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Re: Transurethral Resection (TUR) in Saline Plasma Vaporization of the Prostate vs Standard TUR of the Prostate: ‘The Better Choice’ in Benign Prostatic Hyperplasia?
BENIGN PROSTATIC HYPERPLASIA
1385
and pharmaceutical manufacturers of 5␣-reductase inhibitors define a prostate volume of greater than 30 ml as enlarged, many urologists would disagree. Steven A. Kaplan, M.D.
Re: Transurethral Resection (TUR) in Saline Plasma Vaporization of the Prostate vs Standard TUR of the Prostate: ‘The Better Choice’ in Benign Prostatic Hyperplasia? B. Geavlete, R. Multescu, M. Dragutescu, M. Jecu, D. Georgescu and P. Geavlete Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania BJU Int 2010; 106: 1695–1699.
Objective: To evaluate the efficiency, safety and short-term outcome of transurethral resection in saline plasma vaporization of the prostate (TURis-PVP), and to compare it to the standard TUR of the prostate (TURP). Patients and Methods: In all, 155 patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), with a maximum urinary flow rate (Qmax) of ⬍10 mL/s, an International Prostate Symptom Score (IPSS) of ⬎19 and prostate volume of 30-80 mL were enrolled in this prospective, randomized trial. All patients were evaluated preoperatively and at 1, 3 and 6 months after surgery by IPSS, health-related quality of life (HRQL) score, Qmax and postvoid residual urine volume (PVR). Results: Patients from both series had similar preoperative characteristics. TURis-PVP and TURP were successfully performed in all cases (75 and 80, respectively). The operative duration, catheterization period and hospital stay were significantly shorter for TURis-PVP patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and 47.6 vs 93.1 h, respectively (all P ⬍ 0.05). At the 1, 3 and 6 months follow-ups, improvements in the variables measured were better in the TURis-PVP group: the IPSS was 4.4 vs 8.3 and the Qmax was 22.7 vs 20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6 and the Qmax was 22.3 vs 20.0 mL/s at 3 months; and the IPSS was 5 vs 9.1 and the Qmax was 21.8 vs 19.3 mL/s at 6 months (All P ⬍ 0.05). Conclusions: TURis-PVP represents a valuable endoscopic treatment alternative for patients with BPE, with superior efficacy, short-term results and complication rates compared with monopolar TURP. Editorial Comment: Urologists love new toys and techniques, and surgical therapy for benign prostatic hyperplasia has been a fertile playpen for the last 2 decades. Novel electrosurgical and laser techniques have studded the literature, with various reports touting safety and efficacy. What impact has this evolution had on surgical management of BPH? Clearly laser therapy is on the increase, with almost 50% of all procedures done with either KTP or holmium laser. More recently bipolar electrovaporization using saline has found a niche in our armamentarium. Various loops have been used with this technique, with the most popular being the mushroom or button electrode. In this study comparing bipolar to monopolar electrosurgery there appear to be distinct advantages to using the bipolar technique, including operative duration, catheterization period and hospital stay. Surprisingly outcomes including symptom and flow rate improvement were better in the bipolar group. Bleeding and transfusion were increased in the monopolar group. As a natural-born skeptic, I am somewhat perplexed by the results, having performed both techniques. Our own experience with TURP is not consistent with that of the authors, and I always wonder if in these types of comparison studies the investigators have had less and certainly different experience with traditional monopolar TURP. The Cornell experience with bipolar TURP is in its early stages and evolving, and we too have initial enthusiasm about the technology, notwithstanding the increased bleeding and longer operative time compared to traditional TURP. Ultimately surgical optimization and patient selection will determine the long-term success of this technology. Steven A. Kaplan, M.D.
1385
and pharmaceutical manufacturers of 5␣-reductase inhibitors define a prostate volume of greater than 30 ml as enlarged, many urologists would disagree. Steven A. Kaplan, M.D.
Re: Transurethral Resection (TUR) in Saline Plasma Vaporization of the Prostate vs Standard TUR of the Prostate: ‘The Better Choice’ in Benign Prostatic Hyperplasia? B. Geavlete, R. Multescu, M. Dragutescu, M. Jecu, D. Georgescu and P. Geavlete Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania BJU Int 2010; 106: 1695–1699.
Objective: To evaluate the efficiency, safety and short-term outcome of transurethral resection in saline plasma vaporization of the prostate (TURis-PVP), and to compare it to the standard TUR of the prostate (TURP). Patients and Methods: In all, 155 patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), with a maximum urinary flow rate (Qmax) of ⬍10 mL/s, an International Prostate Symptom Score (IPSS) of ⬎19 and prostate volume of 30-80 mL were enrolled in this prospective, randomized trial. All patients were evaluated preoperatively and at 1, 3 and 6 months after surgery by IPSS, health-related quality of life (HRQL) score, Qmax and postvoid residual urine volume (PVR). Results: Patients from both series had similar preoperative characteristics. TURis-PVP and TURP were successfully performed in all cases (75 and 80, respectively). The operative duration, catheterization period and hospital stay were significantly shorter for TURis-PVP patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and 47.6 vs 93.1 h, respectively (all P ⬍ 0.05). At the 1, 3 and 6 months follow-ups, improvements in the variables measured were better in the TURis-PVP group: the IPSS was 4.4 vs 8.3 and the Qmax was 22.7 vs 20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6 and the Qmax was 22.3 vs 20.0 mL/s at 3 months; and the IPSS was 5 vs 9.1 and the Qmax was 21.8 vs 19.3 mL/s at 6 months (All P ⬍ 0.05). Conclusions: TURis-PVP represents a valuable endoscopic treatment alternative for patients with BPE, with superior efficacy, short-term results and complication rates compared with monopolar TURP. Editorial Comment: Urologists love new toys and techniques, and surgical therapy for benign prostatic hyperplasia has been a fertile playpen for the last 2 decades. Novel electrosurgical and laser techniques have studded the literature, with various reports touting safety and efficacy. What impact has this evolution had on surgical management of BPH? Clearly laser therapy is on the increase, with almost 50% of all procedures done with either KTP or holmium laser. More recently bipolar electrovaporization using saline has found a niche in our armamentarium. Various loops have been used with this technique, with the most popular being the mushroom or button electrode. In this study comparing bipolar to monopolar electrosurgery there appear to be distinct advantages to using the bipolar technique, including operative duration, catheterization period and hospital stay. Surprisingly outcomes including symptom and flow rate improvement were better in the bipolar group. Bleeding and transfusion were increased in the monopolar group. As a natural-born skeptic, I am somewhat perplexed by the results, having performed both techniques. Our own experience with TURP is not consistent with that of the authors, and I always wonder if in these types of comparison studies the investigators have had less and certainly different experience with traditional monopolar TURP. The Cornell experience with bipolar TURP is in its early stages and evolving, and we too have initial enthusiasm about the technology, notwithstanding the increased bleeding and longer operative time compared to traditional TURP. Ultimately surgical optimization and patient selection will determine the long-term success of this technology. Steven A. Kaplan, M.D.