Continuous vs conventional bipolar plasma vaporisation of the prostate and standard monopolar resection: a prospective, randomised comparison of a new technological advance.
OBJECTIVE
To evaluate in a prospective, randomised trial the surgical efficiency and safety of a new energy source enabling a continuous bipolar plasma vaporisation of the prostate (C-BPVP) by comparing with standard vaporisation (S-BPVP) and monopolar transurethral resection of the prostate (TURP) in men with benign prostatic hyperplasia (BPH). To comparatively assess the short-term functional outcome of the three methods.


METHODS
In all, 180 men with BPH with prostate volumes of 30-80 mL, maximum urinary flow rates (Q(max)) of <10 mL/s and International Prostate Symptom Score (IPSS) of >19 were equally randomised for C-BPVP, S-BPVP and monopolar TURP. All men were evaluated preoperatively and at 1, 3 and 6 months after surgery by IPSS, Q(max), health-related quality of life (HRQL) score and post-void residual urine volume (PVR). The prostate volume and PSA level were postoperatively assessed at 6 months.


RESULTS
The mean operation time was significantly reduced in C-BPVP vs S-BPVP and TURP, with a substantial 22.4% and 39.1% decrease in duration for C-BPVP when compared with S-BPVP and TURP, respectively. The mean haemoglobin level decrease (0.4 and 0.6 vs 1.4 g/dL), capsular perforation rate (1.7% and 3.3% vs 10%), postoperative haematuria rate (1.7% and 1.7% vs 13.3%), catheterisation period (24.1 and 23.9 vs 73.6 h) and hospital stay (2.1 and 2.2 vs 4.5 days) were significantly lower for C-BPVP and S-BPVP vs TURP. At 1, 3 and 6 months follow-up, there were statistically ameliorated IPSS and Q(max) measurements in the C-BPVP and S-BPVP series, while similar HRQL scores, PVRs, PSA levels and postoperative prostate volumes were found in all three study arms.


CONCLUSIONS
The operation time for C-BPVP was on average 20% and 40% quicker than S-BPVP and TURP, respectively. Both C-BPVP and S-BPVP had better perioperative safety and improved follow-up voiding and symptom scores than TURP.
Department of Urology, 'Saint John' Emergency Clinical Hospital, Bucharest, Romania.
Bogdan
B
Geavlete
Florin
F
Stanescu
Cristian
C
Moldoveanu
Petrisor
P
Geavlete
D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D013997:Time Factors; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome; D014554:Urination; D014835:Volatilization
continuous bipolar plasma vaporisation of the prostate; medium-sized BPH; monopolar TURP; standard BPVP