Step-by-step TURP: schematic illustration
After noting the landmarks, especially the verumontanum, resect the middle lobe forming a central channel first between 5 and 7 o’clock position. Then resect at 2 and 10 o’clock down posteriorly to join the central channel. As for a new resectionist, it is safer to diathermy bleeding points as you go along. There can be very large vessels at 4 and 8 o’clock, so ensure that your irrigant flow (glycine or saline) is appropriate, with a theater assistant on hand to change bags at the correct time. The anterior lobe should then be resected, with the resection limit at all times being proximal to the verumontanum. The depth of resection should be limited by the transverse fibers of the prostatic “surgical” capsule. Its thickness varies in different glands so beware of small prostates where capsular perforation is often seen.