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1978 THE BIPOLAR PLASMA ENUCLEATION OF THE PROSTATE VERSUS OPEN PROSTATECTOMY IN CASES OF PROSTATES OVER 80 ML - A PROSPECTIVE, RANDOMIZED COMPARISON
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THE JOURNAL OF UROLOGY姞
Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012
1977
1978
A PROSPECTIVE, LONG TERM, RANDOMIZED COMPARISON OF THE BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE, MONOPOLAR AND BIPOLAR RESECTION IN CASES OF AVERAGE SIZE PROSTATES
THE BIPOLAR PLASMA ENUCLEATION OF THE PROSTATE VERSUS OPEN PROSTATECTOMY IN CASES OF PROSTATES OVER 80 ML - A PROSPECTIVE, RANDOMIZED COMPARISON
Bogdan Geavlete*, Razvan Multescu, Florin Stanescu, Dragos Georgescu, Marian Jecu, Cristian Moldoveanu, Petrisor Geavlete, Bucharest, Romania INTRODUCTION AND OBJECTIVES: A prospective, long term, randomized trial was performed aiming to compare the bipolar plasma vaporization of the prostate (BPVP), the bipolar transurethral resection in saline (TURis) and the monopolar transurethral resection of the prostate (TURP) concerning the surgical efficacy, complication rate and follow-up results. METHODS: A total of 510 benign prostatic hyperplasia (BPH) patients with prostate volume between 30 and 80 ml, maximum flow rate (Qmax) ⬍ 10 ml/s and International Prostate Symptom Score (IPSS) ⬎ 19 were included in the trial. All cases were evaluated preoperatively and at 1, 3, 6, 12, 18, 24 and 30 months after surgery by IPSS, Qmax, quality of life score (QoL) and post-voiding residual urinary volume (RV). The prostate volume and PSA level were measured every 6 months. RESULTS: The mean operation time (39.7 versus 52.1 and 55.6 minutes), catheterization period (23.5 versus 46.3 and 72.8 hours) and hospital stay (1.9 versus 3.1 and 4.2 days) were significantly shorter for BPVP patients. The mean hemoglobin drop (0.5 versus 1.2 and 1.6 g/dl), intraoperative bleeding (1.8% versus 8.2% and 13.5%) and capsular perforation (1.2% versus 7.1% and 9.4%) rates were significantly reduced in the BPVP series. The rate of early irritative symptoms was statistically similar in the 3 study arms. In the BPVP and TURis groups, significantly lower postoperative hematuria (2.9% and 4.7% versus 15.3%) and blood transfusion (1.2% and 1.8% versus 6.5%) rates were determined. During the long term follow-up, BPVP patients emphasized significantly superior parameters concerning IPSS and Qmax. The QoL score and RV values were statistically similar in the 3 series. Also, at 6 months’ intervals, the PSA level and the postoperative prostate volume emphasized a similar evolution regardless of the initial treatment approach. CONCLUSIONS: BPVP displayed superior surgical efficacy, reduced perioperative morbidity and faster postoperative recovery when compared to TURis and TURP. During the long term follow-up, the method provided significantly improved parameters regarding the symptom scores and voiding characteristics, fewer complications and similar BPH tissue removal capabilities. BPVP
TURis
Monopolar TURP
1 month
4.6
7.2
7.2
3 month
4.3
7.1
7.5
IPSS
6 month
4.2
7.3
7.6
12 month
4.5
7.5
8.0
18 month
5.0
7.9
8.3
24 month
5.1
8.2
8.4
30 month
5.2
8.3
8.6
1 month
24.8
21.7
20.9
3 month
24.9
21.6
20.8
6 month
24.5
21.4
20.6
12 month
24.0
21.1
20.3
18 month
23.7
20.6
20.2
24 month
23.5
20.3
20.0
30 month
23.4
20.1
19.8
Qmax (ml/s)
Source of Funding: None
Bogdan Geavlete*, Razvan Multescu, Cristian Moldoveanu, Dragos Georgescu, Florin Stanescu, Marian Jecu, Petrisor Geavlete, Bucharest, Romania INTRODUCTION AND OBJECTIVES: This prospective, randomized trial aimed to evaluate the viability of the bipolar plasma enucleation of the prostate (BPEP) by comparison to open transvesical prostatectomy (OP) in cases of large prostates (over 80 ml) from the perspectives of surgical efficacy, perioperative morbidity and follow-up parameters. METHODS: A total of 130 benign prostatic hyperplasia (BPH) patients with prostate volume over 80 ml, maximum flow rate (Qmax) ⬍ 10 ml/s and International Prostate Symptom Score (IPSS) ⬎ 19 were randomized in the 2 study arms (65 patients each). All cases were evaluated preoperatively and at 1, 3, 6 and 12 months after surgery by IPSS, Qmax, quality of life score (QoL) and post-voiding residual urinary volume (RV). The prostate volume and PSA level were measured every 6 months. RESULTS: The BPEP and OP series emphasized similar preoperative parameters, including the prostate volume (135.8 versus 133.2 ml). Also, similar operating times were determined for BPEP and OP (89.8 versus 87.6 minutes). The mean hemoglobin drop (2.0 versus 3.3 g/dl), postoperative hematuria (3.1% versus 15.4%) and blood transfusion (1.5% versus 10.8%) rates were significantly improved for BPEP. The mean catheterization period (35.4 versus 98.3 hours) and hospital stay (2.4 versus 5.2 days) were also significantly lower in the BPEP group. Early acute urinary retention occurred in the OP series alone (in 6.1% of the cases), while the rates of early irritative symptoms (12.3% versus 9.2%) were similar for BPEP and OP. During follow-up, urethral strictures appeared in one case of each series and bladder neck contracture only occurred in 4.6% of the OP patients. At 1, 3, 6 and 12 months, no statistically significant difference was determined in terms of IPSS, Qmax, QoL and RV between the 2 study arms. Also, at 6 and 12 months, similar values were established in terms of PSA and prostate volume, with equivalent prostate volume decrease (88.388.9% versus 87.3-87.7%). CONCLUSIONS: BPEP represents a promising endoscopic approach in large BPH cases, characterized by good surgical efficiency, significantly reduced complications, faster postoperative recovery, similar BPH tissue removal capabilities and satisfactory follow-up results when compared to the standard open surgical procedure. Source of Funding: None
1979 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) PRIOR TO RADIATION IS SAFE AND EFFECTIVE AT TREATING SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA (BPH) IN MEN DIAGNOSED WITH PROSTATE CANCER Michael Shy, Thomas Gerald, Kumaran Sathyamoorthy*, Andrew Lee, Ricardo Gonzalez, Houston, TX INTRODUCTION AND OBJECTIVES: Benign prostatic hyperplasia (BPH) and prostate cancer (CaP) are common in aging men and often coexist. There is no published data on men with symptomatic BPH and CaP who opt for treatment with photoselective laser vaporization of the prostate (PVP) prior to undergoing radiation therapy (XRT). The primary purpose of this retrospective review is to examine the complications of PVP followed by XRT with a secondary goal to evaluate symptom score changes. METHODS: Over a 32-month period, we reviewed 40 consecutive patients with symptomatic BPH diagnosed with prostate cancer who elected to undergo PVP prior to external beam XRT for primary CaP treatment. Preoperative assessment included prostate volume, International Prostate Symptom Score (IPSS) as well as uroflowmetry,
THE JOURNAL OF UROLOGY姞
Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012
1977
1978
A PROSPECTIVE, LONG TERM, RANDOMIZED COMPARISON OF THE BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE, MONOPOLAR AND BIPOLAR RESECTION IN CASES OF AVERAGE SIZE PROSTATES
THE BIPOLAR PLASMA ENUCLEATION OF THE PROSTATE VERSUS OPEN PROSTATECTOMY IN CASES OF PROSTATES OVER 80 ML - A PROSPECTIVE, RANDOMIZED COMPARISON
Bogdan Geavlete*, Razvan Multescu, Florin Stanescu, Dragos Georgescu, Marian Jecu, Cristian Moldoveanu, Petrisor Geavlete, Bucharest, Romania INTRODUCTION AND OBJECTIVES: A prospective, long term, randomized trial was performed aiming to compare the bipolar plasma vaporization of the prostate (BPVP), the bipolar transurethral resection in saline (TURis) and the monopolar transurethral resection of the prostate (TURP) concerning the surgical efficacy, complication rate and follow-up results. METHODS: A total of 510 benign prostatic hyperplasia (BPH) patients with prostate volume between 30 and 80 ml, maximum flow rate (Qmax) ⬍ 10 ml/s and International Prostate Symptom Score (IPSS) ⬎ 19 were included in the trial. All cases were evaluated preoperatively and at 1, 3, 6, 12, 18, 24 and 30 months after surgery by IPSS, Qmax, quality of life score (QoL) and post-voiding residual urinary volume (RV). The prostate volume and PSA level were measured every 6 months. RESULTS: The mean operation time (39.7 versus 52.1 and 55.6 minutes), catheterization period (23.5 versus 46.3 and 72.8 hours) and hospital stay (1.9 versus 3.1 and 4.2 days) were significantly shorter for BPVP patients. The mean hemoglobin drop (0.5 versus 1.2 and 1.6 g/dl), intraoperative bleeding (1.8% versus 8.2% and 13.5%) and capsular perforation (1.2% versus 7.1% and 9.4%) rates were significantly reduced in the BPVP series. The rate of early irritative symptoms was statistically similar in the 3 study arms. In the BPVP and TURis groups, significantly lower postoperative hematuria (2.9% and 4.7% versus 15.3%) and blood transfusion (1.2% and 1.8% versus 6.5%) rates were determined. During the long term follow-up, BPVP patients emphasized significantly superior parameters concerning IPSS and Qmax. The QoL score and RV values were statistically similar in the 3 series. Also, at 6 months’ intervals, the PSA level and the postoperative prostate volume emphasized a similar evolution regardless of the initial treatment approach. CONCLUSIONS: BPVP displayed superior surgical efficacy, reduced perioperative morbidity and faster postoperative recovery when compared to TURis and TURP. During the long term follow-up, the method provided significantly improved parameters regarding the symptom scores and voiding characteristics, fewer complications and similar BPH tissue removal capabilities. BPVP
TURis
Monopolar TURP
1 month
4.6
7.2
7.2
3 month
4.3
7.1
7.5
IPSS
6 month
4.2
7.3
7.6
12 month
4.5
7.5
8.0
18 month
5.0
7.9
8.3
24 month
5.1
8.2
8.4
30 month
5.2
8.3
8.6
1 month
24.8
21.7
20.9
3 month
24.9
21.6
20.8
6 month
24.5
21.4
20.6
12 month
24.0
21.1
20.3
18 month
23.7
20.6
20.2
24 month
23.5
20.3
20.0
30 month
23.4
20.1
19.8
Qmax (ml/s)
Source of Funding: None
Bogdan Geavlete*, Razvan Multescu, Cristian Moldoveanu, Dragos Georgescu, Florin Stanescu, Marian Jecu, Petrisor Geavlete, Bucharest, Romania INTRODUCTION AND OBJECTIVES: This prospective, randomized trial aimed to evaluate the viability of the bipolar plasma enucleation of the prostate (BPEP) by comparison to open transvesical prostatectomy (OP) in cases of large prostates (over 80 ml) from the perspectives of surgical efficacy, perioperative morbidity and follow-up parameters. METHODS: A total of 130 benign prostatic hyperplasia (BPH) patients with prostate volume over 80 ml, maximum flow rate (Qmax) ⬍ 10 ml/s and International Prostate Symptom Score (IPSS) ⬎ 19 were randomized in the 2 study arms (65 patients each). All cases were evaluated preoperatively and at 1, 3, 6 and 12 months after surgery by IPSS, Qmax, quality of life score (QoL) and post-voiding residual urinary volume (RV). The prostate volume and PSA level were measured every 6 months. RESULTS: The BPEP and OP series emphasized similar preoperative parameters, including the prostate volume (135.8 versus 133.2 ml). Also, similar operating times were determined for BPEP and OP (89.8 versus 87.6 minutes). The mean hemoglobin drop (2.0 versus 3.3 g/dl), postoperative hematuria (3.1% versus 15.4%) and blood transfusion (1.5% versus 10.8%) rates were significantly improved for BPEP. The mean catheterization period (35.4 versus 98.3 hours) and hospital stay (2.4 versus 5.2 days) were also significantly lower in the BPEP group. Early acute urinary retention occurred in the OP series alone (in 6.1% of the cases), while the rates of early irritative symptoms (12.3% versus 9.2%) were similar for BPEP and OP. During follow-up, urethral strictures appeared in one case of each series and bladder neck contracture only occurred in 4.6% of the OP patients. At 1, 3, 6 and 12 months, no statistically significant difference was determined in terms of IPSS, Qmax, QoL and RV between the 2 study arms. Also, at 6 and 12 months, similar values were established in terms of PSA and prostate volume, with equivalent prostate volume decrease (88.388.9% versus 87.3-87.7%). CONCLUSIONS: BPEP represents a promising endoscopic approach in large BPH cases, characterized by good surgical efficiency, significantly reduced complications, faster postoperative recovery, similar BPH tissue removal capabilities and satisfactory follow-up results when compared to the standard open surgical procedure. Source of Funding: None
1979 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) PRIOR TO RADIATION IS SAFE AND EFFECTIVE AT TREATING SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA (BPH) IN MEN DIAGNOSED WITH PROSTATE CANCER Michael Shy, Thomas Gerald, Kumaran Sathyamoorthy*, Andrew Lee, Ricardo Gonzalez, Houston, TX INTRODUCTION AND OBJECTIVES: Benign prostatic hyperplasia (BPH) and prostate cancer (CaP) are common in aging men and often coexist. There is no published data on men with symptomatic BPH and CaP who opt for treatment with photoselective laser vaporization of the prostate (PVP) prior to undergoing radiation therapy (XRT). The primary purpose of this retrospective review is to examine the complications of PVP followed by XRT with a secondary goal to evaluate symptom score changes. METHODS: Over a 32-month period, we reviewed 40 consecutive patients with symptomatic BPH diagnosed with prostate cancer who elected to undergo PVP prior to external beam XRT for primary CaP treatment. Preoperative assessment included prostate volume, International Prostate Symptom Score (IPSS) as well as uroflowmetry,