[The low hydraulic pressure transurethral resection of the prostate results in 340 patients with great adenomas]

[Radical transurethral resection of the prostate. An alternative therapy for the treatment of prostate cancer]

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 < or =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.

[Development and usage of a new laser resectoscope]

BACKGROUND

Endoscopes for the application of laser energy have not been modified substantially for 3 decades. They have two essential disadvantages: the laser probe has no sufficient fixation and irrigation is ineffective in clearing endoscopic vision from hemorrhage. These defects were corrected in cooperation with the R. Wolf Company when developing a new laser resectoscope. In addition the one-handed usage was improved.

MATERIAL AND METHOD

The new instrument was used in 71 of the 329 patients undergoing surgery of the prostate with KTP laser by 8 surgeons in our institution. No instrument has been damaged by laser since. Seven of eight surgeons have acknowledged the advantages and approved the new laser endoscope.

CONCLUSION

The new laser resectoscope can be recommended to improve the safety of endoscopic laser surgery in general.