To evaluate long-term efficacy and safety of low-pressure transurethral resection of the prostate for prostates < 70 cc (group 1) vs. > 70 cc (group 2).
In this study patients operated with monopolar TURP between 2009 and 2012 were evaluated retrospectively. During surgery a specially designed trocar (18 Fr) was placed suprapubically and connected to a suction pump to maintain stable low-pressure conditions. After sample size calculations, long-term follow-up was completed for 70 invited patients in each group up to 9/2015.
Follow-up period was 57 vs. 56 months for group 1 and 2, respectively (p = 0.56). At baseline there was no significant difference in age, IPSS, peak flow, and post void residual (PVR). Mean prostate volume was 47 cc (15–65) vs. 100 cc (70–163). Mean operating time was 55.4 vs. 82.6 min (p = 0.00). Blood transfusion was necessary in 0.0 vs. 2.9% (p = 0.16), and 0.0 vs. 1.4% developed TUR syndrome (p = 0.32). At follow-up mean relative improvement in IPSS was 63 vs. 57% (p = 0.29), QoL 64 vs. 64% (p = 0.93), peak flow 139 vs. 130% (p = 0.85), and PVR 58 vs. 63% (p = 0.80). Long-term complications included recurring adenoma in 1.4 vs. 4.3% (p = 0.31), and stricture in 7.2 vs. 5.8% (p = 0.73). 1 patient in each group reported worsening incontinence symptoms.
In terms of safety and efficacy, the aforementioned modality of standardized monopolar TURP using suprapubic suction was non-inferior for prostates > 70 cc compared to the same procedure for prostates < 70 cc. This technique is a potential low-cost alternative for clinics that cannot afford modern laser approaches.
Gratzke C, Bachmann A, Descazeaud A et al (2015) EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67:1099–1109. https://doi.org/10.1016/j.eururo.2014.12.038 CrossRefPubMed
Oelke M, Bachmann A, Descazeaud A et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64:118–140. https://doi.org/10.1016/j.eururo.2013.03.004 CrossRefPubMed
Reich O, Gratzke C, Bachmann A et al (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180:246–249. https://doi.org/10.1016/j.juro.2008.03.058 CrossRefPubMed
Korth K (1989) Pressure constant, transurethral resection with the new suprapubic “overflow regulator”. Urol Ausg A 28:77–79
Korth K (1991) Suprapubic puncture kit. J Endourol 5:151–153 CrossRef
Young J, Badgery-Parker T, Dobbins T et al (2015) Comparison of ECOG/WHO performance status and ASA score as a measure of functional status. J Pain Symptom Manag 49:258–264. https://doi.org/10.1016/j.jpainsymman.2014.06.006 CrossRef
Mandal S, Sankhwar SN, Kathpalia R et al (2013) Grading complications after transurethral resection of prostate using modified Clavien classification system and predicting complications using the Charlson comorbidity index. Int Urol Nephrol 45:347–354. https://doi.org/10.1007/s11255-013-0399-x CrossRefPubMed
Schönthaler (2012) The Freiburg index of patient satisfaction (FIPS): proposal for a new questionnaire, 63. Kongress der Deutschen Gesellschaft für Urologie, Hamburg, Deutschland
Schoenthaler M, Miernik A, Offner K et al (2014) The cumulative analgesic consumption score (CACS): evaluation of a new score to describe postsurgical analgesic consumption as a surrogate parameter for postoperative pain and invasiveness of surgical procedures. Int Braz J Urol 40:330–336. https://doi.org/10.1590/S1677-5538.IBJU.2014.03.06 CrossRefPubMed
Ahyai SA, Gilling P, Kaplan SA et al (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58:384–397. https://doi.org/10.1016/j.eururo.2010.06.005 CrossRefPubMed
Issa MM, Young MR, Bullock AR et al (2004) Dilutional hyponatremia of TURP syndrome: a historical event in the 21st century. Urology 64:298–301. https://doi.org/10.1016/j.urology.2004.03.023 CrossRefPubMed
Skolarikos A, Papachristou C, Athanasiadis G et al (2008) Eighteen-month results of a randomized prospective study comparing transurethral photoselective vaporization with transvesical open enucleation for prostatic adenomas greater than 80 cc. J Endourol 22:2333–2340. https://doi.org/10.1089/end.2008.9709 CrossRefPubMed
Kuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 53:160–166. https://doi.org/10.1016/j.eururo.2007.08.036 CrossRefPubMed
Bachmann A, Rieken M (2015) Words of wisdom. Re: greenLight™ laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostate hyperplasia: a randomized controlled study. Eur Urol 67:976. https://doi.org/10.1016/j.eururo.2014.12.066 CrossRefPubMed
Yucel M, Aras B, Yalcinkaya S et al (2013) Conventional monopolar transurethral resection of prostate in patients with large prostate (≥ 80 grams). Cent Eur J Urol 66:303–308. https://doi.org/10.5173/ceju.2013.03.art13
Skolarikos A, Rassweiler J, de la Rosette JJ et al (2016) Safety and efficacy of bipolar versus monopolar transurethral resection of the prostate in patients with large prostates or severe lower urinary tract symptoms: post hoc analysis of a european multicenter randomized controlled trial. J Urol 195:677–684. https://doi.org/10.1016/j.juro.2015.08.083 CrossRefPubMed
Cornu J-N, Ahyai S, Bachmann A et al (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67:1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017 CrossRefPubMed
Bachmann A, Tubaro A, Barber N et al (2014) 180-W XPS greenlight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European multicentre randomised trial—the GOLIATH study. Eur Urol 65:931–942. https://doi.org/10.1016/j.eururo.2013.10.040 CrossRefPubMed
- Low-pressure monopolar electroresection of the prostate for glands sized > 70 vs. < 70 cc performed with continuous irrigation and suprapubic suction: perioperative and long-term outcome
Ioana Maria Cazana
- Springer Berlin Heidelberg
Neu im Fachgebiet Urologie
Meistgelesene Bücher in der Urologie
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