Handbook of Transurethral Resection (TUR) Technique M Anandan
Page numbers followed by f refer to figure and t refer to table.
Abdominal traction 124
ACMI hemielectrode 86, 87f
enucleation of 76
lifting of 99f
mucosa junction 73f, 74f
separation of 79f
yellowish brown appearance of 45f
Alexander's syringe 47
Amino acid, nonessential 64
Analgesics 125
Anesthesia 113
epidural 27, 113
general 30, 59, 113
regional 27, 59
spinal 27, 29, 113
Anesthetic management 29
Anticoagulants 28, 28t
Antiplatelets 28t
Apical lobe dissection 97
Avascular enucleated adenoma, resection of 81f
Baumrucker system 4
Beta blockers 28
Bilobar gland 75
Bipolar circuit 14f
Bipolar energy 110
Bipolar enucleation, instruments for 68f
Bipolar resection 6
carcinoma 102
distension 109
diverticulum, tumor in 109
dome, resection at 108
endoscopic anatomy of 18
irrigation, continuous 103
jackstone calculus, large 52f
lateral wall of 109f
mucosa 24
neck 23, 103, 118
aperture 23f
contracture 135
elevation, severe 23f
incision 53, 54f
level of 99f
proximal level of 79f
shelf like elevation of 24f
perforation 111
minimal 112f
tumor 111
large 105f
management 111
wall, tumor on anterior 108
Bleeding 129
and coagulopathy 32
and transfusion 127
control of 42
postoperative 111
Blind obturator 11
pressure 62
transfusion rates, lower 117
Boat (canoe) shaped chips 40f
Bradycardia 131
Budenoch artery, coagulation of 119f
Bulbar urethra 19, 20f, 50
Button electrode 86
Capsular fibers 96
Capsular perforation 127, 130
with fat exposed 47f
Capsular resection, deeper 46f
Capsule, superficial layer of 46f
Carcinoma in situ, diffuse 106
Cardiac pacemaker 117
Cardiac rhythm either 12
Cardiovascular system assessment 28
Catheter insertion 122
Catheterization, difficult 122
irrigation 123
traction 123
Cautery artifact, reducing 110
Cerebral edema 65
Clot retention 127, 132
Collin's knife 107
incision 9
Commissure incision, anterior 98f
Crisscrossing fibers 45
Cystoscope 7, 59
sheath 7
basic 39
initial 104
steps of 95
white light 104
Cytal 65
Deflate balloon 126
Diabetes mellitus 27
and lasers 12
cable 5
equipment 5
pads 36
Diode lasers 16
Distal sphincter 51f
Drainage hose 6
Drug intake 27
Dysuria 113
Electric desiccation 106
Electrode 9
design 85
Ellick's evacuator 9, 11, 47, 100
classical 48f
modified 47f
Endoscopes 3
steam sterilization of 7
Endoscopic enucleation 67
Endoscopic surgery 3, 63
Energy shock waves, high 114
Enucleate small glands 82
Enucleation 82
anatomical landmarks for 73
Epididymitis 127
Epidural analgesia 30
Equipment 94
Evacuator 5
Fasting guidelines 29
Fine parallel fibers 46f
Finger-operated working element 8
Fluid, extravasation of 130
Fluorescence cystoscopy 104
Fresh frozen plasma 28
Gas sterilization 7
and capsule, differentiation of 44
small wedges of 88
Glucose 65
Glycine 63, 64
toxicity 31
Grooved rollerbar 85
Guyon's catheter 122
Haemorrhage, primary 125
Hematuria 102
painless 102
Hemoglobinuria, postoperative 63
Hemostasis 99
Holmium laser 17
application for prostate 94
enucleation of prostate 94
Holmium:yttrium-aluminum-garnet laser 94
Hydronephrosis 127
Hypertension, secondary to 27
Hyponatremia 131
Hypotension 131
Hypothermia 32, 129
Incontinence 127
Infection 113
Insulin 28
Intensity focused ultrasound, high 114
International Prostate Symptom Score 83
Intracranial tumors, removal of 50
Intraoperative priapism 129
Intraperitoneal extravasation 112
Irrigants 31t
Irrigating solutions 104
Irrigation fluids 64
Irrigation tubes 5
Karl Storz for bipolar enucleation of prostate 70f
Kegel's exercises 134
KTP lasers 17
KTP:YAG laser 16
Laparoscopic surgery 18
Laser 15
enucleation 94
fibers 16
types of 110
Lateral lobe dissection 97
Linear blood vessels 20f
Lithotomy position, classical 35
Litter's glands 19f
of lateral 97f
of left lateral 91f
of median 90f, 95, 95f, 96f
of right 77f
of right lateral 91f
from roof, separation of lateral 98
part of 97f
of left lateral 57f
of median 118
of right 118
small median 51f
Local microwave thermotherapy 114
electrode 9
for resection 5
types of 5
Mannitol 65
Meatal calibration 128
Meatus 18
Median lobe 119
resection 119f
Membranous urethra 19
Mercier's bar 26
Minimally invasive surgery, advantages of 83
Mitomycin C, postoperative 111
Monopolar circuit 14f
Monopolar resection, cornerstone of 49
Morcellation 100
Mushroom button electrode from olympus 71f
Myocardial infarction 129
Navicular fossa 18, 135
Nd:YAG laser 16, 17
Nesbit system 4
Nesbit technique 61
Nonmuscle invasive tumors 102
Nonsteroidal anti-inflammatory drugs 28, 125
O'connor drape 62f
Obstructive pulmonary disease, chronic 27
Obstructive uropathy 27
Obturator 4
externus 33
nerve block 33
Occlusive lateral lobe 51f
Operation theater 3, 37
set up 38f
Oral hypoglycemic agent 28
Ortho-phthalaldehyde 7
Otis urethrotome 59
Oxyhemoglobin 15
Papillary low-grade tumors 110
Pearly white glistening capsule 45f
Penile urethra 19, 20f
Perforation 130
Peroneal nerve injury 35
Phimosis 128
button vaporization 89f
energy, advantages of 86
vaporization with button electrode 88
enucleation 67
resection 14, 88
vaporesection 91
vaporization 84, 86
Plexiform blood vessels 20f
Prevent obturator jerk 109f
Proctoclysis enema 35
Prostate 62, 118
ablation 2
bipolar enucleation of 67
chip being resected from 41f
chips of exposed loop length 43
fossa 123, 124, 132
gland lateral lobes 23f
in floor of 76f
on roof of 76f
parenchyma 41f, 42f
resection of 50, 67
surgery, history of 115
vaporization of 94
Prostatectomy, open 67
Prostatic calcification 46f
Prostatic chips 47
Prostatic hyperplasia
benign 2, 27, 54, 133
management of benign 67
Prostatic obstruction 49
Prostatic tissue 55, 88
bipolar resection of 116
removal 116
Prostatic urethra 20, 21
Prostatovesical junction 118
Reactionary bleeding, management of 125
Resected chips, removal of 47
Resection instruments 3
Resection near apex 61
inner sheath of 10
outer sheath of 10
sheath 4, 7
Respiratory system 29
Reuter suprapubic trocar 128
Robotic surgery 18
Roller electrode 85f
Rollerball 85
electrode 9
Sachse's knife 128
Saline, normal 65
Salvaris traction 124
Schmidt's obturator 4, 39
Schmidt's visual obturator 132
Sexual function 136
Sorbitol 65
Sphincter 118
Spinal anesthesia, contraindications for 30
Squamous cell carcinomas 102
Sterile water 64
Sterilization 6
Stern-McCarthy resectoscope 50
Toomey's evacuators 100
Toomey's syringe 9, 47, 48, 48f
Transurethral catheter 110
Transurethral enucleation 67
of prostate 68, 83
with bipolar 67, 69f, 71f, 72f
resection of prostate 67
Transurethral incision 50, 61
of prostate 50, 53, 54f
Transurethral monopolar resection of prostate 49
Transurethral procedures 1
Transurethral prostatectomy 49
Transurethral resection 2, 3, 34, 40, 60, 136
basics of 39
complications of 111
instruments for 37f
of bladder tumor 27, 32, 102, 103, 104
procedure 103
surgery 32
of prostate 2, 50, 55, 63, 67, 72f, 94, 115, 122
anatomical 118
anesthesia for 27
author's technique of bipolar 118
bipolar 115, 116
complications of 31, 127
efficacy of 127
mechanism of bipolar 115
monopolar 116
safety of 127
syndrome 31, 127, 131
syndrome, treatment of 32
technique of 58
training in 60
reaction 63
syndrome 57, 63, 112, 118, 130
elimination of 117
technique of 39
surgery, theater setup for 37
vaporization of prostate 84, 91
Tumor at dome 108
Tumor location 107
Urea 65
Ureteral orifice 26, 107
resection of 132
tumor involving 107
Ureteric catheter in situ 108f
Ureteric orifice 108f, 118
Urethra 103
anatomy of 18
dilated part of 18
endoscopic anatomy of 18
narrowed 53f
bougies 59
calibration 128
dilator, insertion of 122
meatus, external 18
sphincter, external 19, 21f
stricture 135
Urethrotomy 50
incontinence 133
retention 113, 134
infection 127, 135
symptoms, lower 121
Uroendoscopy, history of 1
Urological diseases, management of 1
Urosepsis 127
Urothelial cancer 102
Vapor tome 86
Vaporcut electrode 85f
Vaporesection 88
Vaporization, concept of 84
Verumontanum 20, 118
Vessels, types of 100
Visual obturator 11
Chapter Notes

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Editor M Anandan MS MCh Fellowship in Minimally Invasive Urology (Robotic Surgery) Consultant Urologist Kovai Medical Center and Hospital Coimbatore, Tamil Nadu, India Foreword PN Dogra
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Handbook of Transurethral Resection (TUR) Technique
First Edition: 2019
Printed at
Contributors Foreword
I am delighted to introduce the Handbook of Transurethral Resection (TUR) Technique of the prostate and bladder tumor edited by M Anandan. I have known M Anandan as a resident fellow while his rotation in urology during his training in surgery at All India Institute of Medical Sciences (AIIMS), New Delhi, India. He is a very keen observer and academician at heart. He was very sincere and methodical in managing patients and keeping the record. Many stalwarts in the field of urology have contributed to this handbook and I am sure this will be of immense help to the postgraduates and practicing urologists. The material and the quality of the pictures and photographs are excellent.
PN Dogra MS MCh FAMS DSc (H)
Immediate Past President of Urological Society of India
Professor and Head, Department of Urology
All India Institute of Medical Sciences
New Delhi, India
Transurethral endoscopic procedures have become as inherent part of urology. A thorough knowledge of the basics of transurethral endoscopy is necessary for a urologist. Though surgery is learnt in the operation theater, basic knowledge is essential for safe learning. This book will be helpful as a guide while endeavoring into uroendoscopy. Keeping in mind the need of the beginners of uroendoscopy, chapters have been designed to impart ‘practical’ knowledge of basic transurethral resection techniques to the readers. Chapters on endoscopic anatomy, instruments used for urethrocystoscopy, and patient preparation will be useful for beginners. The technique of resecting a prostatic chip is explained in detail. Transurethral resection of the prostate by unipolar and bipolar techniques has been described in separate chapters. Newer advancements like techniques of transurethral enucleation and resection, transurethral vaporization, holmium laser vaporization of the prostate have also been included. The surgical procedure is incomplete without postoperative care. Chapters on complications and postoperative care will give a comprehensive knowledge of uroendoscopy.
I convey my immense gratitude to the authors who have contributed to this book.
M Anandan
I am grateful to the authors who have passed on their decades old wisdom to the readers by contributing the chapters.
I thank Arunkumar, Deepak Rathi, Ganesh Gopalakrishnan, R Manikandan, Mallikarjuna Chiruvella, RM Meyyappan, PVLN Murthy, Narmada P Gupta, K Senthil, N Selvarajan, and R Vijayakumar, for devoting their precious time and effort in drafting the chapters.
I thank M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, and their staff for providing all the necessary help in shaping of the book.
I convey my gratitude to my parents, wife and daughters for supporting me in bringing out this book.
I thank the Almighty for giving me the opportunity to edit this book.