Zani Emerson Luís, Netto Nelson Rodrigues
Division of Urology, Hospital Israelita Albert Einstein, Unicamp R. Augusta 2347, 3o andar, 01413-000 São Paulo, Brazil.
Int Urol Nephrol. 2007;39(1):161-8. doi: 10.1007/s11255-006-9053-1. Epub 2007 Mar 2.
Despite the development of new technologies, transurethral resection of the prostate (TURP) is still considered the gold standard for surgical treatment of the benign prostate hyperplasia (BPH). In general, new minimally invasive treatments have not demonstrated better outcomes than TURP in evidence based medicine trials published to date, and should be reserved for patients who prefer to avoid surgery, who are unsuitable candidates for surgery or who no longer respond favorably to medication. TUMT and TUNA appears to be more effective than medical therapy but less effective than TURP. Both treatments can be given under topical anesthesia or local prostatic or perineal block. Efficacy of transurethral vaporization appears similar to TURP, but the studies are short-term and the glands operated on are relatively small. In patients with small prostates, the transurethral incision of the prostate can also be a good option, associated with less morbidity than TURP. Bipolar resection of the prostate is similar to TURP in effectiveness, but the data are inconclusive regarding blood loss, length of catheterization and hospital stay. Long-term comparative trials are needed to determine if the minimally invasive therapies are superior to standard TURP.
尽管新技术不断发展，但经尿道前列腺切除术（TURP）仍被视为良性前列腺增生（BPH）手术治疗的金标准。总体而言，在迄今发表的循证医学试验中，新的微创治疗方法并未显示出比TURP更好的疗效，应保留给那些不愿接受手术、不适合手术或对药物治疗不再有良好反应的患者。经尿道微波热疗（TUMT）和经尿道针刺消融术（TUNA）似乎比药物治疗更有效，但比TURP效果差。这两种治疗均可在局部麻醉或局部前列腺或会阴阻滞下进行。经尿道汽化术的疗效似乎与TURP相似，但研究为短期且所治疗的腺体相对较小。对于前列腺较小的患者，经尿道前列腺切开术也是一个不错的选择，其发病率低于TURP。前列腺双极切除术在有效性方面与TURP相似，但关于失血、导尿时间和住院时间的数据尚无定论。需要进行长期比较试验来确定微创治疗是否优于标准TURP。
