Zusammenfassung
Die transurethrale Elektroresektion der Prostata (TUR-P) gilt als „golden standard“ bei der Behandlung des BPH-Syndroms. Mit dem Aufkommen alternativer, minimal-invasiver Verfahren wurden neue Anforderungen an diese Form der Hochfrequenz-Chirurgie gestellt. Bei gleicher Effektivität mussten Blutungs- und Einschwemmungsraten reduziert werden. Mit dem Einsatz breiterer Schlingen- und Rollerelektroden wollte man, über einen verlängerten Gewebekontakt, eine effektivere Koagulation beim Schneidevorgang erlangen. Modifikationen am Hochfrequenzgenerator führten zu dem „koagulierenden intermittierenden Schneiden“ (KIS), der „Instante-Response-“ und der „Dry-Cut-Technologie“. Diese Verfahren kombinieren Schneide- und Koagulationseffekte zur Realisierung eines blutungsarmen und effizienten Resektionsvorganges. Die Einführung der bipolaren Stromführung eröffnete zudem die Möglichkeit der Resektion in isotonischer Kochsalzlösung und damit der theoretischen Vermeidung eines Einschwemm-Syndroms. Durch die neoadjuvante Gabe von 5α-Reduktase-Hemmern vor geplanter TUR-P sollten Blutungskomplikationen, über eine Größenreduktion und Minderdurchblutung der Prostata, gesenkt werden.
Einiges davon setzte sich durch und so blieb die transurethralen Resektionschirurgie Methode der Wahl bei der instrumentellen Therapie des BPH-Syndroms. In Wirkung und Kosten wird sie in Zukunft mit der Laserresektion und der Laservaporisation zu vergleichen sein.
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 5α-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.
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Alschibaja, M., May, F., Treiber, U. et al. Transurethrale Resektion bei benigner Prostatahyperplasie. Urologe [A] 44, 499–504 (2005). https://doi.org/10.1007/s00120-005-0802-z
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DOI: https://doi.org/10.1007/s00120-005-0802-z
Schlüsselwörter
- Benignes Prostatasyndrom
- TUR-P
- Hochfrequenz-Chirurgie
- Koagulierend-intermittierendes Schneiden
- Dry-Cut-Technologie