The "Wedge" resection device for electrosurgical transurethral prostatectomy

Plasmakinetic vaporization versus transurethral resection of the prostate: Six-year results

OBJECTIVE

Benign prostate hyperplasia (BPH) is becoming more prevalent in parallel to the changing demographic structures of the community. Transurethral resection is still considered the most effective treatment. Due to advances in technology, different treatment modalities are being attempted. In our study, we compared the long-term results of standard transurethral resection of prostate (TURP) with plasmakinetic vaporization of prostate (PKVP, Gyrus Medical Ltd., Bucks, UK).

MATERIAL AND METHODS

Of the 75 patients who were admitted to our outpatient clinic between 2001 and 2003 with lower urinary tract complaints and who were randomized into two groups (transurethral resection (TUR) and PKVP), 36 were enrolled to study and completed a follow-up period of 72 months.

RESULTS

Both groups were equal in terms of age and preoperative parameters. The preoperative maximum uroflow rate (Qmax) in the PKVP group was 6 (2.3) mL/s and the rates were 21.8 (3.4) and 20.1 (3.1) during the control visits at 36 and 72 months, respectively. For the PKVP group, these rates were 6 (3.1), 14.4 (2.6), and 15.6 (2.8), respectively. In terms of the international prostate symptom score (IPSS), for the TUR group, these values were 22 (3.8), 5.7 (1.2), and 7.9 (2.6). For the PKVP group, the respective values were 21 (3.4), 7.6 (1.4), and 11 (2.4). The IPSS and Qmax values measured at the 36(th) and 72(nd) months for both groups were significantly different from each other (p<0.05).

CONCLUSION

Compared to standard TURP, PKVP was found to be unsuccessful in the treatment of BPH when long-term outcomes were considered.

The learning curve for holmium laser enucleation of the prostate: a single-center experience

Purpose

Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve and, as a result, its clinical usage has limitations. The purpose of this study was to analyze the learning curve and early complications following the HoLEP procedure.

Materials and Methods

A retrospective analysis was performed on 161 patients who had undergone the HoLEP procedure for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) from July 2008 to September 2009. The procedure was done by two surgeons. Perioperatively, enucleated tissue weight, enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), and enucleation efficiency (enucleated weight/enucleation time) were analyzed, and early complications were assessed.

Results

Mean enucleation time, morcellation time, and enucleation ratio were 61.3 min (range, 10-180 min), 12.3 min (range, 2-60 min), and 0.66 (range, 0.07-2.51), respectively. In terms of efficiency, enucleation efficiency was 0.32 g/min (range, 0.02-1.25 g/min) and morcellation efficiency was 1.73 g/min (range, 0.1-7.7 g/min). Concerning the learning curve, enucleation efficiency was stationary after 30 cases (p<0.001), morcellation efficiency reached a learning curve at 20 cases (p=0.032), and enucleation ratio had no learning curve in this study. There were several cases of surgery-related complications, including bladder mucosal injury by the morcellator (13%), capsular injury during enucleation (7%), and conversion to a conventional resectoscopy procedure (15%), which showed a reduction in incidence with time.

Conclusions

The learning curve of HoLEP is steep; however, it can be overcome gradually. Further study is necessary with respect to long-term postoperative follow-up.

Transurethral vapor resection of prostate is a good alternative for prostates >70 g

BACKGROUND AND PURPOSE

The morbidity associated with transurethral resection of the prostate (TURP) for large-volume prostates has prompted attempts to modify the standard equipment and techniques. Patients with large prostates (>70 g) need longer operative time, and have greater blood loss and higher irrigant fluid requirements; therefore, the traditional surgical recommendation for the management of benign prostatic hyperplasia (BPH) >70 g is open surgery. We assessed the effectiveness and safety of transurethral vapor resection of the prostate (TUVRP) for the management of prostate glands with a volume >70 g.

MATERIALS AND METHODS

Eighty-nine patients with a diagnosis of BPH who had a prostate volume >70 grams determined by abdominal ultrasonography underwent TUVRP between July 2002 and March 2006. Preoperative evaluation included assessment of International Prostate Symptom Score (IPSS), prostate volume, postvoid residual (PVR), and maximum flow rate (Q(max)). Intraoperative and postoperative parameters, including operative time, total irrigant requirement, blood loss, duration of postoperative catheterization, hospital stay, and complications were also analyzed.

RESULTS

The mean prostate volume for the 89 patients was 83.3 g (range 70-169 g). The mean age was 67.25 years (range 55-87 yr). Symptom duration varied from 2 months to 7 years. Twenty-two patients used a catheter preoperatively. The mean IPSS score, Q(max), and PVR were 23, 7.1 mL/sec, and 116 mL, respectively. The mean operative time was 64 minutes, and mean irrigant used was 21.4 L. The mean weight of resected tissue was 31.3 g. The average postoperative catheter duration was 2.25 days. Complications included transient dysuria in 11 patients, hyponatremia in two patients, and urethral stricture in two patients. No patient required a blood transfusion postoperatively. The effectiveness as assessed at 6 months was IPSS 5.1, Q(max) 22.5 mL/sec, and PVR not significant.

CONCLUSIONS

TUVRP is safe and effective in patients with large prostates (>70 g) with minimal complications and faster postoperative recovery. This technique helps to avoid the morbidity associated with open surgery.

Comparison of transurethral prostate resection and plasmakinetic prostate resection according to cautery artefacts in tissue specimens

OBJECTIVES

The objectives were to evaluate cautery artifacts histopathologically in tissue specimens after plasmakinetic prostate resection (PKRP) and transurethral prostatectomy (TURP), and compare the results of the two procedures.

MATERIALS AND METHODS

The histopathological specimens of 65 patients who underwent PKRP and TURP were examined retrospectively. Tissue chips for examination were selected randomly. Artifactual pathological patterns that were identified in the specimens included: abnormal cellular orientation and spindling, artifactual cellular detachment from the underlying basement membrane, atypical cytological changes and stromal coagulative necrosis. Each pattern identified was awarded 1 point. The severity of the cautery artefact was graded as absent, mild, moderate or severe according to the sum of points in each specimen.

RESULTS

In TURP, the artefacts were graded absent (9%), mild (6%), moderate (18.7%), and severe (65.6%) changes. In PKRP, the artefacts were graded absent (6%), mild (18.1%), moderate (36.3%), and severe (39.4%) changes. While the number of mild and moderate artefacts observed was higher in PKRP (P = 0.023), severe artefacts were observed in higher numbers with TURP (P = 0.034). No prostate cancer was detected during the follow-up period.

CONCLUSIONS

It has been observed that the application of TURP causes fewer mild to moderate artefacts and PKRP causes fewer severe artefacts in the histopathological evaluation of specimens in comparison to each other.

Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g

OBJECTIVES

To compare the safety and efficacy of two alternatives for surgically treating symptomatic benign prostatic hyperplasia (BPH), i.e. transurethral vapour resection of the prostate (TUVRP) and holmium laser enucleation of the prostate (HOLEP), with transurethral resection of the prostate (TURP), the standard surgical therapy, as treating large prostates is associated with greater morbidity, and to date there is no simultaneous comparison of these three methods.

PATIENTS AND METHODS

We prospectively randomized 150 patients (50 in each group) with BPH and glands of >40 g to undergo either TURP, TUVRP or HOLEP. The evaluation before treatment included urine culture, serum prostate specific antigen (PSA) level estimation, the International Prostate Symptom Score (IPSS), peak urinary flow rate (Q(max)), and transabdominal ultrasonography to estimate prostate size and postvoid urine residue (PVR). The operative duration, blood loss, resected tissue weight, change in levels of haemoglobin and serum sodium, nursing contact time, duration of catheterization, and complications were noted. After surgery patients were reassessed for the IPSS, Q(max) and PVR at 6 months and 1 year.

RESULTS

The patients in all three groups had comparable characteristics before surgery. The mean operating duration and intraoperative irrigant used for TUVRP was less than for HOLEP or TURP, and blood loss with HOLEP and TUVRP was less than with TURP (all P < 0.001). Postoperative irrigation, nursing contact time, and catheter duration were significantly less for HOLEP than TURP or TUVRP, and for TUVRP than TURP. At follow-up, patients in all groups had a significant improvement from baseline in IPSS, Q(max,) and PVR, but the differences between the groups were not significant at 6 months or 1 year.

CONCLUSIONS

HOLEP and TUVRP are both acceptable alternatives to TURP for treating large prostate glands, with less perioperative morbidity and comparable efficacy at 6 months and 1 year.

Short Term Outcomes of High Power (80 W) Potassium-titanyl-phosphate Laser Vaporization of the Prostate

PURPOSE

We have evaluated the safety and efficacy of 80 W potassium-titanyl-phosphate (KTP) laser in the treatment of patients with lower urinary system symptoms (LUTS) due to benign prostatic hyperplasia.

MATERIALS AND METHODS

A total of 186 patients with LUTS have been evaluated using the International Prostate Symptom Score (IPSS) and quality of life (QoL) scoring questionnaire. Volume of prostate, post-micturition volume of residual urine (PVR), maximum flow rate (Qmax) and serum prostate specific antigen (PSA) values were determined. Laser vaporization of the prostate with an 80 W KTP was applied to all the patients. IPSS and QoL scores were evaluated on postoperative days 30, 90 and 180. The below values were measured on the postoperative days mentioned respectively: Qmax-15, 30 and 90; PSA-1, 15, 30 and 60; PVR-90.

RESULTS

The results of 186 patients, who underwent KTP laser treatment, have been evaluated. Mean age of the patients was 66+/-8 (47-90). Mean volume of prostates, mean operative time and mean energy delivery were 48.1+/-13.2 ml (26-70), 57+/-17 minutes (10-120) and 105+/-37 kJ (20-350), respectively. Following the procedures, Foley catheters were removed after a mean time of 7.59+/-0.9 hours (6-13). Compared with the preoperative period, IPSS, QoL, PVR and Qmax values decreased significantly during the postoperative period (p<0.01). Mean preoperative PSA value was 2.59+/-0.9 ng/ml (0.28-4). There were statistically significant increases in PSA values on postoperative day 1 (p<0.001). However, on postoperative day 15, PSA values decreased as low as preoperative values. There was moderate dysuria in 55 (30%) patients with a mean duration of 2 months and mild hematuria in 10 (18%) patients with a mean duration of 1 month postoperatively. Urinary tract infection occurred in 12 (6%) patients. None of the patients had fever or required re-catheterization. We observed contracture of the bladder neck in 2 (1%) patients and clot retention in 2 (1%) patients. Urinary incontinence due to operation was not observed.

CONCLUSIONS

KTP laser vaporization of the prostate is a treatment method which can be used in patients at high risk of anesthesia. This procedure is safe and effective in that it quickly relieves bladder outlet obstruction symptoms and has a low rate of postoperative complications. However, long-term follow-up studies are called for in order to ascertain whether the results of this procedure are durable or not.

Prospective randomized controlled trial comparing plasmakinetic vaporesection and conventional transurethral resection of the prostate

OBJECTIVE

Plasmakinetic vaporesection of the prostate (PKVP) using normal saline irrigation has the theoretical advantage of avoiding transurethral resection syndrome and minimizing blood loss. It may also shorten the operative time since tissue is resected instead of just vaporized. The aim of this study was to evaluate the efficiency, safety and advantages of PKVP compared with standard transurethral resection of the prostate (TURP) at a regional acute hospital.

METHODS

A total of 60 consecutive men admitted from a waiting list for surgery for benign prostatic hyperplasia (BPH) were prospectively randomized to either PKVP or TURP. Peri- and postoperative outcome data at 3 months were obtained.

RESULTS

The PKVP loop achieved a fast and sharp cutting action similar to that with the traditional TURP loop. Data analysis was based on 51 patients. There were no significant differences between the methods in resection time, postoperative catheterization time and hospital stay. The mean reductions in serum sodium 2 hours after PKVP and on postoperative day 1 were 0.52 mmol/L and 3.35 mmol/L, respectively, while mean reductions in haemoglobin were 0.36 g/dL and 0.24 g/dL, respectively. There was no significant difference in haemoglobin reductions between PKVP and TURP (p = 0.326 at 2 hours; p = 0.192 on day 1) and serum sodium (p = 0.757 at 2 hours; p = 0.888 on day 1). Both groups achieved comparable improvement in International Prostate Symptom Score (p = 0.862), quality-of-life score (p = 0.169) and peak flow rate (p = 0.96) at 3-month follow-up.

CONCLUSION

PKVP achieved comparable results to traditional TURP and was an effective and safe procedure. However, it did not demonstrate obvious advantages over TURP in this acute regional hospital regular TURP list setting.

Thick Loop Prostatectomy in the Endoscopic Treatment of Benign Prostatic Hyperplasia: Results of a Prospective Randomised Study

OBJECTIVE

The thick loop is a new device employed for transurethral resection of the prostate (TURP) using the standard resectoscope. The loop is broader and thicker than the standard one, resulting in better hemostasis because of its ability to cut, coagulate and vaporize tissue simultaneously. We evaluated the safety and efficacy of the thick loop device compared with the standard loop.

PATIENTS AND METHODS

103 patients with symptomatic benign prostatic hyperplasia were randomized to undergo either thick loop (51 patients) or standard loop TURP (52 patients). Patients were considered for surgery with the American Urological Association (AUA) symptom score greater than 7 and a maximum urinary flow rate <15 ml/s. Serum hemoglobin, hematocrit, electrolytes, operative time, prostate resected weight, catheterization time and complications were recorded. Twelve months later, the AUA score, maximum urinary flow rate (Q(max)) and postvoiding residual urine volume were evaluated.

RESULTS

There were no significant differences between thick and standard loop TURP regarding the operative and catheterization time, prostate resection weight and postoperative levels of hemoglobin, hematocrit and electrolytes. Twelve months after TURP, the AUA score was significantly lower and Q(max) greater in the thick loop compared to the standard loop groups.

CONCLUSIONS

Thick loop TURP is as safe as standard loop TURP with respect to blood loss, operative time and complications. Operating in a virtually bloodless field could allow a more radical TURP and provide an explanation for the better functional results (Q(max) and AUA score) obtained by the thick loop resection.

Die 80-Watt-Kalium-Titanyl-Phosphat- (KTP-)Laservaporisation der Prostata

BACKGROUND

Despite good efficacy, even in our days, TURP remains a potentially difficult procedure to perform and is associated with significant risks for the patient. Several alternatives have been tried to reduce the known perioperative morbidity. We report our first experiences with 80 W potassium titanyl phosphate (KTP) laser vaporization of the prostate in patients with symptomatic BPH.

PATIENTS AND METHODS

In 70 patients 80 W KTP laser vaporization was performed successfully. Mean age was 70.5 years (46-93 years) and mean transrectal prostate volume was 48.1 ml (10-250 ml).

RESULTS

Mean operating time was 41 min ( n=22), 64 min ( n=33), and 80 min ( n=15) for a 26 ml, 46 ml, and a 91 ml prostate, respectively. At time of discharge, after 1 month, and 6 months the urinary peak flow increased by 75.4%, 166.8%, and 168.6%, respectively.

CONCLUSION

The 80 W KTP laser vaporization of the prostate combines the tissue-debulking properties of transurethral resection of the prostate with the known good hemostatic properties of other laser procedures. It is a safe procedure for the patient and provides a virtually bloodless operation and immediate improvement of voiding.

EXPERIMENTAL COMPARISON OF HIGH POWER (80 W) POTASSIUM TITANYL PHOSPHATE LASER VAPORIZATION AND TRANSURETHRAL RESECTION OF THE PROSTATE

PURPOSE

Perioperative hemorrhage is still the major complication of standard transurethral prostate resection (TURP). Potassium titanyl phosphate (KTP) laser vaporization using 80 W is a novel technique that promises instant hemostatic tissue ablation. In this ex vivo investigation we compared the hemostatic properties of the 2 procedures.

MATERIALS AND METHODS

Ex vivo, blood perfused porcine kidneys were used to verify the hemostatic efficacy of KTP laser vaporization and TURP-like tissue resection. Bleeding could be exactly quantified in relation to tissue ablation for the 2 techniques. In addition, specimens were examined microscopically.

RESULTS

KTP laser vaporization demonstrated highly significantly decreased bleeding as compared to conventional tissue resection for a standardized ablation volume of 16 cm tissue (2.1 vs 23.3 ml per minute, p <0.0001). Tissue ablation was more rapid in the resection group (20 vs 100 seconds, p <0.001). Histological examinations revealed larger coagulation zones for the KTP group compared to conventional tissue resection (0.9 vs 0.6 mm, p <0.01).

CONCLUSIONS

Ex vivo, 80 W KTP laser vaporization is a virtually bloodless ablative procedure, giving rise to hemostasis that is highly superior to conventional TURP-like tissue resection. However, the novel procedure is considerably more time-consuming.

Ex-vivo comparison of the haemostatic properties of standard transurethral resection and transurethral vaporization resection of the prostate

OBJECTIVE

To compare the haemostatic properties of standard transurethral resection of the prostate (TURP) and transurethral vaporization resection of the prostate (TUVRP), as perioperative bleeding is still regarded as the major complication of prostate resection.

MATERIALS AND METHODS

Isolated blood-perfused porcine kidneys were used to determine the haemostatic efficacy of TURP and TUVRP (using two different electrodes). Bleeding was quantified precisely in relation to tissue ablation for the two techniques, and specimens were evaluated histologically.

RESULTS

Both TUVRP groups had significantly less bleeding (P = 0.005) than the TURP group for a standardized ablation volume of perfused kidney tissue (18.9, 19.5 and 24.1 mL/min, respectively). The different TUVRP electrodes had no significant haemostatic differences. The histology showed significantly (P = 0.03) larger coagulation zones for the TUVRP groups than for standard TURP.

CONCLUSIONS

TUVRP ex-vivo was associated with significantly better haemostasis than TURP. The haemostatic properties of different active electrodes for TUVRP seem to be equivalent.

Vapor resection: a good alternative to standard loop resection in the management of prostates >40 cc

BACKGROUND AND PURPOSES

The morbidity of transurethral vesection of the prostate (TURP) necessitates constant attempts at modifications to the standard equipment and technique. Patients with larger prostates (>40 cc) need a longer time for the procedure, and the blood loss, requirement for irrigation fluid, and incidence of postoperative complications tend to be greater. We report on the safety and efficacy of TURP with the thick vapor resection loop compared with the standard wire loop in comparable groups of patients with prostates >40 cc.

PATIENTS AND METHODS

We randomized 100 patients with benign prostatic hyperplasia (BPH) into two groups of 50 each which were similar in age. The inclusion criteria included an indication for prostatectomy and prostate size >40 cc. Patients who were on finasteride preoperatively (six) and those who had histopathologic adenocarcinoma of the prostate (three) were excluded. Preoperative evaluation included assessment of International Prostate Symptom Score (IPSS), prostate volume by abdominal ultrasonography, maximum flow rate (Q(max)), and residual urine volume. The two groups were similar in the signs and symptoms of BPH. Patients in Group 1 underwent transurethral vapor resection of the prostate (TUVRP) using the vapor resection loop (Wing trade mark; Richard Wolf, Germany), while patients in Group 2 underwent TURP using a standard wire loop. All procedures were performed by consultant urologists with equivalent experience. We used a Martin ME 401 (Gebruder Martin, Tuttlingen, Germany) electrosurgical generator with settings of 120 to 150 Watts and 50 to 70 W for cutting and coagulating, respectively, for the thick loop and 70 to 80 W and 40 to 50 W for the standard loop. Operating time, resected tissue weight, duration of catheterization, nursing contact time, hospital stay, hemoglobin change, serum sodium concentrations, and any complications were noted and analyzed using the Kruskal-Wallis paired variables test, and P values were calculated. P value <0.04 was considered significant. The IPSS, Q(max), and residual urine volume were reevaluated at 6 months and 1 year after the procedure and compared for the two groups.

RESULTS

The median prostate volume was 63 cc and 54 cc in Groups 1 and 2, respectively, and the median resected weight was 20 and 19 g, respectively (P = NS). The differences in operating time (median 45 v 60 minutes; P < 0.0001), intraoperative irrigant use (15 v 21 L; P < 0.0001), and intraoperative blood loss (median 52.5 v 150 mL; P < 0.0001) in the two groups were statistically significant. Peroperative blood loss was estimated by the indicator dilution method of Freedman et al in three 5-mL samples of the irrigant fluid and arriving at the average of the three values and adjusted for the volume of irrigant fluid used. The differences in postoperative irrigant (P < 0.01) and catheter duration (P = 0.04) were also significant. Two patients received blood transfusion in Group 2 and none in Group 1. The difference in the change in hemoglobin and serum sodium postoperatively in the two groups was not statistically significant. The complications were dysuria in six patients lasting for a month and one capsular perforation in Group and incontinence lasting for 6 months in two patients and stricture in one patient in Group 2. The efficacy, assessed with IPSS, Q(max), and residual urine volume, was comparable at 6 months and at 1 year.

CONCLUSION

The use of a thick vapor resection loop for TURP coupled with higher generator settings as recommended for them, especially for prostates >40 cc, is beneficial, as it significantly reduces operating time, blood loss, irrigant requirement, nursing contact time, and duration of catheterization, besides providing clear vision during surgery and ease of resection. There was no reduction in efficacy or increase in complications.

Urethral reconstruction of strictures resulting from treatment of benign prostatic hypertrophy and prostate cancer

Urethral strictures commonly result from treatments for prostate disease, such as transurethral resection, radical prostatectomy, and radiotherapy. Treating these strictures can be difficult: it may be complicated by previous irradiation, and endoscopy often fails. We review the risk factors for development of strictures resulting from the treatment of prostate disease and discuss the success rates of both endoscopic and open therapies.

Thick vs thin loop transurethral resection of the prostate: a double-blind prospective trial of early morbidity

OBJECTIVE

To compare blood loss, irrigation requirements and hospital stay between standard transurethral resection of the prostate (TURP) and resection incorporating vaporization, i.e. transurethral vaporization resection (TUVRP).

PATIENTS AND METHODS

Seventy patients were prospectively randomized in a blinded fashion between TURP with a standard resection loop (thin loop) or resection with a roller cutting electrode (thick loop). The outcome was assessed as the change in haemoglobin at 30 min and 24 h after the resection finished. Secondary outcome measures were irrigation requirements, length of catheterization, hospital stay, changes in serum sodium, and complications. The nursing staff and surgical registrar managing the patients after surgery were unaware of the resection technique used.

RESULTS

Data were available for 65 patients (36 thin loop and 29 thick loop resections). The mean decrease in haemoglobin after TURP was 14.8 g/L at 30 min and 11.8 g/L at 24 h; for TUVRP the corresponding values were 14.6 and 14.2 g/L (P = 0.69). In addition, there was no difference in irrigation requirements, changes in serum sodium, length of catheterization, hospital stay or bleeding complications.

CONCLUSION

The use of a thick loop at higher cutting current settings during TUVRP offers no advantage over standard thin-loop TURP.

Erectile function following high-energy thick loop prostatectomy

OBJECTIVES

To evaluate the effects of the high energy cutting current that is used in conjunction with the thick loop on erectile function in patients with benign prostatic hyperplasia (BPH) undergoing prostatectomy.

PATIENTS AND METHODS

Seventy patients with BPH were included in this prospective study. All patients underwent transurethral vaporization resection of the prostate (TUVRP) using the "Wing" thick loop and 250-Watt cutting current. Potency questionnaire to define if the patient was fully potent, partially potent or impotent was obtained both pre operatively and 3 months post-TUVRP. Adequate preoperative counseling on the procedure and its outcome particularly in relation to sexual activity was given to all patients that were sexually active. Age of the patients, size of the prostate, resectate weight and operation time was recorded for correlation with erectile function post-TUVRP.

RESULTS

The mean age of patients was 70.1 +/- 6.3 years, the mean prostate size was 53.9 +/- 31.1 grams. Thirty-two patients (46%) were either impotent or sexually inactive at presentation. Thirty men were fully potent and 8 patients presented with reduced potency. Only 2 patients (5.2%) developed impotence post-TUVRP, both were partially impotent at presentation.

CONCLUSIONS

Our results indicate that the frequency of erectile dysfunction following TUVRP may be low. It seems that the higher energy use in TUVRP does not adversely affect potency possibly because of the cooling effect of the circulating blood in the neurovesical bundles and the use of irrigation fluids intraoperatively.

Changes of serum prostate-specific antigen following high energy thick loop prostatectomy

We evaluated the effect of the high electrocuting energy used with the thick loop, in transurethral vaporization resection of the prostate (TUVRP), on serum prostate-specific antigen (PSA). Forty-eight patients with benign protatic hyperplasia (BPH) were included in this prospective single arm sequential study. All patients had TUVRP using the 'Wing' thick resection electrode (Richard Wolf, Germany). Serum PSA was measured before, 1 day and 6 weeks in the morning post TUVRP. PSA values were correlated to preoperative prostate size and to prostatic resection weight. Serum PSA values (mean +/- SD) were 6.29+/-4.4 ng/ml, 14.9+/-11.1 and 2.3+/-1.9 before, 1 day and 6 weeks post TUVRP respectively. The mean increase in the PSA at 1 day over baseline value was 2.72, this was statistically significant (p < or = 0.0001). The PSA level returned to less than pre TUVRP value in all but 3 patients by 6 weeks. The PSA value 1 day post TUVRP correlated well with the pre PSA level, prostate size and prostatic resection weight (r = 0.58, r = 0.38 and r = 0.44 respectively) however, the PSA level at 6 weeks correlated only to pre TUVRP values (r = 0.53). We conclude that that serum PSA is not reliable within 6 weeks of TUVRP. The reversible increase in serum PSA value is similar to other forms of prostatectomy which, suggests that the increased level of electrosurgical energy that is used in TUVRP does not have an added adverse effect on the PSA levels.

Transurethral vaporization of the prostate: current techniques

Electrovaporization has quickly become a popular procedure for treating benign prostatic hyperplasia. By using standard transurethral electrosurgical technology, electrovaporization offers standard transurethral loop-like resection and transurethral prostatectomy (TURP)-like efficacy with less morbidity than that associated with TURP. Through a combination of two electrosurgical effects (vaporization and desiccation), electrovaporization ablates significant volumes of prostatic tissue with each passage of the electrode. Newly designed thicker loop electrodes have led to a modification of the original electrovaporization technique. "Vaporizing-resection" adds the advantages of transurethral resection to those of electrovaporization with the use of one electrode. Very large glands can be treated efficiently, and prostatic tissue specimens are produced. Moreover, additional vaporization of tissue occurs with minimized bleeding. This report reviews basic electrosurgical principles, electrode design, and factors that affect vaporizing efficiency. Current long-term data on electrovaporization compared with TURP are summarized, and pilot studies evaluating vaporizing- resection have shown promising results. A new technology that has entered the market--bipolar electrovaporization--is also discussed. Finally, combination therapy and Columbia's 4-year experience with vaporization techniques are discussed.

Prospective randomized study of transurethral vaporization resection of the prostate using the thick loop and standard transurethral prostatectomy

OBJECTIVES

Transurethral vaporization resection of the prostate (TUVRP) is a recent modification of the standard transurethral prostatectomy (TURP). The procedure uses one of the novel, thick resection loops coupled to augmented electrocutting energy. We evaluated the safety and efficacy of TUVRP in comparison with TURP.

METHODS

Sixty-eight patients with prostatic outflow obstruction were prospectively randomized between equal TUVRP and TURP treatment groups. Safety parameters evaluated included changes in serum hemoglobin, hematocrit, and sodium 1 and 24 hours after resection. Operative time, catheterization time, and incidence of complications were noted. Efficacy parameters included evaluation by the International Prostate Symptom Score and maximum flow rate.

RESULTS

Patients of both groups were balanced for the different baseline variables. One hour after TURP, patients had significantly lower levels of hemoglobin, hematocrit, and sodium (P = 0.03, 0.03, and 0. 01, respectively). The prostate resection weight was similar in both groups; however, the difference in the mean operative time was significant (TUVRP group 42.4 minutes and TURP group 35.9 minutes, P = 0.02). The postoperative catheterization time was significantly shorter for the TUVRP group (23.1 +/- 10.3 versus 36 +/- 17.3 hours, P <0.0001). All patients were followed up for an average of 9 months. The International Prostate Symptom Score was 4 +/- 3.4 and 5.6 +/- 3.1 and the maximum flow rate was 19 +/- 6.5 and 15.2 +/- 10 mL/s for the TUVRP and TURP groups, respectively; these differences were statistically significant (P = 0.03 and 0.01, respectively). Complications included urethral strictures (6 patients) and delayed hemorrhage with clot retention (2 patients); no differences in the incidence of complications were noted between the two groups.

CONCLUSIONS

The results of the present study have demonstrated that TUVRP is as safe and efficacious as TURP in the treatment of men with prostatic outflow obstruction. The shorter catheterization time observed after TUVRP may be clinically significant, considering the demand for lower morbidity profiles by patients. The longer operative time in TUVRP was related to the slower motion of the Wing electrode needed to add the advantages of electrovaporization.

Transurethral electrovaporization-resection of the prostate using the "wing" cutting electrode: preliminary results of safety and efficacy in the treatment of men with prostatic outflow obstruction

OBJECTIVES

Transurethral vaporization-resection of the prostate (TUVRP) is a modification of the standard transurethral prostatectomy (TURP). The technique uses the "Wing" resection loop with electrovaporization current to achieve simultaneous resection, vaporization, and coagulation of prostatic tissue. We evaluate the early safety and efficacy results of TUVRP in the treatment of patients with prostatic outflow obstruction.

METHODS

The first 31 patients treated with TUVRP since September 1997 are reported. The group included 19 patients with urinary retention and 12 patients with lower urinary tract symptoms (LUTS). Patients with symptoms were assessed at baseline with the International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax). The same parameters were evaluated at 3 months for the entire group. Safety parameters included changes in serum hematocrit and sodium concentration, incidence of side effects, and changes in sexual function.

RESULTS

All patients with retention were voiding spontaneously with an IPSS of 3.9+/-3.1 and Qmax of 21.3+/-10.2 mL/s. In the patients who presented with LUTS, the IPSS decreased from 24.3+/-8.3 to 4.1+/-4.9 at 3 months and Qmax increased from 5.2+/-4.5 mL/s to 16+/-7.5 mL/s at 3 months (P <0.001). Mean resection weight was 27.9+/-18.4 g. Mean postoperative catheter time was 24.1 hours. Mean change in hematocrit concentration was 2.5 mL/dL and the change in sodium concentration was 0.8 mEq/L. Complications included 1 patient with a bladder neck contracture, 1 with a urethral stricture, and 1 with clot retention; 1 patient developed transurethral syndrome. No change in sexual function was noted in this group.

CONCLUSIONS

TUVRP is a promising new modification of TURP. This procedure combines the excellent debulking capabilities of TURP (with preservation of the entire specimen for histopathologic examination) and adds the benefits of electrovaporization, resulting in minimal blood loss and electrolyte disturbance.