CU 20. Transurethral resection of the large - volume prostate and its efficacy

Objective: To investigate the operative methods, techniques and efficacy assessments of transurethral resection of the prostate (TURP) for the treatment of large volume prostate.

Methods: Clinical data were retrospectively analyzed in 13 patients with prostate volume >100 g who underwent TURP in our hospital from March 2008 to March 2009 to summarize operative skills and evaluate operative effect. Operative Methods: a resectoscope were inserted into the urethra under direct vision, the morphology, size and main proliferation sites of prostate were assessed and the interureteric ridge was located. Excision sequence: cut out two troughs deep to prostate capsule from the bladder neck to the prostatic apex at the 5 and 7 o'clock position, bleedings was completely stopped and to the most blood supply of the prostate was cut off to make this part of prostate tissue island-like. The movement of endoscopic sheath was marked by the trough cut before, and prostate tissue was rapidly resected. And then set the 5 and 7 o'clock position as starting point to resect the rest prostate tissue in clockwise and counterclockwise directions. The resected tissue should be stripped and scaphoid. The section should be thin-crossed in the area close to the capsule, prostatic apex that is very important was left to performed at last. yperplasic tissue was completely removed as marked by seminal hillock, especially the hyperplasic tissue at the 12 o'clock position that is also the most vunerable part in urethral sphincter. It should be carefully identified to prevent injury. The prostatic apex should be like a circle hole without tissue collapse or pedicled flap tissue to prevent the affect on postoperative urination.

Results: Resected prostate tissue was 90-150 with the average of 115 g; the operative time was 90-140 min, the mean time was 110 min. Intraoperative blood loss was 250-500 mL, 2 units of concentrated red cells were administrated in 4 cases respectively. No TURS and other complication occurred. The follow-up lasted for 6 months. The maximum urinary flow rate was rate (17.5±7) mL/s and significantly improved compared with that of preoperation (P<0.01).

Conclusions: Skilled TURP by partitions is a safe and effective way to treat benign prostatic hyperplasia with the weight more than 100 g.