Introduction: 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).
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).
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, the PSA level and the postoperative prostate volume emphasized a similar evolution.
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.