Dynamic approach to transurethral resection of large prostate adenoma

Since it is not how much tissue is removed but rather how much is left behind that attests to the quality of a TURP, an explanation of four common complications is offered hoping that with this increased understanding the resectionist will be more comfortable with the procedure and undertake careful resection of larger prostate glands. The following guidelines are offered: (1) allow time after the initial resection of easily reached adenoma for the delivery by the contracting capsule of the peripheral adenoma and the apical masses. One can always return to these areas for further rapid resection. (2) Do not resect within 0.5 or 1.0 cm of the bladder neck until the very end of the procedure. This will minimize the undermining of the vesicle neck and the "climbing" of the trigone. It will also allow for the preservation of vesicle mucosa up to or over the bladder neck thus lessening the chance of later contracture at this site. (3) Do not resect the juxta capsular adenoma in the "levator ani area" until near the end of the procedure.