Rotoresect for bloodless transurethral resection of the prostate: a 4-year follow-up

Efficacy and Safety of Transurethral Columnar Balloon Dilation of the Prostate for the Treatment of Benign Prostatic Hyperplasia: A Multicenter Trial

Objective

To observe the efficacy and safety of transurethral columnar balloon dilation of the prostate (TUCBDP) for benign prostatic hyperplasia (BPH) in a multicenter trial.

Method

This multicenter study included 2050 patients with BPH who underwent TUCBDP from 11 cities of Zhejiang Province, from September 2015 to June 2021. Clinical assessment included recording and measurement of preoperative and postoperative data including prostate volume, serum prostate-specific antigen (PSA) levels, IPSS score, quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Index of Erectile Function (IIEF-5), and Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). Additionally, the correlation of the indicators was analyzed using linear regression and early postoperative complications were also recorded.

Results

One month after surgery, the patients' IPSS score, QoL, and PVR were significantly decreased, while the Qmax, IIEF-5, and MSHQ-EjD-SF scores were increased considerably, compared with preoperative data. After surgery, the patient's IPSS score, QoL, and Qmax were improved year by year, while PVR gradually decreased. Three months after TUCBDP, IIEF-5 and MSHQ-EjD-SF levels reached the climax. Linear regression analysis showed that the serum PSA level was significantly positively correlated with Qmax at 3 months after TUCBDP, while at 6 months after surgery, it was negatively related to IPSS and QoL. Early postoperative complications appeared in 384 cases during follow-up.

Conclusion

Collectively, TUCBDP may effectively improve the urinary and sexual function of BPH patients, with fewer postoperative complications, and its efficacy is not limited by age and prostate volume. It can be considered a better treatment option for BPH.

Rotoresection versus transurethral resection of the prostate: short-term evaluation of a prospective randomized study

PURPOSE

We compared in a prospective fashion the short-term outcome of rotoresection to transurethral resection of the prostate.

MATERIALS AND METHODS

A total of 50 patients with bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized into 2 groups, rotoresection and transurethral resection of the prostate. Mean+/-SD patient age was 60.76+/-5.85 years in the rotoresection and 64.24+/-6.84 in the transurethral resection groups. All patients had an International Prostate Symptom Score of 8 or more, maximum free flow rate less than 15 ml per second, prostate volume 20 to 100 ml and prostate specific antigen 1 to 4 ng/ml. Pressure flow study revealed bladder outlet obstruction (Schafer's grade 3 or more). Patients were assessed at 1, 3 and 6 months by International Prostate Symptom Score, maximum free flow rate, transrectal ultrasound, pressure flow study, hemoglobin and urinalysis.

RESULTS

At 6 months International Prostate Symptom Score decreased from 26.2+/-4.06 to 5.32+/-1.52 in the rotoresection group and from 22.84+/-4.56 to 7+/-1.4 in the transurethral resection group. Maximum free flow rate increased from 7.87+/-2.24 to 25.29+/-10.39 ml per second in the rotoresection group and from 9.44+/-2.29 to 25.2+/-5.8 ml per second in the transurethral group. Prostate volume decreased from 41.2+/-16.58 to 17.24+/-7.61 ml in the rotoresection group and from 40.6+/-16.93 to 18.28+/-8.75 ml in the transurethral group. Detrusor pressure at maximum flow and Schafer grade decreased from 79.84+/-26.8 cm H2O and 4.24+/-0.97 to 38.8+/-18.8 cm H2O and 1.24+/-0.93 in the rotoresection group, and from 63.04+/-21.08 cm H2O and 3.48+/-0.65 to 34.16+/-12.7 cm H2O and 1+/-0.7 in the transurethral group. Dilutional hyponatremia was higher with transurethral resection of the prostate (p=0.005) but no patient showed manifestations of the transurethral syndrome. Mild stress urinary incontinence was noted in 4 patients in the rotoresection group and in 3 in the transurethral group.

CONCLUSIONS

Rotoresection is a safe and effective method of treating bladder outlet obstruction resulting from benign prostatic hyperplasia, and its efficacy is comparable to transurethral resection of the prostate.

A 2-year follow-up after rotoresection of the prostate: a prospective study

OBJECTIVE

To evaluate the success of rotoresection of the prostate for benign prostatic hyperplasia (BPH), after a follow-up of 24 months.

PATIENTS AND METHODS

The 24 patients who were the subject of a previous report were followed for up to 24 months; only one patient was lost to follow-up.

RESULTS

The mean (sd) American Urologic Association-7 score decreased from 20.5 (3.8) before surgery to 1.12 (1.56) at 24 months; the mean maximum urinary flow rate increased from 8.7 (2.1) to 21.8 (8.5) mL/s, and the mean total prostate volume decreased from 36.5 (12.9) to 21 (7.9) mL. Early complications were urinary tract infection in 10 patients and mild stress urinary incontinence in 11. One patient had a urethral stricture and another had a posterior urethral stone at 6 months; both were treated successfully with good urinary flow rates thereafter. At 24 months, 23 patients had sterile urine and were continent.

CONCLUSION

Thus far, rotoresection of the prostate is a safe and effective method for treating BPH. The hospital stay was short and the functional results excellent at up to 24 months.

Photoselective Vaporization of the Prostate: The Basel Experience after 108 Procedures

OBJECTIVES

This study aims to investigate safety and efficacy of 80 watt high-power potassium titanyl phosphate (KTP) laser vaporization of the prostate in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

METHODS

108 patients underwent 80W KTP laser vaporization. Functional follow-up included measurement of maximum urinary flow rate (Qmax), postvoid residual volume (Vres) and International Prostate Symptom Score (IPSS) within a 12 months period.

RESULTS

The average prostate volume was 52.2+/-24.3 ml and the preoperative PSA value was 3.6+/-3.6 ng/dl. Mean operation time was 54.5+/-25.0 min. Qmax increased highly significantly (p<0.001) by 111% (+7.9 ml/s) at discharge, 212% (+15.1 ml/s) after three months, 201% (+14.3 ml/s) after six months and 252% (+17.9 ml/s) after 12 months. Correspondingly, Vres, IPSS and Bother Score improved to an extent that was statistically highly significant (p<0.001) immediately after surgery. The observed complication rate within one year was low.

CONCLUSIONS

80 W KTP laser vaporization is a virtually bloodless, safe and effective procedure for surgical treatment of LUTS secondary to BPH. A significant improvement of objective and subjective voiding parameters was observed just after surgery. KTP laser vaporization is associated with a low rate of complications.

Transurethrale Resektion bei benigner Prostatahyperplasie

Transurethral resection of the prostate still represents the "gold standard" in surgical treatment of symptomatic benign prostatic enlargement (BPE). New demands were made on transurethral electrosurgery with the appearance of alternative, minimal invasive procedures. Bleeding complications had to be reduced. Different attempts were made to improve the conventional TURP. Band loops and roller bars were developed in order to gain a more effective coagulation during the cutting process by a larger tissue contact. Major advances could be achieved by modifications of the high-frequency generator. Improved procedures like the "Coagulating-Intermittent-Cutting" (CIC), the "Instant-Response-", as well as the "Dry-Cut-Technology" combine cutting and coagulating effects to realize lowered bleeding and an efficient resection process. The introduction of bipolar currency flow opens the possibility of conventional TUR-P with saline solutions and thus to the theoretical avoidance of the TUR-syndrome. By the neoadjuvant use of 5alpha-reductase-inhibitors before planned TUR-P, bleeding- and irrigation fluid absorption should be reduced by lowering perfusion and the size of the prostate. Regarding these innovative approaches which improve the surgical standard and minimize the risk of perioperative complications, transurethral electrosurgery remains the method of choice in instrumental therapy of symptomatic BPE. In the future efficacy and costs will be comparable to those of the transurethral laser-resection or laser-vaporisation.