Transurethral resection of the prostate (TURP) has been gradually adopted in Japan as well as in Europe and America for benign prostatic hyperplasia. TURP is a safe method for older patients, because they have a minimal morbidity from the operations. The main disadvantage with this method is that it is very difficult to remove the prostate completely from the surgical capsule without inflicting an injury on the external urethral sphincter or without causing a perforation of the surgical

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... Open prostatectomy is to detach adenoma from the surgical capsule with a finger or a pair of scissors. In order to achieve this end more effectively, I elaborated the method of the detachment of the enlarged prostatic gland by transurethral approach, and devised a detaching instrument . The top of the detaching instrument was tongue-shaped so as to detach the prostate easily and prevent a perforation of the surgical capsule. The instrument was employed together with a resectoscope. The instrument was interchangeable with the loop of the resectoscope. The prostate was detached with the instrument and resected with the loop . The detaching instrument was movable forward and backward in the same way as the loop (Fig. 1) . The urethral mucosa was incised in the form of a ring at the abutment to the urethral membrane of the apex of the prostate with the resectoscope knife . When endoscopic vision was not good on account of the poor flow of irrigation fluid, the prostatic gland was partially resected with TURP so as to improve the flow. The detaching instrument was inserted into the apex of the prostate, and the prostatic gland was detached , using a finger introduced into the rectum as the guide. The surgical capsule was identified and along this capsule, detachment was carried out from the apex to the bladder neck (Fig . 2 ). The detached prostate gland, which was still partly attached to the bladder neck, could be resected more easily with TURP. The new method was employed in 7 benign prostatic hyperplasia cases between May and July in 1983 . The patients ranged in age from 65 to 83 years, (average: 73). The operation time was 60 to 90 min (average: 68 min) . Twenty five min in average (20-30 min) were needed for the incision of the urethral mucosa and detachment of the prostate . The resected tissue weighed 6-47g (average : 19g). The blood loss was 226 ml in average , ranging from 90 to 450 ml and there were no cases of blood transfusions . In 3 of 7 cases, the prostate was completely removed. In the remaining 4 cases, the detachment was complete in the Present address :