TURP Technique (lecture n video)
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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.
TURP Technique (lecture n video)
- 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
- 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
- 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
- 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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