Transurethral plasma vaporization of the prostate: 3-month functional outcome and complications.
Study Type - Therapy (multi-centre cohort). Level of Evidence 2b.


OBJECTIVE
To evaluate the early functional outcomes of transurethral plasma vaporization of the prostate (TUVis) in a multicentre study.


METHODS
A prospective multicentre observational study was conducted in eight urology departments. The inclusion criterion was benign prostatic hyperplasia (BPH) requiring surgical treatment. Patients on anti-coagulant therapy were not excluded. The TUVis procedure was performed according to a classic transurethral resection of the prostate (TURP) scheme following the manufacturer's recommendations. We evaluated subjective functional outcome using self-questionnaires (International Prostate Symptom Score [IPSS] and five-item International Index of Erectile Function [IIEF-5]) and objective criteria (prostate volume, prostate-specific antigen [PSA], uroflowmetry, post residual volume) at baseline and at 1- and 3-month follow-ups. All types of complications were systematically recorded.


RESULTS
Despite 52% of patients receiving anticoagulant therapy before surgery, we reported only 3% with haemorrhagic complications, no blood transfusion, a mean catheterization time of 44 h and a mean postoperative stay of 2.9 nights. No significant change in irrigation time, catheter time or hospital stay was observed in patients with or without anticoagulant therapy. The IPSS and bother scores significantly decreased after the 3-month follow-up (57% and 59%, respectively), but the average remaining prostate volume was 29 cc and the tissue ablation rate was only 0.5 cc/min. Three major complications occurred, consisting of two urinary fistulas and one partial bladder coagulation.


CONCLUSIONS
The TUVis procedure has a proven fast postoperative recovery time, good short-term functional outcome and good haemostatic efficiency. However, the tissue ablation rate was lower than expected and we encountered three major complications, the mechanisms of which remain unclear. Considering the high energy level required to create the plasma effect, the generator, cable and resectoscope must be carefully checked before each procedure.
CHU de Bordeaux Pellegrin, Bordeaux-2 Victor Segalen University, Bordeaux, France. gregoire.robert@chu-bordeaux.fr
Grégoire
G
Robert
Aurélien
A
Descazeaud
Nicolas Barry
NB
Delongchamps
Charles
C
Ballereau
Olivier
O
Haillot
Christian
C
Saussine
François
F
Kleinklauss
Gilles
G
Pasticier
Abdel-Rahmène
AR
Azzouzi
Bertrand
B
Lukacs
Olivier
O
Dumonceau
Marc
M
Fourmarier
Alexandre
A
De La Taille
Marian
M
Devonec
D000368:Aged; D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000209:etiology; D004564:Electrocoagulation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D059411:Lower Urinary Tract Symptoms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000209:etiology; D014548:Urinary Fistula / Q000209:etiology