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A long term solution in secondary bladder neck sclerosis cases – Bipolar plasma vaporization overcoming standard TUR in a prospective, randomized comparison


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A long term solution in secondary bladder neck sclerosis cases – Bipolar plasma vaporization overcoming standard TUR in a prospective, randomized comparison
 
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 Objective: A long term, prospective, randomized trial assessed the surgical efficiency and safety, perioperative morbidity, postoperative convalescence and follow-up parameters specific for the bipolar plasma vaporization (BPV) approach by comparison to monopolar transurethral resection (TUR) in cases of secondary bladder neck sclerosis (BNS).
Materials and Methods: A total of 70 patients with BNS subsequent to TURP (46 cases), open prostatectomy for benign prostatic hyperplasia (BPH – 18 cases) and radical prostatectomy for prostate cancer (6 cases) were equally randomized for BPV and standard TUR (35 cases each). The inclusion criteria consisted of maximum flow rate (Qmax) below10 mL/s and International Prostate Symptom Score (IPSS) over 19. All patients were evaluated preoperatively and every 6 months after surgery for a 2½ year’ period by IPSS, quality of life score (QoL), Qmax and post-voiding residual urinary volume (PVR).
Results: The mean operation time (10.3 versus 14.9 minutes), catheterization period (0.75 versus 2.1 days) and hospital stay (1.1 versus 3.2 days) were significantly reduced in the BPV series. During the immediate postoperative evolution, the re-catheterization for acute urinary retention only occurred in the TUR group (5.7%). The long term re-treatment requirements due to BNS recurrence were significantly lower in the BPV study arm (4.2% versus 11.2%). During all the semiannual follow-up check-ups, statistically similar values were determined for the two therapeutic alternatives concerning the IPSS, QoL, Qmax and PVR features.
Conclusions: BPV represents a reliable treatment approach for secondary BNS patients, favorably comparable to standard TUR in terms of surgical efficiency, perioperative morbidity and postoperative recovery. The method emphasized similar long term follow-up symptom scores and voiding parameters when compared to monopolar resection as well as a significantly reduced BNS recurrence rate.