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Operative Therapie des benignen Prostatasyndroms – resezieren, vaporisieren oder enukleieren?

Surgical treatment of benign prostatic hyperplasia—resection, vaporization or enucleation?

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Zusammenfassung

Hintergrund

Das benigne Prostatasyndrom (BPS) ist die häufigste Erkrankung im Bereich des unteren Harntrakts des Mannes. Zur operativen Therapie stehen neben der transurethralen Resektion (TURP) die Vaporisation der Prostata und die endoskopische Enukleation zur Verfügung.

Ziel der Arbeit

Es wird eine Übersicht der aktuellen Daten zum Stellenwert einzelner Verfahren in der Therapie des BPS aufgezeigt.

Material und Methoden

Zum Thema der operativen Therapie des BPS wird ein narrativer Review der englischsprachigen Literatur gegeben.

Ergebnisse

Zur operativen Therapie des BPS stehen neben der TURP, welche weiter als Referenztechnik für ein Prostatavolumen <80 ml gilt, die Greenlight-Laservaporisation (GLV) und die endoskopische Enukleation (EEP) der Prostata als etablierte und evidenzbasierte Alternativen zur Verfügung. In zahlreichen prospektiv randomisierten Studien konnte sowohl die GLV als auch die EEP als der TURP ebenbürtiges Verfahren hinsichtlich funktioneller Resultate gezeigt werden. Als Referenztechnik, an der sich neue Verfahren messen, sollte aufgrund der geringeren Morbidität sowie vergleichbarer funktioneller Resultate primär die bipolare TURP und nicht mehr die monopolare TURP gelten. Die GLV weist auch bei Patienten mit fortgeführter oraler Antikoagulation oder Thrombozytenaggregationshemmung eine hohe intra- und postoperative Sicherheit auf. Die EEP hat als einziges transurethrales Therapieverfahren auch bei Patienten mit Prostatavolumina >80 ml eine hohe Evidenz von Sicherheit und Wirksamkeit.

Schlussfolgerung

Die Wahl des operativen Therapieverfahrens des BPS sollte individuell in Abhängigkeit von Prostatagröße, Komorbiditäten sowie Erfahrung des Operateurs gewählt werden.

Abstract

Background

Benign prostatic hyperplasia (BPH) is the most common condition affecting the male lower urinary tract. Besides transurethral resection of the prostate (TURP), vaporization of the prostate and endoscopic enucleation of the prostate are available.

Objectives

To provide an overview of the current status of surgical therapies for BPH.

Materials and methods

Narrative review of the literature on the surgical treatment of BPH.

Results

Besides TURP, which still can be regarded as the reference technique for surgical treatment of BPH in men with a prostate volume <80 cc, greenlight laser vaporization of the prostate (GLV) and endoscopic enucleation of the prostate (EEP) are established and evidence-based alternatives. A multitude of prospective randomized trials could show comparable functional outcomes of GLV or EEP in comparison to TURP. Based on lower comorbidity and comparable outcomes, bipolar TURP rather than monopolar TURP should be regarded as the surgical reference technique. In patients with ongoing oral anticoagulation of thrombocyte aggregation inhibition, GLV provides high intra- und postoperative safety. Endoscopic enucleation of the prostate is the only transurethral surgical method which provides high level evidence concerning safety and efficacy in patients with prostates >80 cc.

Conclusions

Choice of surgical treatment of BPH should be individualized and based on prostate size, comorbidities and surgical experience.

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Authors and Affiliations

  1. alta uro AG, Centralbahnplatz 6, 4051, Basel, Schweiz

    M. Rieken FEBU

  2. Universität Basel, Basel, Schweiz

    M. Rieken FEBU

  3. Spital Thurgau AG, Kantonsspital Frauenfeld, Frauenfeld, Schweiz

    T. R. W. Herrmann

  4. Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland

    C. Füllhase

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  1. M. Rieken FEBU
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  3. C. Füllhase
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Correspondence to M. Rieken FEBU.

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M. Rieken, T. R. W. Herrmann und C. Füllhase geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Rieken, M., Herrmann, T.R.W. & Füllhase, C. Operative Therapie des benignen Prostatasyndroms – resezieren, vaporisieren oder enukleieren?. Urologe 58, 263–270 (2019). https://doi.org/10.1007/s00120-019-0891-8

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