Transurethral resection of the prostate

Transurethral resection ( TUR ) is a urological surgical technique, is removed in the diseased tissue from the bladder or prostate. The surgery is performed without outer section of the urethra through. Colloquially, the TUR is also called planing.

Technology

The TUR is the oldest method of minimally invasive surgery. It is carried out by means of a resectoscope. A resectoscope includes a light source, a channel for the view of the surgeon, a fluid supply and a working channel.

TUR for a wire loop is used on an electric current flows. This diseased tissue in the bladder or prostate is removed layer by layer. Haemorrhages are electrically desolate ( cauterization ). The physical principle corresponds to the high-frequency surgery. During this operation a rinsing liquid is introduced via the resectoscope permanently. It is used for a bladder filling and on the other the washout of resected tissue and blood. This solution was, until recently, hypotonic, which means it has a lower electrolyte concentration than the blood. The low electrolyte concentration is due to the need for a low conductivity. At the end of the operation, the resected tissue is rinsed and placed an irrigation catheter after adequate hemostasis.

Besides the classical unipolar resection loops, which require the use of hypotonic irrigation fluids and therefore associated with the risk of a so-called " TUR syndrome " (see below ), there are now bipolar resectoscope, which allow flushing with isotonic fluid.

Types of applications

Transurethral resection of the bladder

Transurethral resection of the bladder ( TURB or TUR -B) is mainly used for the treatment of bladder cancer. Another field of application is the treatment of Blasendivertikeln ( Divertikulotomie ).

Transurethral resection of the prostate

Transurethral resection of the prostate (TURP or TUR -P ) is a standard method for the removal of obstacles to the urine flow through the prostate. It is in this case only the inner portion of the prostate removed, which faces the urethra. The peripheral prostatic tissue and organ capsule remain, continue to be protected seed hill and urethral sphincter. Mostly it is used in the treatment of benign prostatic hyperplasia (benign prostatic hyperplasia or prostatic adenoma ). A TURP, but can also be used for other drainage obstacles, for example by prostate cancer.

Complications

In addition to general surgical or anesthetic risks (infection, bleeding, scarring, cardiovascular disorder, thrombosis, etc.) there are also special risks of TUR:

  • TUR syndrome: Hypotonic hyperhydration with cardiovascular load up to acute right heart failure due to Einschwemmung hypotonic irrigation fluid. Symptoms include nausea, vomiting, confusion and restlessness.
  • Retrograde ejaculation; rarely impotence is observed.
  • Incontinence / stress incontinence: An injury to the external sphincter can lead to incontinence. An observed often after catheter removal stress incontinence can be caused by irritation of the bladder, an infection, postoperative edema, and / or by a weakness of the external sphincter and usually sounds over a period of three months.
  • Injury to the ureter or urethra: It can form strictures of the urethra ( stricture ). In rare cases, it may result in injuries to the mouth of the ureter with the consequence of Harnrückstaus in the kidney.
  • Violation of the prostatic capsule with leaking into the small pool
  • Bladder neck sclerosis
  • Inflammation of the testicles or epididymis

History

The conditions for the TURB as surgical technique was created by the development of electrically lighted cystoscope by Max Nitze in 1879. Nitze developed later Operationszystoskope and led the cauterization one in the ablation of bladder tumors.

Although Ambroise Paré already with a sharp hollow probe abtrug Harnabflusshindernisse through the urethra in the 16th century, the modern TURP developed later than the TURB. A precursor of today's method was TURP transurethral Stanzresektion of the prostate ( " cold punch " ), which was introduced in 1909 by Hugh Hampton Young ( 1870-1945 ). George Luys introduced in 1913, the first coagulation of smaller prostate adenomas by means of high frequency current through ( forage de la prostate ).

Max Stern (1873-1946) combined 1926 Youngs punch instrument with cystoscope and electric snare, and introduced the concept resectoscope. Thus he created the prototype of today's resectoscope. With the improvements made in 1931 by Joseph McCarthy ( 1874-1965 ) the instrument as a star - McCarthy resectoscope was known.

In the 1970s, the continuous irrigation was popularized by José Iglesias de la Torre ( 1904-1979 ). However, Iglesias ' first instrument was based on preliminary work not mentioned by Hans Joachim Reuter (1923-2003) in cooperation with the Storz.

782556
de