Die transurethrale Behandlung des Prostata-Adenoms durch Kombination von Elektroresektion (TUR) und Kältechirurgie

Summary

The drawbacks of simple blind cryosurgery made it necessary to seek new ways of improving the procedure. In the first place, the septic complications cryonecrosis within the bladder have to be precluded. The combination of TUR and cryosurgery in the same session proved to be benefical, as each procedure complets the other.

1. By utilising a transurethral technique, first, a canal is made in the adenoma which facilitates the separation of slough.

2. In TUR it is difficult to coagulate the bleeding. Therefore we subsequently employ cryosurgery to aid in hemostasis.

3. By endoscopic control of the freezing process, the results can be improved. In addition it is simpler to establish a suprapubic fistula catheter through the sheath of a 25 F trocar cystoscope.

4. The freezing period is very short (up to 3 min.) so that extensive necrosis does not develop.

5. Indications for surgery are based on the degree of the risk to the patient.

a) Surgical prostatectomy is performed in all patients considered normal operative risk.

b) The combination of TUR and endoscopic cryosurgery is employed in all patients with an increased operative risk. Postoperative complications are low, mortality is under 1%.

The results after 4-year follow-up are good. Notably no post-operative strictures were seen. In only 7% of the patients recurrent urinary infections occurred, consequent to retained adenoma remnants. Based on the favourable results of combined cryosurgery and TUR we can highly recommend this method as a complement for conventional prostatic surgery.

Key-Words

TUR-transurethral electroresection - cryosurgery - endoscopic- - combined- - trocar-cystoscopy - cryonecrosis - suprapubic prostatectomy