TUEB Surgery Guide
TUEB (Transurethral Enucleation with Bipolar) Procedures
Supervised by Ken Nakagawa, M.D., Department of Urology, Keio University
Sample of TUEB procedures
1. Marking & Incision of Urethral Mucosa Incise and mark the urethral mucosa on the distal end of the adenoma along the Nesbit sign with a loop (or needle) electrode.
2. Resection around 12 o’clock
Resect the tissue between the 11 and 1 o’clock position with a loop electrode. This step makes enucleation of the left and right lobe easier.
3. Resection at 5 & 7 o’clock
Resect the 5 and 7 o’clock position from the bladder neck to the marked position at 1 with a loop (or needle) electrode, for dividing the adenoma into three blocks; the median, left and right lobe.
4. Enucleation of the Median Lobe Enucleate the median lobe, using a TUEB electrode. Applying the tip of the electrode’s
spatula, enucleate the lobe longitudinally from the marked position at 1 to the area nearby the bladder neck. To keep the view clear, you need to simultaneously coagulate the blood vessels and stop bleeding with enucleation.
5. Enucleation of the Median Lobe nearby the Bladder Neck
Rotate the spatula 90° and then enucleate the median lobe at the bladder neck laterally along the round of the internal urethral orifice. Incise the remaining mucosa with arc discharge of a TUEB electrode. The entire median lobe is pushed into the bladder, leave them until 8 is performed.
6. Enucleation of the Left Lobe
Enucleate the left lobe from the marked position at 1 with a TUEB electrode. In general, up to the 3 o’clock position, enucleate the lobe longitudinally with back and forth strokes.
Upward ventrally from the 3 o’clock position, apply the whole spatula to enucleate the lobe by rotating the spatula itself. If it is hard to enucleate the left lobe, perform the additional delicate incision with arc discharge.
7. Enucleation of the Right Lobe Enucleate the right lobe with performing the same procedure as 6 .
8. Recovery of the Enucleated Adenoma After completing the enucleation, trim the surface with a loop electrode. Larger fragments are then recovered from the bladder with a morcellator.
