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.

   Why: The verumontanum is the operation's sea wall: the external sphincter lies just beyond it, and every cut of the resection happens proximal to that landmark or continence is the price.

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.

   Why: The capsule's white criss-cross fibres are the floor of the dissection: deep enough for a lasting channel, shallow of the sinuses and rectum. System beats speed, orphan strips left behind are tomorrow's obstruction.

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.

   Why: TURP bleeding is managed vessel by named vessel; the main arteries enter at predictable clock positions at the neck. A dry field now is what makes the catheter phase boring, which is the goal.

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.

   Why: Every chip goes to the lab, incidental cancer changes lives. The three-way catheter is the postoperative operation: irrigation fast enough to outrun clot is what keeps the channel open overnight.

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.