IMPROVEMENT OF PROSTATIC DETACHING BLADE FOR TRANSURETHRAL ENUCLEATION OF BENIGN PROSTATIC HYPERPLASIA

Abstract

A prostatic detaching blade and a new endoscopic method have been devised for complete removal of benign prostatic hyperplasia as well as open prostatectomy. The Hiraoka's prostatic detaching blade which has the same function as the finger used in open prostatectomy was used, which was inserted into the resectoscope instead of the loop. The continuous irrigation method was useful. Circular incision of the urethral mucosa and periurethral fibromuscular layer was performed deeply to the adenoma at its apex with an electric knife. Circular resection of the central region of the adenoma was done with the loop and hemostasis of the main arteries was made at the bladder neck. The detaching blade was inserted into the urethral mucosal incision line and the apex of the adenoma was detached from the adjacent tissues. The detachment took place from the apex to the bladder neck except at the 6 o'clock region underneath the bladder neck for the prevention of perforation and dropping of a big mass into the bladder. The resection was completed with the loop. 100 cases were operated by this method and all were succeeded in total resection. The operation time was from 20 to 120 minutes with an average of 62 minutes. The weight of resected tissue ranged from 1.5 to 75g. (average: 22.9g). As intra and post operative complications were one case of perforation, two blood transfusion, one transurethral coagulation for hemorrhage on the day of operation and two internal meatal stenosis. Transurethral enucleation of benign prostatic hyperplasia provides complete removal of the adenoma safely and easily. We believe this new method provides a significant advantage over the routine transurethral resection.