Sulser T
Urologische Klinik, Universitätsspital Zürich.
Ther Umsch. 1995 Jun;52(6):383-92.
Benign prostatic hyperplasia is a common disease of men and will lead in most cases to micturition difficulties. Up to now 2 or 4 of 10 men in their sixties are operated for BPH. As standard treatment we know the transurethral resection of the prostate and in some cases of very big adenomas the open adenomectomy carried out in a suprapubic or retropubic way. However, in view of a rare, but as a result of these treatments appearing morbidity we have to ask ourselves whether the surgical resection of the obstructive prostatic tissue remains the only way of treatment. For several years now apart from drug therapy there have also been applied less invasive alternatives. Whether these alternatives of little side effect and further complications are equally effective for the treatment of the obstructive BPH is to verify. This paper provides a general view of the possibilities of the surgical interventions as well as of their alternatives. Because of a lack of dates as to the efficiency of particular procedures a final judgement is outstanding in most cases. Where possible we hear of particular alternatives, though fully promoted, being nothing but a passing tendency. This is certainly true of the hyperthermy, the balloon dilatation and the urethral implants. These by now various conspicuous necrotising procedures (transurethral microwave thermotherapy, laser-ablation, high intensity focused ultrasound, transurethral needle-ablation) are by now in prospective random studies still subject to extensive clinical tests. The question whether one of these alternatives will one day be apt to exceed the TURP as "golden standard" of BPH-treatment, that remains as far as now the question to be put. The advantages of the necrotising procedures, at present highly recommended, consist in the first place of a rare intra- and postoperative morbidity with a simultaneous lack of mortality. These procedures can be performed as a outpatient or as a short stationary treatment and sometime even under local anaesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)
良性前列腺增生是男性的一种常见疾病，在大多数情况下会导致排尿困难。到目前为止，60多岁的男性中每10人就有2至4人因良性前列腺增生接受手术。作为标准治疗方法，我们知道经尿道前列腺切除术，在某些腺瘤非常大的情况下，会采用耻骨上或耻骨后开放式腺瘤切除术。然而，鉴于一种罕见但因这些治疗而出现的发病率，我们不得不自问，手术切除梗阻性前列腺组织是否仍然是唯一的治疗方法。多年来，除了药物治疗外，还应用了侵入性较小的替代方法。这些副作用和进一步并发症较少的替代方法在治疗梗阻性良性前列腺增生方面是否同样有效还有待验证。本文概述了手术干预及其替代方法的可能性。由于缺乏关于特定手术效率的日期，在大多数情况下，最终的判断尚未得出。在可能的情况下，我们听说一些特别的替代方法，尽管得到了充分推广，但不过是一种短暂的趋势。热疗、球囊扩张术和尿道植入物肯定是这种情况。目前这些各种引人注目的坏死性手术（经尿道微波热疗、激光消融、高强度聚焦超声、经尿道针刺消融）目前正在前瞻性随机研究中接受广泛的临床试验。这些替代方法之一是否有朝一日会超过经尿道前列腺切除术成为良性前列腺增生治疗的“金标准”，到目前为止这仍然是一个有待提出的问题。目前极力推荐的坏死性手术的优点首先在于术中及术后发病率低，同时没有死亡率。这些手术可以作为门诊手术或短期住院治疗进行，有时甚至可以在局部麻醉下进行。（摘要截选至400字）
