Operative note 07 Core
TURP - core resection technique
What it does: shave the prostate through the penis, chip by chip.
- Tight urethra for the 24/26Ch sheath? Dilate with Clutton sounds. Or cut with Otis to 30.
- Cut canoe-shaped chips. Bring the loop fully out, or cut on the sheath edge.
- Never pull the loop deep inside the sheath. The spark can crack the lens.
- Rhythm: lift the handpiece, sink the loop, stroke towards yourself.
- Make each stroke count. Chip as deep as the loop.
- ALWAYS know where the veru is. The veru is the distal limit. Neck is the top limit.
- Arterial bleeder: coagulate on sight, at its point, not the bed around it. Venous sinus: do not chase it. Coagulating it opens it.
- Venous ooze: slow the water. Fast flow hides veins.
- Chips out with the Ellik: bulb full, no air. Squeeze and release until the return is clear. Look behind the neck for the last chip.
- Bubbles: stop flow, drain, tap the scope.
- Legs at 45 degrees max to the table.
- Watch: Spinal anaesthetic is common. An awake patient sees flashing lights early. That can be the first sign of TUR syndrome. (Fluid getting into the veins. Sodium drops.)
- 2026 update: Bipolar TURP on saline is now the UK default. No glycine. No classic TUR syndrome.
- 2026 update: Big gland over 80-100 mL? EAU 2026 backs laser enucleation (HoLEP or ThuLEP). Size does not limit it.
- 2026 update: Rezum, Aquablation, UroLift, PAE also in the pathway.
From the UroRef Operative Quick Guide.