

Barnes’ Method
• Start from median lobe
• Lateral lobe will be resected from the bottom to the top

Barnes’ Method

Post operative
• POD 0:
• Irrigation is running freely, is no darker than vin rose, and fully conscious
 send to wards
• ...

Postoperative Care
• When the irrigation fluid becomes clear  catheter traction can be
released up to 4 h
• Continue irri...

Complications
INTRA OP EARLY POST OP POST OP
Haemorrhage
Urethral injury
Bladder Injury
TUR syndrome
Mortality
Urinary Ret...

Reference
• Mauermayer, Wolfgang. Transurethral surgery. Springer Science & Business Media,
2012.
• John P. Blandy. Transu...

THANK YOU

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