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Die radikale transurethrale Resektion der Prostata

Eine alternative Operationsmethode zur Behandlung des Prostatakarzinoms

Radical transurethral resection of the prostate

An alternative therapy for the treatment of prostate cancer

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Zusammenfassung

Die Wertigkeit der radikalen transurethralen Resektion der Prostata beim lokal begrenzten Prostatakarzinom (TURPC) als alternative Therapie wird in einer prospektiven Studie untersucht. Von Januar 1995 bis Juli 2008 wurden 533 Patienten mit einem medianen Alter von 67 (40–89) Jahren mit klinisch lokalisiertem Prostatakarzinom mit kurativer Intention vom Erstautor reseziert. Die Verteilung des Stadiums war (in %): pT1: 8, pT2: 61, pT3: 31, und G1: 2, G2: 80, G3: 18. Die TURPC erfordert die Niederdruckdauerspülung mit einem Flüssigkeitsniveau im Irrigationsgefäß auf einer Höhe von <10 cm über der Symphyse. Verwendet werden ein suprapubischer Trokar, ein Resektoskop mit 28-Ch.-Schaft, ein elektronisch geregelter Hochfrequenzgenerator und Videomonitoring. Die Prostata wird komplett reseziert mit peripherer Kapsel und Samenblasen. Das Präparat wird in Fraktionen entnommen, um ein korrektes histopathologisches Staging zu erhalten. Eine Staginglymphadenektomie wird laparoskopisch durchgeführt, wenn sie indiziert ist. Eine Sicherheitsresektion erfolgt nach 8 Wochen, um positive Schnittränder zu vermeiden.

Die Transfusionsrate lag bei 1,5%, Revisionen wegen Nachblutung bei 2,4%, Lungenembolie bei 0,2%, Blasenhalskerbung bei 14%, Inkontinenzgrad 2: 0,6%/314, Impotenz 30%/136. Der PSA-Nadir betrug ≤0,2 ng/ml in 95% der Fälle (n=444), das PSA-Rezidiv nach 5 Jahren 6% pT1, 18% pT2, 31% pT3. Postoperatives Überleben nach 10 Jahren 96% für pT1-, 91% für pT2- und 85% für pT3-Patienten.

Das Prostatakarzinom kann transurethral radikal mit guten onkologischen Ergebnissen und Überlebensraten reseziert werden, wie sie in aktuellen Arbeiten publiziert sind. Die Inkontinenzrate ist gering. Die Niederdruckirrigation mit suprapubischem Trokar ist unabdingbar für die sichere Durchführung.

Abstract

The value of radical transurethral resection of prostate cancer (TURPC) as an alternative therapy was investigated in this prospective study. From January 1995 to July 2008, 533 patients with a median age of 67 years (range 40–89 years) and with clinically localized prostate cancer were resected by the corresponding author with curative intention. The tumor stages were as follows: pT1 8%; pT2 61%; pT3 31%; G1 2%; G2 80%; G3 18%. TURPC requires continuous low-pressure irrigation with the irrigator liquid level at 10 cm water above the pubic region. It also requires a suprapubic trocar, a resectoscope with a 28F sheath, an autoregulated electrosurgical unit, and video monitoring. The prostate is resected completely with peripheral capsule and seminal vesicles. The specimen is retrieved in fractions for correct histopathological staging. If indicated, laparoscopic staging lymphadenectomy is performed. A secondary session for control of positive margins follows after 8 weeks.

The transfusion rate was 1.5%, revision for hemorrhage 2.4%, lung embolism 0.2%, bladder neck incision 14%, grade 2 incontinence 0.6% out of 314, and impotence 30% out of 136. The prostate-specific antigen (PSA) nadir was ≤0.2 ng/ml in 95% of 444 cases. PSA recurrence at 5 years was 6% for pT1, 18% for pT2, and 31% for pT3. Postoperative survival at 10 years was 96% for pT1, 91% for pT2, and 85% for pT3 patients.

Prostate cancer can be resected transurethrally with reasonable oncological results. The outcome with respect to survival and PSA recurrence is comparable with the results of other published procedures. Low-pressure irrigation with a suprapubic trocar is mandatory for safe performance.

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  1. Urologische Klinik, Karl-Olga-Krankenhaus, Hackstraße 61, 70190, Stuttgart, Deutschland

    M.A. Reuter

  2. Institut für Medizinische Biometrie, Universität, Tübingen, Deutschland

    K. Dietz

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  2. K. Dietz
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Correspondence to M.A. Reuter.

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Reuter, M., Dietz, K. Die radikale transurethrale Resektion der Prostata. Urologe 48, 740–747 (2009). https://doi.org/10.1007/s00120-009-1982-8

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  • DOI: https://doi.org/10.1007/s00120-009-1982-8

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