Transurethrale Resektion bei benigner Prostatahyperplasie

Abstract

Transurethral resection of the prostate still represents the "gold standard" in surgical treatment of symptomatic benign prostatic enlargement (BPE). New demands were made on transurethral electrosurgery with the appearance of alternative, minimal invasive procedures. Bleeding complications had to be reduced. Different attempts were made to improve the conventional TURP. Band loops and roller bars were developed in order to gain a more effective coagulation during the cutting process by a larger tissue contact. Major advances could be achieved by modifications of the high-frequency generator. Improved procedures like the "Coagulating-Intermittent-Cutting" (CIC), the "Instant-Response-", as well as the "Dry-Cut-Technology" combine cutting and coagulating effects to realize lowered bleeding and an efficient resection process. The introduction of bipolar currency flow opens the possibility of conventional TUR-P with saline solutions and thus to the theoretical avoidance of the TUR-syndrome. By the neoadjuvant use of 5alpha-reductase-inhibitors before planned TUR-P, bleeding- and irrigation fluid absorption should be reduced by lowering perfusion and the size of the prostate. Regarding these innovative approaches which improve the surgical standard and minimize the risk of perioperative complications, transurethral electrosurgery remains the method of choice in instrumental therapy of symptomatic BPE. In the future efficacy and costs will be comparable to those of the transurethral laser-resection or laser-vaporisation.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: a propensity score-matched analysis

“…The risk of TUR syndrome is eliminated because of the use of bipolar or laser technology with 0.9% sodium chloride solution as the irrigation fluid. 20 21 22 23 24 25 …”

Optimizing Population Health and Economic Outcomes: Innovative Treatment for BPH

“…14 In addition, the procedure is contraindicated for patients older than 80 years of age and patients with coagulopathy. 15 A somewhat less invasive surgery -the transurethral incision of prostate (TUIP) -is an appropriate option for men with very small prostates. Similar in nature to TURP, TUIP involves creating 2 deep channels through a prostate rather than removal of the entire adenoma.…”