Schulte-Baukloh Heinrich, Weber Markus, Höppner Dirk, Heidenreich Holger, Schlomm Thorsten, Weinberger Sarah, Enzmann Thomas, Ralla Bernhard
Department of Urology, Charité-University Hospital Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
Urologic Practice Turmstrasse, Berlin-MitteMoabit, Germany.
Int Urol Nephrol. 2025 May;57(5):1415-1423. doi: 10.1007/s11255-024-04329-6. Epub 2024 Dec 21.
According to the European Association of Urology guidelines, the limit for monopolar, transurethral resection (M-TURP) in BPH- therapy is a volume of 80 g. However, whether larger prostates can also be resected transurethrally might also depend on the experience of the surgeon and especially the resected volume and speed of the resection. Little is known about the latter, and this paper aims to these factors.
This study included 540 patients who received a single-stage M-TURP. Based on the postoperative resection weight, these were divided into four groups: group 1 with 10 to 59.9 g, group 2 with 60 to 79.9 g, group 3 with 80 to 99.9 g, and group 4 with ≥ 100 g. We examined patient age, the ASA-score, the IPSS, quality of life, resection weight, time and speed, pre- and postoperative hemoglobin and serum sodium values, complications, and surgeon experience.
The mean resection weight was 41.6 g, and the mean values for resection time and speed were 61.3 min and 0.7 g/min, respectively. The resection speed increased significantly with resection weight (from 0.7 to 1.3 g/min) as well as with the surgeon's level of experience (from 0.4 to 0.9 g/min). The number of serious complications (Clavien-Dindo ≥ IIIb) increased significantly from a resection volume of 59.5 g (cut-off value). The resection speed of M-TURP increased significantly with the resection weight and the surgeon's level of experience. Regardless of speed, resection weight of more than 60 g might increase the risk of severe complications.
根据欧洲泌尿外科学会指南，良性前列腺增生症（BPH）治疗中经尿道单极切除术（M-TURP）的限度是前列腺体积为80克。然而，更大体积的前列腺是否也能经尿道切除可能还取决于外科医生的经验，尤其是切除体积和切除速度。关于后者知之甚少，本文旨在研究这些因素。
本研究纳入了540例行一期M-TURP的患者。根据术后切除重量，将他们分为四组：第1组为10至59.9克，第2组为60至79.9克，第3组为80至99.9克，第4组为≥100克。我们检查了患者年龄、美国麻醉医师协会（ASA）评分、国际前列腺症状评分（IPSS）、生活质量、切除重量、时间和速度、术前和术后血红蛋白及血清钠值、并发症以及外科医生经验。
平均切除重量为41.6克，切除时间和速度的平均值分别为61.3分钟和0.7克/分钟。切除速度随切除重量（从0.7克/分钟增至1.3克/分钟）以及外科医生的经验水平（从0.4克/分钟增至0.9克/分钟）显著增加。严重并发症（Clavien-Dindo≥IIIb级）的数量从切除体积59.5克（临界值）起显著增加。M-TURP的切除速度随切除重量和外科医生的经验水平显著增加。无论速度如何，切除重量超过60克可能会增加严重并发症的风险。
