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Lasergestützte Resektionstechniken bei benigner Prostatahyperplasie

Laser-based resecting techniques in the treatment of benign prostatic obstruction

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Zusammenfassung

Für kaum eine Erkrankung in der Urologie gibt es so viele Therapieansätze wie für die Therapie der benignen Prostatahyperplasie (BPH). Über die letzten Jahrzehnte wurden immer wieder neue Therapieverfahren auf den Markt gebracht, um den Goldstandard, die monopolare Resektion mit der Schlinge, zu ersetzen. Nur wenige Verfahren haben sich hierbei klinisch tatsächlich etabliert. Nach einer ersten Verbreitungswelle des Nd:YAG-Lasers zur Behandlung der BPH wurde die Lasertherapie allerdings wieder komplett verlassen. Zu lang waren die Operationszeiten, zu mäßig die Erfolge und die Nebenwirkung zu ausgeprägt, um sich mit der TURP messen zu können.

Erst in den letzten Jahren hat, mit zunehmendem Verständnis der Laserphysik und der Entwicklung neuer Laser, die Laserchirurgie der benignen Prostataobstruktion wieder an Bedeutung gewonnen. Hierbei konkurrieren verschiedene vaporisierende und resezierende Verfahren um die Vormachtstellung in der klinischen Anwendung. Ziel dieses Artikels ist es, die aktuell zur Verfügung stehenden lasergestützten Resektionsverfahren vorzustellen und die Vor- sowie Nachteile der Verfahren zu beleuchten.

Abstract

A brought variety of options are at hand in the treatment of benign prostatic obstruction. During the last decades multiple therapeutic approaches have been pushed on the market to compete with the known Gold-Standard, the monopolar TUR-P. Only few have stood the test of time. The first wave of laser-based prostate surgery took place, when the Nd:YAG laser was introduced into clinical urology. However, operating time was long, surgical outcome often poor and the risk of serious complications was high. This lead to the vanishing of Nd:YAG lasers in clinical routine.

During the last years, with growing experience in laser physics and the development of new laser types, the laser-based prostatic surgery gained importance. In clinical routine different vaporizing or resecting techniques are established and compete on the market. Aim of this article is to review those lasers, which are currently used in resection techniques and to highlight advantages, but also disadvantages of the different systems.

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  1. Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland

    A.J. Gross & T. Bach

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  2. T. Bach
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Correspondence to A.J. Gross.

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Gross, A., Bach, T. Lasergestützte Resektionstechniken bei benigner Prostatahyperplasie. Urologe 47, 455–460 (2008). https://doi.org/10.1007/s00120-008-1662-0

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