[Transurethral resection in prostate cancer, a radical procedure. Experience with 1017 cases].

OBJECTIVES

From the beginning of TUR in 1931 the reseccionists thought of resecting prostate cancer. Execution however failed for deficient instruments and techniques. The first transurethral resection for prostate cancer: TURPC--was performed at our institution in 1957 by Hans J. Reuter. Low pressure irrigation enabled safe transurethral resection of the prostate including the capsule. Thus we started in 1985 a prospective study to verify TURPC as a radical procedure.

METHOD

TURPC requires continuous low pressure irrigation with irrigating reservoir fixed at the operating table. The liquid level within is to maintain less than 20 cm. water above the pubic region in lithotomy position. Continuous flow is maintained by suprapubic trocar and a resectoscope with 28Fr. sheath. An autoregulated electro-surgical unit is indispensable. It automatically adjusts the high-frequency current to suit the cut tissue's electrical resistance for precise cutting. Videomonitoring is mandatory. The prostate is resected completely with its capsule into periprostatic fat together with the seminal vesicles. The specimen is retrieved in fractions to guarantee correct histopathological staging. If indicated laparoscopic staging lymphadenectomy is performed. A secondary session for control of positive margins follows after 12 weeks.

RESULTS

From 1985-2004 1,017 patients with a mean age of 68.9 years and with clinically localized prostate cancer were resected by 5 surgeons with curative intention. The cancer stage distribution was in %: T1: 12, T2: 43, T3: 41, T4: 4.--G1: 8, G2: 72, G3: 20. Mortality 1 out of 1,017. Bladder neck incision 8.9%. Incontinence grade 3: none. Postoperative survival over 10 years was 82% in T1, 87% in T2, 81% in T3 and 34% in T4 patients. Biochemical recurrence as of the rise of three consecutive PSA-values was within 5 years 15% in T1, 19% in T2, 27% in T3.

CONCLUSIONS

Considering our results we conclude that prostate cancer can be resected transurethrally as radical as with open surgery. The outcome as to survival and PSA-recurrence is comparable, the incontinence rate is less then with open surgery. It is mandatory to have low pressure irrigation with suprapubic trocar, 28Fr. sheath and on autoregulated electrosurgical unit, video monitoring and a well experienced reseccionist.