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The long term outcome of bipolar plasma enucleation in large BPH cases – The test of time in a prospective, randomized comparison to open prostatectomy

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The long term outcome of bipolar plasma enucleation in large BPH cases – The test of time in a prospective, randomized comparison to open prostatectomy
Bogdan Geavlete1, Florin Stanescu1, Cristian Moldoveanu1, Marian Jecu1, Leon Adou1, Cosmin Ene1, Catalin Bulai1, Petrisor Geavlete1
1 “Saint John” Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
Introduction and Objectives: A long term, prospective, randomized trial assessed the viability of the bipolar plasma enucleation of the prostate (BPEP) by comparison to open transvesical prostatectomy (OP) in cases of large prostates with regard to surgical efficiency and safety, perioperative morbidity, convalescence period and follow-up parameters.
Materials and Methods: A total of 140 benign prostatic hyperplasia (BPH) patients with prostate volume over 80 mL, maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19 were equally randomized in 2 study arms for BPEP and OP (70 cases each). All patients were evaluated preoperatively and every 6 months after surgery for a period of 3 years by IPSS, Qmax, quality of life score (QoL), post-voiding residual urinary volume (PVR), postoperative prostate volume and PSA level evolution.
Results: The two series were characterized by resembling preoperative features, including initial prostate volume (132.6 versus 129.7 mL). The BPEP and OP techniques emphasized similar mean operating times (91.4 versus 87.5 minutes) and resected tissue weights (108.3 versus 115.4 grams). The postoperative hematuria rate (2.9% versus 12.9%), mean hemoglobin level drop (1.7 versus 3.1 g/dL), catheterization period (1.5 versus 5.8 days) and hospital stay (2.1 versus 6.9 days) were significantly reduced in the BPEP group. Re-catheterization for acute urinary retention was more frequent after OP (8.6% versus 1.4%), while the early irritative symptoms’ rates were similar subsequent to BPEP and OP (11.4% versus 7.1%). During the 3 year’ follow-up period, no statistically significant differences were determined in terms of IPSS, Qmax, QoL, PVR, PSA level and postoperative prostate volume between the two series. Consequently, the calculated prostate volume decreases (82.7-84.7% versus 81.0-83.9%) and PSA level reductions (90.2-92.5% versus 89.8-92.6%) by comparison to preoperative measurements were statistically equivalent in the BPEP and OP study arms. 
Conclusions: BPEP represents a promising endoscopic approach in large BPH cases, characterized by good surgical efficiency and similar BPH tissue removal capabilities when compared to standard OP. Plasma enucleation patients benefited from a superior perioperative safety profile, significantly fewer complications, substantially faster postoperative recovery and satisfactory long term follow-up symptom scores and voiding parameters.