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.
Timeline
| 1830 |
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.
Guthrie
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| 1874 |
Enrico Bottini of Italy electrified his prostatic incisor but this instrument was used blind until Freudenberg added a cystoscope.
Bottini
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| 1909 |
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). |
| 1926 |
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.
Stern Davis McCarthy
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| 1939 |
Reed Nesbit modified the Stern-Davis-McCarthy resectoscope by adding a spring so it could be used with one hand.
Nesbit
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| 1947 |
Creevy became worried about TUR syndrome and later introduced 4% glycine as an irrigant to replace water. |
| 1970s |
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.
A brief video of TURP
Introducing TURP into the UK
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