H Leyh1, U Necknig. 1. Abteilung für Urologie, Klinikum Garmisch-Partenkirchen, Auenstraße 6, 82467, Garmisch-Partenkirchen, Deutschland, herbert.leyh@klinikum-gap.de.
Abstract
BACKGROUND: Transurethral resection of the prostate (TURP) is still the most common surgical method for the treatment of benign prostatic syndrome. Despite a significant reduction of mortality rate, the morbidity of TURP is still about 15%. OBJECTIVES: Based on current data, the goal of this article is to analyze which complications are expected today from the standpoint of improved high-frequency surgery and loop technology and what preventive or therapeutic measures should be undertaken. RESULTS: The use of the bipolar resection technique reduces the risk of TUR syndrome. However, cardiac risk due to possible irrigation fluid uptake remains unchanged. The blood transfusion rate has been reduced to 1% by a decreased risk of bleeding due to ongoing technical development in high-frequency surgery and a stricter indication for transfusion. Postoperative urethral strictures, which are generally caused by mechanical and electrical mucosal lesions, should be avoided by using an atraumatic surgical technique. To prevent bladder neck sclerosis, the additional routine incision of the internal sphincter is recommended for all smaller prostates. CONCLUSIONS: Due to a modern high-frequency technology, subsequently avoiding TUR syndrome and enabling a blood-sparing cut, a further reduction of complication rates can be expected.
BACKGROUND: Transurethral resection of the prostate (TURP) is still the most common surgical method for the treatment of benign prostatic syndrome. Despite a significant reduction of mortality rate, the morbidity of TURP is still about 15%. OBJECTIVES: Based on current data, the goal of this article is to analyze which complications are expected today from the standpoint of improved high-frequency surgery and loop technology and what preventive or therapeutic measures should be undertaken. RESULTS: The use of the bipolar resection technique reduces the risk of TUR syndrome. However, cardiac risk due to possible irrigation fluid uptake remains unchanged. The blood transfusion rate has been reduced to 1% by a decreased risk of bleeding due to ongoing technical development in high-frequency surgery and a stricter indication for transfusion. Postoperative urethral strictures, which are generally caused by mechanical and electrical mucosal lesions, should be avoided by using an atraumatic surgical technique. To prevent bladder neck sclerosis, the additional routine incision of the internal sphincter is recommended for all smaller prostates. CONCLUSIONS: Due to a modern high-frequency technology, subsequently avoiding TUR syndrome and enabling a blood-sparing cut, a further reduction of complication rates can be expected.
Authors: Sascha A Ahyai; Peter Gilling; Steven A Kaplan; Rainer M Kuntz; Stephan Madersbacher; Francesco Montorsi; Mark J Speakman; Christian G Stief Journal: Eur Urol Date: 2010-06-11 Impact factor: 20.096
Authors: Charalampos Mamoulakis; Michael Schulze; Andreas Skolarikos; Gerasimos Alivizatos; Roberto M Scarpa; Jens J Rassweiler; Jean J M C H de la Rosette; Cesare M Scoffone Journal: Eur Urol Date: 2012-10-12 Impact factor: 20.096