TURP vs TURBT: how the resectoscope set-up differs for urology OR teams

Same platform, different configuration

Transurethral resection of the prostate (TURP) and transurethral resection of bladder tumour (TURBT) both use a resectoscope: a telescope, a working element, an inner and outer sheath with continuous irrigation, and a cutting loop or electrode connected to an energy source. The platform is shared, so a well-chosen set can serve both lists.

What changes is how the set is built for each case, who needs to be trained, and what extra items the room carries. Our general TURP equipment guide describes the base set; this article focuses on where TURBT differs.

Resectoscope for TURBT and TURP: sheaths, elements and loops

The Richard Wolf SHARK resectoscope uses continuous-irrigation double sheaths in 22/24 Fr and 24/26 Fr, an inner sheath that rotates through 360°, a redesigned electrode fork with an electrode arrest, enlarged irrigation taps and snap-on couplings. Its working elements remain compatible with earlier Richard Wolf sheaths, and it can be used with the ENDOCAM Logic HD PENDUAL camera head.

In practice, departments choose sheath size, telescope angle and loop shape to match the case. For TURBT teams often keep several loop forms available, and a means of retrieving chips; for TURP the working set is similar but fluid handling and chip evacuation are planned around larger tissue volumes. The surgeon decides the technique.

• Sheath size and obturator matched to the case and to the urethra.
• Telescope with the angle the surgeon prefers, plus a spare.
• Loop and electrode types for cutting, coagulation or vaporisation.
• Chip evacuation: evacuator or irrigation-based method, per local practice.
• Specimen containers and labelling for pathology.

Energy: monopolar, bipolar and generator presets

Resection can use monopolar current in non-conductive irrigation fluid, or bipolar current in saline, depending on the system. The choice affects the irrigation fluid stocked, the electrode set and the generator settings, so decide it at planning stage rather than per case.

The HF-GENERATOR 2260 is described as an electrosurgical source for urology, general surgery and gynecology with presets covering monopolar and bipolar TUR-P and TUR-B, bipolar enucleation, laparoscopy and hysteroscopic resection. It delivers up to 400 W cutting and 350 W coagulation, uses RFID detection for quick set-up and connects to core nova via LAN.

Imaging and TURBT: white light, blue light and documentation

TURBT often involves a diagnostic look at the bladder before and during resection, so the imaging chain matters: camera, light source, monitor and recording. Documentation of the tumour sites is typically part of the record.

For departments that add photodynamic diagnosis, the System blue set combines an ENDOCAM Logic 4K controller, PENDUAL blue HD camera head, ENDOLIGHT LED blue light source, PANOVIEW blue telescopes and a special blue fibre light cable, matched to the photosensitizer Hexvix. Per its description, the same camera head also serves for white-light endoscopy. How this is used clinically is for urologists to decide. The Pulvis 60+ thulium laser is also described as suited to TUR-B and en bloc resection of bladder tumours.

Reprocessing and purchasing checklist

Resectoscope components, telescopes and camera heads need validated cleaning and sterilization, and spare sheaths and working elements prevent list cancellations. Confirm the fluid-management setup, the generator's presets, and whether your cystoscopes and resectoscopes share telescopes. See cystoscopy and resection set-ups for room layout.

Beckfinity can prepare a configuration for your urology OR from Richard Wolf components. Request a quote through our contact page.

Also check stock of irrigation fluid, collection bags and tubing, and make sure scrub nurses are trained to assemble the resectoscope and test insulation before every case.