Benign prostate enlargement: New procedure minimizes risks

TURis plasma vaporization combines the advantages of laser processes and classic peeling.

Cologne, January 27,2009 - Patients with benign prostate hyperplasia now have a new procedure for the surgical removal of excess prostate tissue: TURis (Transurethral resection in saline) plasma vaporization. Surgical complications such as urinary incontinence, impotence and especially the potentially life-threatening indwelling syndrome can be virtually avoided with the gentle and minimally invasive procedure. This means that TURis plasma vaporization offers decisive advantages over conventional peeling of the prostate,"emphasizes Dr. Stephan Neubauer, urologist at the West German Prostate Center in Cologne. "Especially elderly and sick patients, as well as patients with an increased risk of bleeding, benefit from the new method."

Constant urination, a weak stream of urine and unpleasant dripping - which for many men becomes a nightmare, is usually due to a benign enlargement of the prostate gland. She meets almost every second man over 50 and almost every 80-year-old. In benign prostatic hyperplasia (BPH), the glandular tissue of the prostate grows in the area of the urethra. Due to the narrowing of the urethra, the strength of the urine stream decreases and residual urine remains in the bladder. This in turn can lead to painful inflammations and promote the formation of bladder stones. 

In the early stages, the symptoms can usually be effectively alleviated with medication. However, if these do not lead to the desired success, the excess tissue usually has to be removed by surgery. The classic peeling (transurethral prostate resection/TURP) is still considered the standard procedure. Excess tissue is removed layer by layer with the help of a wire sling, through which an electric current flows. The current flow from the working electrode through the patient's body to the neutral electrode can cause considerable irritation and tissue damage. This can lead to urethral congestion, rarely erectile dysfunction and in very rare cases to urinary incontinence,"explains Neubauer. Approximately two percent of the patients treated suffer from a serious complication, the so-called TUR syndrome. Flushing fluid enters the bloodstream via opened blood vessels. The result is a change in the electrolyte situation and thus a strain on the circulation. In the worst case, flushing the rinsing fluid can lead to shock, pulmonary or cerebral edema.

Lower risk of bleeding, high effectiveness and shorter waiting times

A new minimally invasive procedure, the so-called TURis plasma vaporization, can now help. Unlike conventional peeling, hypotonic rinsing solution is replaced by a saline solution that is well tolerated. This prevents the potentially life-threatening TUR syndrome. Another advantage is that the current does not flow through the entire body, but only where the tissue is to be removed. The irritation of surrounding organs can thus be minimized and current-related side effects can be largely avoided,"explains Neubauer.

The surgeon can use the innovative system to combine two different techniques: planing (resection) with the aid of electric current and vaporization (evaporation) by using a vaporization electrode. The plasma vaporization electrode vaporizes the tissue like a laser, but without strong heat generation. At the same time, the tissue is scabbed and bleeding is avoided from the front The vaporization electrode is mainly used in the area of the highly perfused mucous membranes. The prostate tissue behind it is pervaded by fewer blood capillaries and can now be planed with an electric loop,"explains the Cologne urologist. The tissue chips produced during resection can be examined for tumour cells by the pathologist.

The unique combination of evaporation and an electric loop allows for the selection of the appropriate electrode and its insertion into the prostate via the working channel, depending on the patient's needs, i. e. whether hemostasis or tissue removal is in the foreground. A further advantage is the shortened operation time. This makes the procedure particularly attractive for patients who have a high risk of bleeding and who suffer from concomitant diseases such as cardiovascular diseases.

As one of the few centers in Germany, the West German Prostate Center now has not only TUR-P, TUNA and the ultra-modern laser processes (greenlight lasers and life diode lasers) but also the innovative TURis plasma vaporization. This provides us with a comprehensive range of minimally invasive and surgical treatment options for benign prostate hyperplasia, enabling us to decide individually for each patient which method is best suited,"said Neubauer.

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