Gupta Narmada P, Nayyar Rishi
Department of Urology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Gurgaon, Delhi, India.
Indian J Urol. 2013 Jul;29(3):225-35. doi: 10.4103/0970-1591.117288.
Transurethral resection of prostate (TURP) has long been the most commonly performed surgical procedure for the management of benign prostate enlargement (BPE), but has several associated limitations. Over the years, laser techniques have developed as major contenders as alternative therapies for BPE. However, simultaneously, TURP has also flourished and with relatively recent development of resection in saline (bipolar TURP), the tussle between laser techniques and TURP has further gained momentum. A systematic search was performed on Medline using the various Medical subject headings related to the surgical management of BPE including TURP, bipolar, lasers, holmium laser enucleation of prostate (HoLEP), photo-selective vaporization of prostate (PVP), etc., All articles types including meta-analysis randomized controlled trials, review articles, guidelines from various urological associations, single center studies from 2002 onward were considered for review. Bipolar TURP, HoLEP, and PVP provide equivalent outcomes for large prostate adenoma (<60 g). For extremely large glands (<150 g), HoLEP is a very efficacious endoscopic alternative to open prostatectomy and has proven long-term results over more than a decade. Bipolar TURP and PVP are attractive with a minimal learning curves and equivalent short term durability. Surgical management of large prostate should be individualized based upon patient's comorbidities and surgeon's expertise.
经尿道前列腺切除术（TURP）长期以来一直是治疗良性前列腺增生（BPE）最常用的外科手术，但存在一些相关局限性。多年来，激光技术已发展成为BPE替代疗法的主要竞争者。然而，与此同时，TURP也蓬勃发展，随着近年来盐水灌注切除术（双极TURP）的发展，激光技术与TURP之间的竞争进一步加剧。我们使用与BPE手术管理相关的各种医学主题词在Medline上进行了系统检索，包括TURP、双极、激光、钬激光前列腺剜除术（HoLEP）、选择性光汽化前列腺术（PVP）等。所有文章类型，包括荟萃分析、随机对照试验、综述文章、各泌尿外科协会的指南、2002年以后的单中心研究均纳入综述。对于大前列腺腺瘤（<60 g），双极TURP、HoLEP和PVP的疗效相当。对于极大型腺体（<150 g），HoLEP是一种非常有效的开放性前列腺切除术的内镜替代方法，并且在十多年来已证明具有长期疗效。双极TURP和PVP具有吸引力，学习曲线最小且短期耐用性相当。大前列腺的手术管理应根据患者的合并症和外科医生的专业知识进行个体化。
