TURP (Transurethral resection of the prostate)
From Guthrie to HoLEP
The TURP as we know it today is a development of prostatic and bladder neck incisions, punches and cautery.
John Hunter and his nephew, Everard Home (1756 – 1832), were the first to describe the prostate as a source of urinary outflow obstruction. Prior to this, some surgeons, such as Ambroise Paré, thought there were urethral carnosities and tried to scrape them out using a sharp sound.
||George Guthrie of London described the use of a spring loaded knife in a hollow sound to cut through the “bar” at the bladder neck and, in 1836, the Parisian Mercier described a “punch” to remove pieces of this bar.
||Enrico Bottini of Italy electrified his prostatic incisor but this instrument was used blind until Freudenberg added a cystoscope.
||Hugh Hampton Young modified his urethroscope into a prostatic punch to cut tissue away from the bladder neck; he added an electric cautery blade in 1911. Both these instruments were used under local anaesthetic and in air. Edwin Beer , also an American, was the first to apply an electrical current under water (the Oudin unipolar current).
||Maximilian Stern (1873 - 1946) presented his "resectoscope". Also capable of working under water, it used a tungsten wire loop to remove "spaghetti-like" pieces of prostate. The resectoscope was further improved by the electrical engineer-turned surgeon, Theodore Davis . Further improvements were made by Joseph McCarthy (1874 - 1965), whose popular resectoscope was the first to pull the loop backwards, out of the bladder towards the user as we do today.
||Reed Nesbit modified the Stern-Davis-McCarthy resectoscope by adding a spring so it could be used with one hand.
||Creevy became worried about TUR syndrome and later introduced 4% glycine as an irrigant to replace water.
||Iglesias modified a 1930’s irrigating cystoscope into a continuous irrigation resectoscope.
The prostatic punch and TURP were new technologies with significant morbidity and mortality in the wrong hands. Take-up in the UK was slow but pioneering urologists such as John Blandy and the members of the Punch Club championed transurethral prostate surgery in Britain.
View a brief video of TURP, together with links to BAUS-approved information leaflets about the procedure, in the "I'm Told I Might Need" (information leaflets) section.
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