TURP (transurethral resection of the prostate)

Why are we operating?

Coring out the obstructing inner prostate through the urethra with a resecting loop, the classic operation for prostatic outflow obstruction and the origin of half of urology's teaching points.

Indication: Benign prostatic obstruction with failed medical therapy, refractory retention, recurrent infections or bladder stones, and haematuria of prostatic origin.

The operation in 4 steps

1. 01Cystoscopy and survey

   The resectoscope is passed under vision, the bladder inspected for stones, diverticula and tumour, and the landmarks fixed: bladder neck above, verumontanum below.

2. 02Resecting the lobes

   The middle lobe then lateral lobes are resected in systematic strips of chips down to the surgical capsule, with continuous irrigation carrying chips and blood clear of the view.

3. 03Haemostasis

   Each arterial bleeder is rolled onto and coagulated, the classic positions at the bladder neck checked, and the field left clear enough to read newsprint through.

4. 04Evacuation and irrigation catheter

   Chips are evacuated from the bladder for histology, a three-way catheter placed, and continuous irrigation run until the outflow clears.

Anatomy you need

The bladder, prostate and urethra in line: the resection works between the bladder neck and the verumontanum and no further.

What can go wrong

• Postoperative bleeding

  Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.