TURP Procedure Guide: Equipment and Workflow for the OR Team

What a TURP set contains

A working set has a resectoscope with an outer sheath, an inner sheath and a working element, a telescope, a cutting loop and coagulation electrodes, a light cable, a camera head and monitor, a high-frequency (HF) generator with footswitch, continuous irrigation and drainage, an evacuator for tissue chips and a urethral catheter. Backup loops, spare telescopes and a second set of sheaths should be ready in case of damage.

The Richard Wolf SHARK resectoscope uses continuous-irrigation double sheaths in 22/24 Fr and 24/26 Fr, an inner sheath rotatable through 360°, enlarged irrigation taps and a redesigned electrode fork with electrode arrest. Snap-on couplings make assembly quick, and its working elements stay compatible with earlier Richard Wolf resectoscope sheaths.

Techniques in TURP: monopolar and bipolar

In monopolar TURP, current passes through the patient to a return pad and a non-conductive irrigation fluid such as glycine or sorbitol solution is required. In bipolar TURP, current stays between electrodes on the instrument and saline is used. Bipolar saline systems reduce the risk of dilutional hyponatraemia, known as TUR syndrome, but fluid absorption is still monitored in both techniques.

The HF generator must match the instrument. The HF-GENERATOR 2260 carries presets for monopolar and bipolar TUR-P, TUR-B, bipolar enucleation, laparoscopy and hysteroscopic resection, with cutting power up to 400 W and coagulation power up to 350 W. Touch-display navigation helps keep voltage within the limit allowed for the connected instrument, and bipolar electrode ignition lets the surgeon cut without tissue contact.

TURP procedure steps from the OR team's view

Typical steps are: positioning in lithotomy and applying the return pad if monopolar; checking the instrument, camera, light and generator before the patient is draped; urethral and bladder inspection; resection of the prostatic tissue in a planned order, usually lobe by lobe, with the surgeon removing tissue toward the bladder; haemostasis by coagulation; flushing out the chips with an evacuator; and insertion of a catheter with irrigation if required.

The team should log the volume of irrigation fluid used and recovered. Time pressure, irrigation height and bladder fullness all matter, and the circulating nurse must tell the surgeon when fluid deficit approaches the department's limit.

• Before: check sheaths, loops, tubing and generator test
• During: monitor view, irrigation, fluid balance and bleeding
• After: evacuate chips, send tissue for histology per protocol, count instruments

Irrigation, fluid deficit and camera

Gravity irrigation is simple but depends on bag height. A pump with deficit monitoring gives the team numbers. FLUID CONTROL 2225 is a suction and irrigation pump for gynaecology, urology and general surgery with a maximum irrigation flow of 1800 ml/min and suction flow of 2000 ml/min. It shows fluid deficit continuously via an optional mobile balancing module with two weighing cells.

A camera makes the procedure visible to the whole team and helps teaching. Check that the camera head fits the telescope eyepiece, that the monitor is placed in the surgeon's line of sight and that image recording meets your documentation needs.

Choosing between TURP and other options

TURP is one option among enucleation and other techniques; the clinical choice is for the surgeon and patient. From an equipment viewpoint see bipolar resectoscope TURP and HoLEP vs TURP to understand how different techniques change the equipment list.

Beckfinity can supply SHARK, the HF generator and the irrigation pump as a coordinated system with installation and staff training. Request a quote or consultation to specify a TURP set for your operating theatre.