This document provides guidance on transurethral resection of the prostate (TURP) techniques. It outlines a triphasic procedure involving 1) cone excision, 2) excavation of the prostate capsule, and 3) resection of apical tissue. This approach allows for rapid initial tissue removal while minimizing risks of injury. It emphasizes achieving hemostasis between stages for good visualization. Different resection methods are described for removing lateral and median lobes, including segmental, tangential, Nesbit's, Barnes', and Alcock & Flocks techniques. Landmarks like the bladder neck and veromontanum help guide apical resection.

1. TUR-P techniques

2. Transurethral prostatectomy
Philosophy :
Do safely & efficiently
Work in low pressure
Achieve good hemostasis
Systematic approach TUR-P

3. Basic rules of resection technique
1. Cone excision
2. Excavation of the capsule
3. Resection of apical tissue
Reasons for this triphasic procedure :
Phases 1 and 2 permit rapid tissue removal, since the
danger of accidental injury is slight. The final phase 3
(close to veromontanum and external sphincter) requires
slow careful surgery

4. Cone excision

5. Techniques to secure the safety
• Careful hemostasis  good visualization for
resection and avoiding complications
• Control the bleeding before move to the next
stage

6. Excavation of the capsule
Resect the lateral lobe in a curve fashion
according to prostatic configuration
Do not resect the lateral lobe in a straight
line fashion

7. Small single cut Extended cutting

8. Instrument control during
excavation

9. Segmental method
Tangential method

10. Resecting Endovesical Lateral Lobe

11. Resecting Endovesical Lateral Lobe

12. Resection of apical tissue

18. Appearance BEFORE
apical resection
Appearance AFTER
apical resection

19. Aids to resection of apical tissue
• examining the neck of the empty bladder
• Advancing and withdrawing the sheath
(Wobble Test)
• Recoqnizing tissue around the apex
• Rectal palpation around the prostatic apex

20. The appearance of apical tissue
BLADDER EMPTY BLADDER FULL
Always asses bladder neck and apical tissue with the bladder empty
The initial cut should be made with an empty bladder

21. The Wobble Test

22. Rectal palpation around the prostatic apex

24. Nesbit’s Method

25. NESBIT
• Mulai dari jam 12
• Lobus lateral direseksi dari atas ke bawah
• Terakhir median lobe

26. Nesbit’s Method

27. Nesbit’s Method

28. Barnes’ Method

29. BARNES
• Mulai dari median lobe
• Lobus lateral direseksi dari bawah ke atas

30. Alcock and Flocks Method

31. ALCOCK & FLOCKS
• Mulai dari jam 9 dan jam 3
• Kemudian tergantung keadaan

32. Mauermayer Method

33. MODIFIKASI ALCOCK & FLOCKS
(METODA MAUERMAYER)
• Mulai dari median lobe
• Kemudian jam 9 dan jam 3
• Selanjutnya --- lihat gambar
• Disinyalir metoda ini baik utk yg baru belajar
dan bisa utk prostat besar atau kecil

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