Miki Makoto, Shiozawa Hiroaki, Matsumoto Tetsuo, Aizawa Taku
Department of Urology, Shinjuku Ishikawa Hospital.
Nihon Hinyokika Gakkai Zasshi. 2003 Nov;94(7):671-7. doi: 10.5980/jpnjurol1989.94.671.
We developed an innovative transurethral resection system (TURis) consisting of a uniquely-designed generator and a resectoscope. The obturator nerve is protected from troublesome reflexes during TURis because the high frequency current delivery route is via the resection loop to the sheath of the resectscope and not via a patient plate. After extensive preclinical evaluation and verification of the system using an animal model to ensure efficacy as well as operational safety, TURis was conducted for treatment of superficial bladder cancer and benign prostatic hyperplasia.
In preclinical experiments swine bladder wall was transurethrally resected using the system in a saline environment. The results were compared with data obtained from an identical resection using the conventional system using sorbitol solution irrigation. Electrolytic contents were measured after TUR for comparative evaluation vis-a-vis corresponding pre-TUR data. Also, the depth of heat degeneration was measured in the resected tissue. From December, 2000 to June, 2002, TURis was performed in 25 cases of superficial bladder cancer and 30 cases of benign prostatic hyperplasia (BPH), using saline irrigation. All 55 cases were performed under spinal anesthesia without an obturator nerve block. The output power was set at 280 W for cut and 120 W for coagulation. A smaller electrode than those used in conventional TUR was used to improve the cutting efficacy. Occurrence of obturator nerve reflexes, difference of hematocrit and electrolytic contents before and after TURis, operation time and total volume of irrigated saline were evaluated.
TURis in animal model: No adductor contraction of a lower limb was observable except for minimal creeping during the resection of a site close to the urethra. There were no apparent anomalies relative to the blood electrolyte content after TURis. No difference was observed in the mean depth of heat-degeneration tissue change compared with the conventional system. TURis for bladder cancer and BPH: No additional skills were required for TURis compared to conventional TUR. No obturator nerve reflex was observed except for a clinically insignificant thigh movement in one case of bladder cancer. The post-TURis blood tests manifested no significant anomalies in blood electrolyte content. Mean operation time for bladder cancer and BPH were 32 and 42 minutes respectively. Mean volumes of saline consumed during TURis were 6,083 ml for bladder cancer and 16,100 ml for BPH.
TURis worked effectively in a saline-irrigated environment. It does not need a patient plate and obturator nerve block even in cases of bladder cancer on the lateral wall. In addition, saline was both safe and cost-effective compared to non-electrolytic solution as irrigant for TUR of BPH. This suggests that TURis may have more applications than conventional TUR.
我们研发了一种创新的经尿道切除系统（TURis），它由一个设计独特的发生器和一个切除镜组成。在TURis过程中，闭孔神经可免受麻烦的反射影响，因为高频电流的传输路径是通过切除环到切除镜的鞘管，而不是通过患者极板。在使用动物模型对该系统进行广泛的临床前评估和验证以确保疗效及操作安全性后，进行了TURis治疗浅表性膀胱癌和良性前列腺增生。
在临床前实验中，在盐水环境下使用该系统经尿道切除猪膀胱壁。将结果与使用山梨醇溶液冲洗的传统系统进行相同切除所获得的数据进行比较。经尿道切除术后测量电解质含量，以便与相应的术前数据进行比较评估。此外，还测量了切除组织中的热变性深度。从2000年12月至2002年6月，对25例浅表性膀胱癌和30例良性前列腺增生（BPH）患者进行了TURis，使用盐水冲洗。所有55例手术均在脊髓麻醉下进行且未行闭孔神经阻滞。切割输出功率设定为280W，凝血输出功率设定为120W。使用比传统经尿道切除术更小的电极以提高切割效果。评估闭孔神经反射的发生情况、TURis前后血细胞比容和电解质含量的差异、手术时间以及冲洗盐水的总量。
动物模型中的TURis：除了在切除靠近尿道部位时出现轻微蠕动外，未观察到下肢内收肌收缩情况。TURis后血电解质含量无明显异常。与传统系统相比，热变性组织变化的平均深度无差异。膀胱癌和BPH的TURis：与传统经尿道切除术相比，TURis无需额外技巧。除了1例膀胱癌患者出现临床上无显著意义的大腿运动外，未观察到闭孔神经反射。TURis后的血液检查显示血电解质含量无明显异常。膀胱癌和BPH的平均手术时间分别为32分钟和42分钟。TURis期间膀胱癌和BPH消耗的盐水平均体积分别为6083ml和16100ml。
TURis在盐水冲洗环境中有效工作。即使对于侧壁膀胱癌病例，它也无需患者极板和闭孔神经阻滞。此外，与用于BPH经尿道切除的非电解质溶液冲洗剂相比，盐水既安全又经济有效。这表明TURis可能比传统经尿道切除术有更多应用。
