madman
Super Moderator
Abstract
In 1926 Maximilian Stern introduced a new instrument to treat obstructions at the vesical orifice and baptized its resectoscope. With reference to astonishing historical statements about the new instrument and surgical technique made by the pioneers and their critics, we will value why transurethral resection of the prostate (TURP) remains the gold standard for most men suffering from lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. TURP is currently challenged by recently introduced new instruments and techniques claiming advantages over TURP. However, TURP offers an excellent balance between high efficacy in symptom relief and low morbidity along with low costs and favorable long-term outcomes compared to other treatment options. We will outline these arguments demonstrating that even after a century has elapsed, since its introduction into the urologist's armamentarium, TURP continues to stand the passage of time.
Introduction
In 1926 Maximilian Stern (Fig. 1) described a new method and new instruments for the treatment of what he called “obstructions at the vesical orifice” [1]. He named the instrument a resectoscope. Most would agree that ever since then the resectoscope is the urologist's most liked and used instrument in the operating room.
As with any other new method, further improvements in the instrument design were introduced rapidly, e.g., the “the two foot switch”, a predecessor of today’s foot pedal by Theodore M. Davis [2] (Fig. 2a, b) and Joseph F. McCarthy’s modifications of the original Stern resectoscope [3]. Needless to say, critics were plentiful questioning the new technique, its safety, and outcome. In 1932 Robert V. Day even concluded that the new method will not come into general use [4]. Some 90 years later, his dire prediction did not occur primarily because he failed to envision the true potential of transurethral resection of the prostate (TURP). TURP soon became the gold standard for the treatment of infravesical obstruction due to benign prostatic enlargement (BPE).
TURP as the reference technique for the surgical treatment of BPE has been challenged in the past decades repeatedly. We will discuss TURP in the light of statements made 80–90 years ago and compare them to the achievements that have been reached in the interim. We will not present a systematic review comparing TURP to emerging new techniques but rather stress the factors why TURP is still considered the reference technique for BPE surgery.
Indication
Preoperative evaluation
From bipolar to monopolar instruments and back again
Surgical technique
Learning curve
LUTS after TURP
Sexual function after TURP
Long term outcome
Complications
Costs
Limitations
Conclusion
TURP has continued to stand the test of time. It is embraced by various generations of Urologists and currently, it remains the surgical gold standard for most men suffering from BPE.
Furthermore,
– It is easy to learn
– The bipolar technique offers advantages over the monopolar technique
– It is cheap
– It has excellent short and long term results
– Sexual function may be preserved
A. A. Kuntzmann 1932: “This method of electrosurgical treatment is here to stay, but not until we have acquired more skill and experience in its performance and careful consideration and observation in the follow-up and end-results over a satisfactory period of time, of at least several additional years, will we be able to give this method its proper indications and evaluation and assign to it its place in the treatment of vesical-neck obstructions” [4].
TURP remains undisputedly the gold standard in the surgical treatment of BPE. If just one reason has to be brought up to justify TURP’s place in the treatment of BPH it’s the argument of time that supports TURP.
Robert V. Day 1932: “The method will not come into general use” [4].
In summary: In hindsight Robert Day was incorrect. However, it is the checks and balances between the pioneers and their critics that ultimately stimulate progress in medicine and push our specialty forward.
In 1926 Maximilian Stern introduced a new instrument to treat obstructions at the vesical orifice and baptized its resectoscope. With reference to astonishing historical statements about the new instrument and surgical technique made by the pioneers and their critics, we will value why transurethral resection of the prostate (TURP) remains the gold standard for most men suffering from lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. TURP is currently challenged by recently introduced new instruments and techniques claiming advantages over TURP. However, TURP offers an excellent balance between high efficacy in symptom relief and low morbidity along with low costs and favorable long-term outcomes compared to other treatment options. We will outline these arguments demonstrating that even after a century has elapsed, since its introduction into the urologist's armamentarium, TURP continues to stand the passage of time.
Introduction
In 1926 Maximilian Stern (Fig. 1) described a new method and new instruments for the treatment of what he called “obstructions at the vesical orifice” [1]. He named the instrument a resectoscope. Most would agree that ever since then the resectoscope is the urologist's most liked and used instrument in the operating room.
As with any other new method, further improvements in the instrument design were introduced rapidly, e.g., the “the two foot switch”, a predecessor of today’s foot pedal by Theodore M. Davis [2] (Fig. 2a, b) and Joseph F. McCarthy’s modifications of the original Stern resectoscope [3]. Needless to say, critics were plentiful questioning the new technique, its safety, and outcome. In 1932 Robert V. Day even concluded that the new method will not come into general use [4]. Some 90 years later, his dire prediction did not occur primarily because he failed to envision the true potential of transurethral resection of the prostate (TURP). TURP soon became the gold standard for the treatment of infravesical obstruction due to benign prostatic enlargement (BPE).
TURP as the reference technique for the surgical treatment of BPE has been challenged in the past decades repeatedly. We will discuss TURP in the light of statements made 80–90 years ago and compare them to the achievements that have been reached in the interim. We will not present a systematic review comparing TURP to emerging new techniques but rather stress the factors why TURP is still considered the reference technique for BPE surgery.
Indication
Preoperative evaluation
From bipolar to monopolar instruments and back again
Surgical technique
Learning curve
LUTS after TURP
Sexual function after TURP
Long term outcome
Complications
Costs
Limitations
Conclusion
TURP has continued to stand the test of time. It is embraced by various generations of Urologists and currently, it remains the surgical gold standard for most men suffering from BPE.
Furthermore,
– It is easy to learn
– The bipolar technique offers advantages over the monopolar technique
– It is cheap
– It has excellent short and long term results
– Sexual function may be preserved
A. A. Kuntzmann 1932: “This method of electrosurgical treatment is here to stay, but not until we have acquired more skill and experience in its performance and careful consideration and observation in the follow-up and end-results over a satisfactory period of time, of at least several additional years, will we be able to give this method its proper indications and evaluation and assign to it its place in the treatment of vesical-neck obstructions” [4].
TURP remains undisputedly the gold standard in the surgical treatment of BPE. If just one reason has to be brought up to justify TURP’s place in the treatment of BPH it’s the argument of time that supports TURP.
Robert V. Day 1932: “The method will not come into general use” [4].
In summary: In hindsight Robert Day was incorrect. However, it is the checks and balances between the pioneers and their critics that ultimately stimulate progress in medicine and push our specialty forward.
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