Complications of transurethral resection of the prostate (TURP) - Incidence, management, and prevention
Complications of transurethral resection of the prostate (TURP) - Incidence, management, and prevention
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DOI：
10.1016/j.eururo.2005.12.042
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发表时间：
2006-11-01
期刊：
影响因子：
23.4
通讯作者：
Hofmann, Rainer
中科院分区：
文献类型：
--
作者：
Rassweiler, Jens;Teber, Doqu;Hofmann, Rainer
目的：更新经尿道前列腺电切术（TURP）的并发症，包括管理和预防的基础上，技术evolution.Methods：基于MEDLINE检索1989年至2005年，2003年巴登符腾堡州的质量管理的结果，并在三个德国中心的长期个人经验，TURP后并发症的发生率进行了分析，为随后的三个时期：早期（1979 - 1994年）;中期（1994 - 1999年）;最近（2000 - 2005年），并提出管理和预防建议。技术的改进，如微处理器控制的单位，更好的医疗设备，如视频TUR，和培训有助于减少围手术期并发症（近期与早期），如输血率（0.4%与7.1%）、TUR综合征（0.0%与1.1%）、血凝块潴留（2%与5%）和尿路感染（1.7%与8.2%）。尿潴留（3%对9%）通常归因于原发性逼尿肌衰竭，而不是不完全切除。早期急迫性尿失禁发生在高达30 - 40%的患者中;然而，晚期医源性压力性尿失禁是罕见的（<0.5%）。尽管年龄增加（55%的患者年龄大于70岁），但TURP的相关发病率维持在较低水平（<1%），死亡率为0 - 0.25%。主要的晚期并发症是尿道狭窄（2.2 - 9.8%）和膀胱颈挛缩（0.3 - 9.2%）。五年后的再治疗率范围为3 - 14.5%.Conclusions：TURP仍然是治疗良性前列腺增生的金标准，并发症发生率降低。双极和激光治疗等技术替代方案可能会进一步降低这种技术上困难的手术的风险。(c)2005年欧洲泌尿外科协会。Elsevier B.V.出版，保留所有权利。
Objectives: To update the complications of transurethral resection of the prostate (TURP), including management and prevention based on technological evolution.Methods: Based on a MEDLINE search from 1989 to 2005, the 2003 results of quality management of Baden-Wurttemberg, and long-term personal experience at three German centers, the incidence of complications after TURP was analyzed for three subsequent periods: early (1979-1994); intermediate (1994-1999); and recent (2000-2005) with recommendations for management and prevention.Results: Technological improvements such as microprocessor-controlled units, better armamentarium such as video TUR, and training helped to reduce perioperative complications (recent vs. early) such as transfusion rate (0.4% vs. 7.1%), TUR syndrome (0.0% vs. 1.1%), clot retention (2% vs. 5%), and urinary tract infection (1.7% vs. 8.2%). Urinary retention (3% vs. 9%) is generally attributed to primary detrusor failure rather than to incomplete resection. Early urge incontinence occurs in up to 30-40% of patients; however, late iatrogenic stress incontinence is rare (< 0.5%). Despite an increasing age (55% of patients are older than 70), the associated morbidity of TURP maintained at a low level (< 1%) with a mortality rate of 0-0.25%. The major late complications are urethral strictures (2.2-9.8%) and bladder neck contractures (0.3-9.2%). The retreatment rate range is 3-14.5% after five years.Conclusions: TURP still represents the gold standard for managing benign prostatic hyperplasia with decreasing complication rates. Technological alternatives such as bipolar and laser treatments may further minimize the risks of this technically difficult procedure. (c) 2005 European Association of Urology. Published by Elsevier B.V. All rights reserved.