TURIS – TRANSURETHRAL
RESECTION IN SALINE
4.811
Review of clinical evidence for bipolar resection and plasma vaporization.
TURIS – CLINICAL BENEFITS
The benefits of TURis
The TURis bipolar resection system provides an outstanding versatility for the treatment of benign prostatic hyperplasia. At
the same time, it maintains all the benefits of bipolar resection in saline. As of today, more than one million successful clinical
cases have proved the safety of the TURis 2.0 system.*
Safety 1
· Reduced risk of TUR syndrome2
· Minimized stimulation of obturator nerve
· E xtended operations times – way beyond monopolar
8.333
· Improved teaching options
Bloodless
· Reduced perioperative blood loss due to safe bipolar hemostasis
· Plasma vaporization with the PlasmaButton provides continuous hemostasis 3
8.330
· Enucleation technique allows for a potentially blood-free procedure
Time-saving 4
· S elf-cleaning effect of loop wire through plasma activation
· Faster post-operative recovery
8.341
· Potentially decreased catheterization times
P lease see the references on page 9. *Data on file
2
TURIS – BIPOLAR PROCEDURES
Loop resection – instant ignition and continuous
activation
· Three effect options for obtaining the desired coagulation
· Smooth cutting and good pathological samples
8.328
zone
· High tissue ablation rate5
4.205
· All benefits of TURis
Plasma vaporization – from laser to plasma
vaporization
· Plasma vaporization enables continuous and safe
· Short learning curve and fast and easy set-up, just as
8.336
hemostasis
simple as standard resection
· Clear and unobstructed view throughout the operation as
4.208
neither tissue chips nor laser impulses impair vision
· The PlasmaButton leads to a smooth post-operative tissue
surface
· Potential for providing transurethral vaporization on a
day-case basis
· A fraction of the cost of PVP
Transurethral enucleation – a bipolar alternative
The TUEB electrode enables the fast enucleation of larger
technology. Transurethral Enucleation with Bipolar (TUEB)
allows for potentially blood-free procedures and a gentle
8.339
prostates without having to invest in additional laser
8.595
enucleation of the prostate.
P lease see the references on page 9.
3
TURIS – TECHNOLOGY AND TECHNIQUES
What is plasma?
Plasma is one of the four fundamental states of matter and is created by applying energy to a gas.
Molecules are ionized, thus turning the gas into a plasma. Due to its conductivity, the plasma allows the
energy to cross at lower energy levels. This effect leads to low operating temperatures and, therefore, less
thermal spread. Tissue is vaporized by a locally confined denaturation process, while surrounding tissueheating effects are minor. It appears yellow due to the sodium which is dissolved in the saline and –as of
today– more than one million successful clinical cases have proved the safety of the TURis 2.0 system.
Solid
Energy
Molecule
Gaseous
Liquid
Free charge carriers
Energy
Energy
Free radicals
What is transurethral enucleation?
This revolutionary technique for the removal of the prostate utilizes
the natural anatomy by virtually peeling the prostate tissue out of
the capsule. The TUEB electrode’s wire loop is only used to locate
the layers and coagulate any bleeding – should this occur. Once
the right layers have been located, the black runner is used to
removed. TUEB potentially produces the same functional results
as the current standard treatment while reducing operating times
for large prostates and – at the same time – keeping intraoperative blood loss to a minimum.
4
4.213
gently peel off the prostate lobes as a whole. The lobes are then
pushed into the bladder, where they are cut and eventually
Plasma
TURIS – TECHNICAL PRINCIPLE
TURis: The gold standard for TUR-P and TUR-B
The TURis bipolar resection system differs from monopolar resection in that the tissue effect takes place
between two electrodes that are part of the same device. The active and return electrode are within the
resectoscope, forming a bipolar electrosurgical system. Due to the conductive saline, only a very small fraction
of the current passes through the tissue, and no neutral electrode is required. In TURis, HF current is used to
4.810
create a plasma corona. After plasma ignition, cutting or vaporization can be performed.
ESG-400 – intelligent HF technology
The TURis bipolar system is powered by the ESG-400 HF generator which is equipped with various safety
features such as automated saline detection and leakage protection sensor to permanently ensure the highest
degree of safety for the user and the patient.
Power (W)
Plasma ignition
4.812
Time (t)
The ESG-400 power curve with optimized energy output
control – energy is immediately reduced after ignition
5
BIPOLAR PLASMA VERSUS MONOPOLAR:
REVIEW OF EVIDENCE
European Urology 56 (2009) 798-809
Bipolar versus Monopolar Transurethral Resection of the
significantly. Irrigation and catheterization duration was
Prostate: A Systematic Review and Meta-analysis of
significantly longer with M-TURP (WMD: 8.75 h; 95% CI, 6.8–10.7
Randomized Controlled Trials
and WMD: 21.77 h; 95% CI, 19.22–24.32; p < 0.00001,
Charalampos Mamoulakis a, Dirk T. Ubbink b, Jean J.M.C.H. de
respectively). Inferences for hospitalization duration could not be
la Rosette
made. PlasmaKinetic TURP showed an improved safety profile.
a,*
Data on TUR in saline (TURis) are not yet mature to permit safe
Context:
conclusions.
Incorporation of bipolar technology in transurethral resection
Conclusions:
(TUR) of the prostate (TURP) potentially offers advantages over
monopolar TURP (M-TURP).
No clinically relevant differences in short-term efficacy
exist between the two techniques, but B-TURP is
Objective:
preferable due to a more favorable safety profile (lower
To evaluate the evidence by a meta-analysis, based on
TUR syndrome and clot retention rates) and shorter
irrigation and catheterization duration. Well-designed
randomized controlled trials (RCTs) comparing bipolar TURP
multicentric/international RCTs with long-term follow-up
(B-TURP) with M-TURP for benign prostatic obstruction. Primary
and cost analysis are still needed.
end points included efficacy (maximum flow rate [Q max],
International Prostate Symptom Score) and safety (adverse
events). Secondary end points included operation time and
duration of irrigation, catheterization, and hospitalization.
Keywords:
Benign prostatic hyperplasia, Bipolar, Electrosurgery, Meta-
Evidence acquisition:
analysis, PlasmaKinetic, Prostate, Randomized controlled trial,
Based on a detailed, unrestricted strategy, the literature was
Review, Saline, Transurethral resection of prostate
searched up to February 19, 2009, using Medline, Embase,
Science Citation Index, and the Cochrane Library to detect all
relevant RCTs. Methodological quality assessment of the trials
was based on the Dutch Cochrane Collaboration checklist.
Meta-analysis was performed using Review Manager 5.0.
© 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Department of Urology, Academic Medical Center, University of Amsterdam,
a
Amsterdam, The Netherlands
Department of Quality Assurance and Process Innovation and Surgery, Academic
b
Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Evidence synthesis:
* C orresponding author. Department of Urology (G4-105), AMC University Hospital,
Sixteen RCTs (1406 patients) were included. Overall trial quality
Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel. +31 20 5666030;
was low (eg, allocation concealment and blinding of outcome
Fax: +31 20 5669585. E-mail address: [email protected]
assessors were poorly reported). No clinically relevant differences
(J.J.M.C.H. de la Rosette).
in short-term (12-mo) efficacy were detected (Q max: weighted mean
difference [WMD]: 0.72 ml/s; 95% confidence interval [CI],
0.08–1.35; p = 0.03). Data on follow-up of >12 mo are scarce for
B-TURP, precluding long-term efficacy evaluation. Treating 50
patients (95% CI, 33–111) and 20 patients (95% CI, 10–100) with
B-TURP results in one fewer case of TUR syndrome (risk
difference [RD]: 2.0%; 95% CI, 0.9–3.0%; p = 0.01) and one fewer
case of clot retention (RD: 5.0%; 95% CI, 1.0–10%; p = 0.03),
respectively. Operation times, transfusion rates, retention rates
after catheter removal, and urethral complications did not differ
P lease see the references on page 9.
6
Summary of results
B-TURP/plasma is equally as effective as M-TURP in improving the
flow rate at 12 months. (WMD: 0.72 ml/s; 95% CI, 0.08–1.35; p=0.03)
M-TURP
Q max at 12 months (ml/s)
B-TURP
B-TURP/plasma involves significantly shorter catheterization time
than M-TURP. (I 2 =0.98; sensitivity analysis on subgroup; p<0.00001)
M-TURP
Catheterization time (hours)
B-TURP
Yang 2004 (n=117)14
Nuhoglu 2006 (n=57)6
Singh 2005 (n=60)15
Seckiner 2006 (n=48)8
Lin 2006 (n=40)7
Kim 2006 (n=50)16
Seckiner 2006 (n=48)8
De Sio 2006 (n=70)9
Abascal 2006 (n=45)17
De Sio 2006 (n=70)9
Nuhoglu 2006 (n=57)6
Patankar 2006 (n=103)18
Ho 2007 (n=100)
10
Michielsen 2007 (n=238)19
Erturhan 2007 (n=240)11
Erturhan 2007 (n=240)11
Rose 2007 (n=72)20
Iori 2008 (n=53)12
Iori 2008 (n=53)12
Bhansali 2009 (n=64)13
Bhansali 2009 (n=67)13
0
5
10
15
20
25
B-TURP/plasma shows significantly lower occurrence of TUR
syndrome than M-TURP. (RD: 2%; 95% CI, 0–3%; p=0.01)
M-TURP
Total
Patient
number
Patient
number
59
30
35
21
21
51
25
30
24
120
34
120
52
26
33
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
58
30
35
24
21
52
25
27
24
120
38
118
48
27
34
13
681
0
681
B-TURP/plasma shows significantly lower occurrence of clot
retention M-TURP. (RD: 0%; 95% CI, 1–10%; p=0.03)
Events
Lin 20067
Patankar 200618
De Sio 2006 9
Ho 200710
Michielsen 200719
Erturhan 200711
Iori 200812
1
2
4
2
6
17
5
Total
37
422
60
80
100
120
Urethral
stricture
Bladder
neck
contracture
Meatal
stenosis
B-TURP
Events
Patient
number
Events Patient
number
Nuhoglu 2006 6
0
26
0
24
Seckiner 2006 8
1
21
2
23
Erturhan 200711
2
120
2
120
Ho 200710
1
52
3
48
Total
4
219
7
215
Lin 20067
1
18
0
22
De Sio 2006 9
1
35
1
35
Nuhoglu 2006 6
0
26
0
24
Erturhan 200711
1
120
0
120
Iori 200812
1
26
1
27
Total
4
225
2
228
Nuhoglu 2006 6
0
26
1
24
Erturhan 200711
2
120
3
120
Total
Cumul. total
2
146
4
144
10
590
13
587
Acronyms:
B-TURP
Patient
number
18
51
35
52
120
120
26
40
M-TURP
Events
1
0
3
0
0
0
0
0
0
2
0
1
2
0
4
M-TURP
20
B-TURP/plasma shows similar long-term urethral complication to
M-TURP at 12 months. (RD: 0%; 95% CI, -2–1%; p=0.58)
B-TURP
Events
Yang 200414
Singh 200515
De Sio 2006 9
Abascal 200617
Akcayoz 200621
Patankar 200618
Kim 200616
Nuhoglu 2006 6
Seckiner 2006 8
Erturhan 200711
Rose 200720
Michielsen 200719
Ho 200710
Iori 200812
Bhansali 200913
0
30
Events
0
0
2
3
4
2
1
Patient
number
22
52
35
48
118
120
27
12
422
WMD:
weighted mean difference
CI:
confidence interval
I2:heterogeneity
RD:
risk difference
Please see the references on page 9. The figures and tables were graphically adapted by Olympus. The content has not been changed.
7
GUIDELINE RECOMMENDATIONS
To put it in a nutshell, B-TURP/plasma has -according to the most recent EAU 2013 guideline on prostate
treatment- equivalent clinical benefit to M-TURP referenced in multiple systematic reviews, based on RCTs.
Moreover, B-TURP/plasma is preferable due to a more favorable safety profile compared with M-TURP. Also,
B-TURP has higher level of evidence and grades of recommendation when compared with laser vaporization.
22
EAU guideline 2013 – Transurethral Resection of the Prostate (TURP) and Transurethral
Incision of the Prostate (TUIP)
TURP/B-TURP
LE
GR
M-TURP is the current surgical standard procedure
for men with prostate sizes of 30–80 ml and
bothersome moderate-to-severe LUTS secondary of
BPO. M-TURP provides subjective and objective
improvement rates superior to medical or minimally
invasive treatments.
1a
A
B-TURP achieves short- and midterm results
comparable with M-TURP.
1a
A
B-TURP has a more favorable perioperative safety
profile compared with M-TURP.
1a
A
Laser (GreenLight)
LE
GR
HoLEP and 532-nm laser vaporisation of the
1a
A
The intermediate-term functional results of 532-nm
laser vaporisation of the prostate are comparable
with TURP.
1b
A
532-nm laser vaporization should be considered in
patients receiving anticoagulant medication or with a
high cardiovascular risk.
3
B
prostate are alternatives to TURP in men with
moderate-to-sever LUTS due to BPO leading to
immediate, objective, and subjective improvements
comparable with TURP.
Level of evidence
Type of evidence
1a
Evidence obtained from meta-analysis of randomised trials
1b
Evidence obtained from at least one randomised trial
3
Evidence obtained from well-designed nonexperimental studies, such as comparative or correlation studies and case reports
Grade
Recommendation
A
Based on clinical studies of good quality and consistency addressing the specific recommendations and including at least one randomised trial
B
Based on well-conducted clinical studies but without randomised clinical trials
Summary B-TURP/plasma
Summary laser
· B -TURP is the most widely and thoroughly investigated
· Only three RCTs to date provide sufficient follow-up data for 12
alternative to M-TURP.
· Available evidence to date includes 33 RCTs with 3,601
randomized patients in total.
· T hree meta-analyses concluded no different efficacy and
months.
· The longest RCT for the 80W KTP laser has a follow-up of only
12 months.
· The longest RCT for the 120W HPS laser has a 36-month
preferred safety profile of B-TURP when compared with M-TURP
follow-up, but with inferior results in reduction of PSA level and
up to 12 months.
prostate volume when compared with TURP; the reoperation rate
· To date, seven RCTs have mid-term follow-up duration between
18 to 60 months.
was significantly higher with PVP.
· No RCTs have been published on the 180W GreenLight laser.
· M id-term results of up to five years show comparable results of
B-TURP in efficacy and safety when compared with M-TURP.
· No individual RCT favors M-TURP.
Please see the references on page 9. The figures and tables were graphically adapted by Olympus. The content has not been changed.
8
Debate over the evidence: B-TURP/plasma has the best available evidence to date (Quotes
from Mamoulakis et al. 2013 23).
Regarding the debate about bipolar transurethral resection of the prostate (B-TURP) versus monopolar
transurethral resection of the prostate (M-TURP), the fact is that we currently have >30 RCTs (>3500
patients) and three recent RCT-based meta-analyses [5]. Indisputably, B-TURP is presently the
most widely used and thoroughly investigated alternative to M-TURP [6].
Pooled results are awaited. However, it should be stressed that no individual RCT favors M-TURP in any
aspect. More than half favor B-TURP in some of the outcomes mentioned above, and the rest
show no difference. Having seven RCTs currently at hand with a follow-up >12 mo, we have
reached acceptable durations to judge the adequacy of B-TURP efficacy and safety comparability with
the predecessor in time. Regarding economic issues, we are still unable to argue decisively.
But can we ignore this ample evidence just because ‘‘the overall quality is not the best,’’ without being
prone to bias? If yes, then what can we infer from much less data on other alternatives to
M-TURP, such as lasers, for which evidence is based on fewer trials with similar methodological
limitations [2]? High-quality international multicenter RCTs are always welcomed; in the modern era of
evidence-based urology, there will always be ‘‘a plea for more.’’ Nevertheless, there comes a time when
we have to decide based on the best available evidence. This is the case for B-TURP versus
M-TURP. Definitely we can decide, and it’s about time!
P lease see the references on page 9.
9
TURIS - SYSTEM CHART
HF resection electrodes
WA22301D Loop, 12°, small
WA22351C Roller, 12° and 30°
WA22305D Loop, 30°, small
WA22355C Needle, 12° and 30°, 45° angled loop
WA22302D Loop, 12°, medium
WA22521C Band, medium, 12°
WA22306D Loop, 30°, medium
WA22523C Band, medium, 30°
WA22503D Loop, 12°, large
WA22557C PlasmaButton, 12° and 30° for
plasma vaporisation
WA22507D Loop, 30°, large
WA22558C Angled loop, 12° and 30° for
TUEB (transurethral enucleation)
WA22331D Angled loop, 12° and 30°, small
WA22332D Angled loop, 12° and 30°, medium
For a detailed list of electrodes, see our Urology catalogue
Electrosurgical unit
Working elements
Telescopes 4 mm, autoclavable
WA00014A HF cable, bipolar, 4 m,
for ESG-400
WA22366A
A22001A
12° direction of view
A22002A
30° direction of view
WA03200A
Light-guide cable,
3 mm, plug type
Working element,
active
WA22367A
WB91051W HF unit ESG-400
Working element,
passive
ESG-400
BIPOLAR
MONOPOLAR
1
SELECT
PROCEDURE
UNIVERSAL
MONOPOLAR
2
FOOT
SWITCH
NEUTRAL
CQM
F
MENU
Rotatable continuous-flow resectoscope
Standard resectoscope
Inner sheath
A22041*
A22040*
For 26 Fr. outer sheath
A22041
For 27 Fr. outer sheath
Outer sheath
A22026A
26 Fr., 2 stopcocks, rotatable
A22021A
27 Fr., 2 stopcocks,
rotatable
Resection sheath,
without irrigation port
Artikel-NR.
Irrigation
port
Maßstab:
Datum
Änderung:
A22051A
A22052A
1 stopcock, rotatable
Datum
15.3.06
Erstellung:
1 luer-lock connector,
rotatable
von:
A22053A
2von:
horizontal stopcocks,Lubert
rotatable
A22054A
Artikel-Bezeichnung:
Maßstab:
1 vertical stopcock, fixed
Artikel-NR.
Datum
15.3.06
Erstellung:
WA22366A.eps
A22055A
1 vertical luer-lock connector, fixed
A22040*
For 26 Fr. outer sheath
Datum
Änderung:
ILL-Name:
von:
A22041*
For 27 Fr. outer sheath
Artikel-Bezeichnung:
Resection sheath, intermittent
irrigation, 24 Fr.
ILL-Name:
WA22367A_fly.eps
Datum
Continuous-flow resectoscope
Inner sheath
Resectoscope with intermittent irrigation
A22014*
von:
Outer sheath
A22027A
26 Fr., 2 vertical stopcocks, fixed
A22023A
27 Fr., 2 vertical stopcocks, fixed
A22025A
27 Fr., 2 horizontal
Datum
stopcocks, fixed
10
Sperlich
Maßstab:
Artikel-NR.
Änderung:
Datum
Erstellung:
von:
von:
Maßstab:
Artikel-NR.
Änderung:
Datum
*Add A or T to the article number for the desired obturator:
Artikel-Bezeichnung:
13.12.01
Erstellung: A220xxA
standard obturator
von:
Maßstab:
Artikel-Bezeichnung:
Datum
Änderung:
ILL-Name:
von:
A220xxT obturator with deflecting tip
von:
Lubert
Artikel-NR.
Datum
Erstellung:
von:
21.9.01
A22040A.ILL
Lubert
ILL-Name:
26.9.01
Lube
A22041A.ILL
REFERENCES
References of page 2:
Patankar S, Jamkar A, Dobhada S, et al. PlasmaKinetic Superpulse transurethral
resection versus conventional transurethral resection of prostate. J Endourol
2006; 20:215–9.
1
uppo P, Bertolotto F, Introini C, et al. Bipolar transurethral resection in saline (TURis):
P
outcome and complication rates after the first 1000 cases. J Endourol. 2009 Jul;
23(7):1145-9
18 2
ichielsen DP, Debacker T, De Boe V, et al. Bipolar transurethral resection in saline--an
M
alternative surgical treatment for bladder outlet obstruction? J Urol. 2007 Nov;
178(5):2035-9
19
ichielsen DP, Debacker T, De Boe V, et al. Bipolar transurethral resection in
M
saline-an alternative surgical treatment for bladder outlet obstruction? J Urol
2007; 178:2035–9.
3
eavlete B, Stanescu F, Moldoveanu C, et al. Continuous vs conventional bipolar
G
plasma vaporisation of the prostate and standard monopolar resection: a prospective,
randomised comparison of a new technological advance. BJU Int. 2013 Jun 13.
20
ose A, Suttor S, Goebell PJ, et al. Transurethral resection of bladder tumors and
R
prostate enlargement in physiological saline solution (TURIS). A prospective study [in
German]. Urologe A 2007; 46:1148–50.
4
agerström T, Nyman CR, Hahn RG. Complications and clinical outcome 18 months after
F
bipolar and monopolar transurethral resection of the prostate. J Endourol. 2011 Jun;
25(6):1043-9
21
kcayoz M, Kaygisiz O, Akdemir O, et al. Comparison of transurethral resection and
A
plasmakinetic transurethral resection applications with regard to fluid absorption
amounts in benign prostate hyperplasia. Urol Int 2006; 77: 143–7.
References of page 3:
5
agerström T, Nyman CR, Hahn RG. Degree of vaporization in bipolar and monopolar
F
resection. J Endourol. 2012 Nov; 26(11):1473-7
References of page 7:
6
7
uhoglu B, Ayyildiz A, Karagüzel E, et al. Plasmakinetic prostate resection in the
N
treatment of benign prostate hyperplasia: results of one-year follow-up. Int J Urol
2006; 13:21–4.
in MS, Wu JC, Hsieh HL, et al. Comparison between monopolar and bipolar TURP in
L
treating benign prostatic hyperplasia: one-year report. Mid-Taiwan J Med 2006;
11:143–8.
8
eckiner I, Yesilli C, Akduman B, et al. A prospective randomized study for comparing
S
bipolar plasmakinetic resection of the prostate with standard TURP. Urol Int 2006;
76:139–43.
9
e Sio M, Autorino R, Quarto G, et al. Gyrus bipolar versus standard monopolar
d
transurethral resection of the prostate: a randomized prospective trial. Urology
2006; 67:69–72.
10
o HSS, Yip SKH, Lim KB, et al. A prospective randomized study comparing
H
monopolar and bipolar transurethral resection of prostate using transurethral
resection in saline (TURIS) system. Eur Urol 2007; 52:517–24.
References of page 8:
elke M, Bachmann A, Descazeaud A, et al. EAU Guidelines on the Treatment and
O
Follow-up of Non-neurogenic Male Lower Urinary Tract Symptoms Including Benign
Prostatic Obstruction. European Urology 64, 2013; 118-140.
22
References of page 9:
Mamoulakis C, Schulze M, Skolarikos A, et al. Best Available Evidence in 2012 on
Bipolar Versus Monopolar Transurethral Resection of the Prostate for Benign
Prostatic Obstruction: It’s About Time to Decide! Eur Urol 2013; 63:679–80.
23 [2] B achmann A, Muir GH, Wyler SF, et al. Surgical benign prostatic hyperplasia trials:
the future is now! Eur Urol 2013; 63:677–9.
[5] M amoulakis C, Sofras F, de la Rosette J, et al. Bipolar versus monopolar
transurethral resection of the prostate for lower urinary tract symptoms secondary to
benign prostatic obstruction. Cochrane Collaboration, John Wiley & Sons; 2012.
http://dx.doi.org/10.1002/14651858.CD009629.
[6] O
elke M, Bachmann A, Descazeaud A, et al. members of the European Association
of Urology Guidelines Office. Guidelines on the management of male lower urinary
tract symptoms (LUTS), incl., (BPO) BPO. Paper presented at: 27th European
Association of Urology Annual Congress; February 24–28, 2012; Paris, France.
Erturhan S, Erbagci A, Seckiner I, et al. Plasmakinetic resection of the prostate versus
standard transurethral resection of the prostate: a prospective randomized trial with
1-year follow-up. Prostate Cancer Prostatic Dis 2007; 10:97–100.
11 Iori F, Franco G, Leonardo C, et al. Bipolar transurethral resection of prostate: clinical
and urodynamic evaluation. Urology 2008; 71: 252–5.
12 13
hansali M, Patankar S, Dobhada S, et al. Management of large (>60 g) prostate
B
gland: PlasmaKinetic Superpulse (bipolar) versus conventional (monopolar)
transurethral resection of the prostate. J Endourol 2009; 23:141–6.
Yang
S, Lin WC, Chang HK, et al. Gyrus plasmasect: is it better than monopolar
transurethral resection of prostate? Urol Int 2004; 73: 258–61.
14 15
ingh H, Desai MR, Shrivastav P, et al. Bipolar versus monopolar transurethral
S
resection of prostate: randomized controlled study. J Endourol 2005; 19:333–8.
16
im JY, Moon KH, Yoon CJ, et al. Bipolar transurethral resection of the prostate: A
K
comparative study with monopolar transurethral resection. Korean J Urol 2006; 47:493–7.
Abascal
Junquera JM, Cecchini Rosell L, Salvador Lacambra C, et al. Bipolar versus
monopolar transurethral resection of the prostate: preoperative analysis of the
results. Actas Urol Esp 2006; 30:661–6.
17 11
E0492139 · 2.000 · 04/14 · PR
TURIS – TRANSURETHRAL RESECTION IN SALINE
Specifications, design, and accessories are subject to change without any notice or obligation on the part of the manufacturer.
Postbox 10 49 08, 20034 Hamburg, Germany
Wendenstrasse 14–18, 20097 Hamburg, Germany
Phone: +49 40 23773-0, Fax: +49 40 237765
www.olympus-europa.com