03 / Urology · endoscopic
TURP (transurethral resection of the prostate)
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.
Stage
1 / 4
Cystoscopy 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.
Watch for: Missed bladder pathology · Urethral injury on insertion
The surgeon asks
Why is the verumontanum the resection's absolute distal limit?
Why are we operating?
TURP resects the obstructing prostate from inside the urethra: a diathermy loop channels through the adenoma in strips until the capsule's fibres appear, converting a compressed slit into an open cavity. It remains the reference operation for benign prostatic obstruction, the one against which every laser and lift is measured, offered when catheters, retention or complications have ended the medication conversation.
Pulls toward surgery
Gives the team pause
Shared foundations
What the surgeon is thinking
Cystoscopy and survey
Why is the verumontanum the operation's sacred landmark?
It marks the distal limit: the external urinary sphincter lies just beyond it, and every strip resected respects that boundary because continence lives there. The survey fixes the veru, the ureteric orifices and the bladder's state in mind before any resection redraws the map.
Resecting the lobes
What does 'resect to the capsule' actually look like?
The adenoma's tissue shaves in loose chips until the fibrous, criss-crossing fibres of the surgical capsule appear: that texture change is the depth gauge. Beyond it lie the venous sinuses whose opening floods the field and the perforation that lets irrigation escape, so the capsule is the floor, recognised and respected lobe by lobe.
Haemostasis
Why is the systematic sweep for bleeders the operation's endgame?
The fossa is a raw vascular bed that will spend the night under irrigation: arterial bleeders are chased and sealed at the end with the field at moderate filling, because what looks dry in a distended fossa bleeds at rest. The night's irrigation workload is decided in these minutes.
Evacuation and irrigation catheter
What is the three-way catheter actually doing overnight?
Two jobs: continuous irrigation dilutes blood before it clots, and the channel evacuates what forms anyway. The chips were evacuated and sent (histology finds incidental cancer in a fraction), and the catheter's colour trend, rosé clearing, is the fossa's report card read hourly.
Decision points
A large gland and a resection clock: how much is enough?
Complete channel, capsule reached, time respected
The goal is an open channel, not an empty prostate: a finished operation within safe time beats a total resection past it.
Staged or alternative approach for the huge gland
Very large adenomas belong to enucleation techniques or open surgery: choosing the right operation beats heroically extending the wrong one.
The old TUR-syndrome clock has softened with saline bipolar systems, but the principle survives: resection time, irrigation absorption and blood loss all compound, and the operation's endpoint is functional (a channel to the capsule) rather than anatomical completeness.
In recovery the catheter blocks and the irrigation stands still.
Bedside washout now
Clot has blocked the channel: a bladder syringe washout restores flow before the bladder distends and re-bleeds the fossa: this is the ward skill of the operation.
Traction and escalation
For bleeding that defeats washout: catheter balloon traction tamponades the fossa, and the persistent bleeder goes back to theatre without pride.
The blocked catheter is the TURP night's defining emergency, and its physiology is a spiral: clot blocks flow, the bladder distends, distension tears the fossa, more bleeding makes more clot. The washout that breaks the spiral early is worth ten later heroics.
Leaving the OR
The handoff
- Procedure
- Bipolar TURP, 45 g resected to capsule; veru and sphincter respected
- Haemostasis
- Systematic sweep completed; irrigation rosé and clearing
- Catheter
- Three-way, continuous irrigation running; chips to histology
- Watch for
- Irrigation colour hourly, catheter patency (washout drill known), sodium if absorption suspected
A fictional educational patient, handed over the way real ones are.
The postoperative course
- Night 0Irrigation titrated to colour; the blocked-catheter drill is the covering doctor's required knowledge tonight.
- Day 1-2Irrigation off, then catheter out when clear: the first voids judged on flow and comfort, with retention after removal a known, recoverable event.
- Weeks 1-3Urgency and frequency while the fossa epithelialises; the secondary bleed around day 10 as slough separates is counselled by name before discharge.
- MonthsFlow re-measured, histology closed out, and the honest audit: retrograde ejaculation is near-universal, continence and potency reviewed rather than assumed.
Watch it done
TURP: transurethral resection of the prostate
The resection loop at work: landmarks, the verumontanum, and haemostasis.
Source: Professor Mohamed H Khadra, urological surgeon · Watch on YouTubeTURP tips and tricks with Dr John Gore
A full teaching session from the urology education charity.
Source: IVUmed · Watch on YouTube