title: Bipolar plasma vaporization versus monopolar TUR and "cold-knife" TUI in secondary bladder neck sclerosis - an evidence based, retrospective critical comparison in a single center clinical setting.
abstract: BACKGROUND
  A long term, retrospective study was performed aiming to outline a critical comparison concerning the efficacy, safety and durability of the bipolar plasma vaporization (BPV), standard monopolar transurethral resection (TUR) and "cold-knife" "star" transurethral incision (TUI) in secondary bladder neck sclerosis (BNS) cases.
  
  
  METHODS
  Of the 126 patients included in the trial based on maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19, classical resection was performed in 46 cases, "cold-knife" TUI in 37 cases and bipolar vaporization in 43 patients. The evaluation protocol comprised IPSS, QoL (quality of life) score, Qmax and PVR (post-voiding residual urinary volume) assessment performed at 1, 3, 6, 12, 18 and 24 months after the initial intervention.
  
  
  RESULTS
  Significant intraoperative complications (capsular perforation - 8.7%; bleeding - 4.3%) occurred secondary to monopolar resection. "Star" TUI was the fastest technique, followed by plasma-button vaporization (7.2 and 11.4 versus 16.5 minutes). BPV and TUI patients benefitted from the shortest catheterization periods (0.75 and 1 versus 2.0 days) and hospital stays (1.0 and 1.25 versus 2.0 days). Immediate postoperative adverse events consisted of hematuria (6.5% of the TUR cases) and acute urinary retention (8.1% of the TUI group). Significantly higher long term BNS recurrence rates requiring re-treatment were established in the TUI (18.7%) and TUR (12.8%) series by comparison to BPV (5.4%). Among patients that completed the follow-up protocol, equivalent IPSS, QoL, Qmax and PVR features were determined in the 3 study arms.
  
  
  CONCLUSIONS
  The plasma vaporization approach was confirmed as a successful match to conventional TUR and "cold-knife" TUI in terms of surgical safety profile, postoperative recovery, therapeutic durability and urodynamic and symptom score parameters.
authors.affiliation: "Saint John" Emergency Clinical Hospital, Department of Urology.
authors.forename: C
authors.initials: C
authors.lastname: Moldoveanu
authors.affiliation: "Saint John" Emergency Clinical Hospital, Department of Urology.
authors.forename: B
authors.initials: B
authors.lastname: Geavlete
authors.affiliation: "Saint John" Emergency Clinical Hospital, Department of Urology.
authors.forename: M
authors.initials: M
authors.lastname: Jecu
authors.affiliation: "Saint John" Emergency Clinical Hospital, Department of Urology.
authors.forename: F
authors.initials: F
authors.lastname: Stanescu
authors.affiliation: "Saint John" Emergency Clinical Hospital, Department of Urology.
authors.forename: L
authors.initials: L
authors.lastname: Adou
authors.affiliation: "Saint John" Emergency Clinical Hospital, Department of Urology.
authors.forename: C
authors.initials: C
authors.lastname: Bulai
authors.affiliation: "Saint John" Emergency Clinical Hospital, Department of Urology.
authors.forename: C
authors.initials: C
authors.lastname: Ene
authors.affiliation: "Saint John" Emergency Clinical Hospital, Department of Urology.
authors.forename: P
authors.initials: P
authors.lastname: Geavlete
mesh_terms: D053715:Cystotomy / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D011788:Quality of Life; D012189:Retrospective Studies; D012598:Sclerosis / Q000209:etiology / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000009:adverse effects*; D018666:Ureteroscopy / Q000379:methods*; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000601:surgery*; D014835:Volatilization
keywords: bipolar plasma vaporization; monopolar transurethral resection; secondary bladder neck sclerosis; “cold-knife" transurethral incision