ADPO 2/2019 GU surgery

The TURP procedure step

1. The surgeon dilates the urethra with sounds sized from 20F to 30F.
2. Cystourethroscopy is performed to assess the degree of prostatic obstruction
and to inspect the bladder.
- Some surgeons perform this diagnostic procedure several days before surgery
- whereas others perform the examination in the OR immediately before surgery.
3. The surgeon passes a well-lubricated postresectoscopesheath with its fitted
Timberlake obturator into the urethra.
4. The Timberlake obturator is removed, and the workingelement (resectoscope),
assembled with the forobliquetelescope and cutting loop, is inserted through the
sheath.
5. The irrigation tubing, light cord, and high-frequency cordare appropriately
connected, and the surgeon opens thestopcock to allow the irrigation fluid to fill
the bladder.
6. With the bladder distended, the surgeon inspects theprostatic urethra and
bladder trigone.
7. After determining the location of the ureteral orifice, thesurgeon begins
electrodissection, alternating cutting andcoagulating currents as required.

1
ADPO 2/2019 GU surgery

8. The bladder is drained, washing out prostatic tissue and small blood clots.
-At times the surgeon may use the Ellik evacuator to remove resected prostatic
tissue.
-The Ellik is used by removing the working element of the resectoscope, fitting
the nozzle of the evacuator onto the resectoscope sheath, and removing the
bladder contents by manual pulsatile pressure.
-The scrub person ensures an Ellik or Urovac evacuator or a Toomey syringe is
readily available for manual irrigation.
-Fluid may be drawn from the irrigant directly into the resectoscope sheath
through the already attached tubing.
9. When the resection is completed, the surgeon inspects the prostatic fossa to
ensure that all bleeding points have been coagulated.
10. The resectoscope is then removed
- a Foley catheter (22F or 24F, two-way or three-way, 30-mL balloon) is inserted
into the bladder for urinary drainage.
- The balloon is inflated (Fig. 15.25A), pulled gently in traction against the
bladder neck, and secured, to help control venous bleeding (see Fig. 15.25B).
- The Foley balloon must not be inflated within the prostatic fossa (see Fig.
15.25C), in which it may cause excessive bleeding from the resected prostatic
capsule.
- If desired, continuous irrigation with gravity drainage is initiated, with normal
saline as the bladder irrigant instead of sorbitol or glycine. A 3- to 4-L urinary
drainage system is suggested to avoid frequent emptying of the drainage bag.

2
ADPO 2/2019 GU surgery

References
Rothrock J.C, ( 2019) Care of the Patient in Surgery 16th Edition
Page: 3032 ( PDF mode)