During TURP, while dissecting around the verumontenum, the surgeon should specifically take care to avoid injury to which of the following?
|C||Trigone of the bladder|
|D||External urethral sphincter|
The most common area of injury to the external sphincter is at the 12-o'clock position, where direct visualization of the verumontanum is not possible. Therefore, be extremely careful at the distal surgical margins, particularly when resecting at the 12-o'clock position opposite the verumontanum, to avoid inadvertent damage to the external sphincter.
a. The Nesbit technique is probably the best-known and most commonly performed TURP method.
b. The single most important anatomical landmark in transurethral prostate surgery is the verumontanum . It is a midline structure located on the floor of the distal prostatic urethra just proximal to the external sphincter muscle.
c. The orifices to the ejaculatory ducts emerge in the verumontanum. Its importance lies with its position immediately proximal to the external sphincter muscle. This allows it to be used as the distal landmark for prostate resection. The precise distance between the verumontanum and the external sphincter demonstrates some slight individual variation and should be verified visually before starting the resection and periodically during the surgery.
d. The posterior urethra is dissected caudally to the verumontanum.
e. Care is taken when dissecting near the seminal vesicles to avoid injuring the NVBs that are situated just lateral to the seminal vesicles. Blunt and sharp dissection, avoiding the use of electrocautery, is recommended, especially during dissection of the tip of the seminal vesicles.
f. Correct handling of puboprostatic ligaments, external urethra sphincter, prostatic fasciae and neurovascular bundle (NVB) diminishes the disturbance to urogenital function after RPE.