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A medium term, prospective, randomized assessment of a prostate bipolar vaporization advancement – Continuous versus standard plasma vaporization and monopolar TURP in medium size BPH cases


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A medium term, prospective, randomized assessment of a prostate’ bipolar vaporization advancement – Continuous versus standard plasma vaporization and monopolar TURP in medium size BPH cases
 
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 medium term, prospective, randomized study evaluated the efficiency and safety of the newly introduced continuous bipolar plasma vaporization (C-BPVP) approach by comparison to previous generation standard vaporization technique (S-BPVP) and conventional transurethral resection of the prostate (TURP) in medium size benign prostatic hyperplasia (BPH) cases.
Materials and Methods: A total of 180 BPH patients with prostate volume between 30 and 80 mL, maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19 were equally randomized for C-BPVP, S-BPVP and classical TURP (60 cases each). All patients were assessed preoperatively and at 1, 3, 6 and 12 months after surgery by IPSS, Qmax, quality of life score (QoL), post-voiding residual urinary volume (PVR), postoperative prostate volume and PSA level evolution.
Results: The mean operation time was significantly shorter in C-BPVP cases by comparison to standard vaporization and resection (31.5 versus 40.6 and 49.8 minutes – 22.4% and respectively 39.1% reduction in surgical length). Significantly lower capsular perforation (1.7% and 1.7% versus 8.3%) and intraoperative bleeding (1.7% and 3.3% versus 11.7%) rates as well as mean hemoglobin level drops (0.4 and 0.6 versus 1.4 g/dL) were emphasized in the C-BPVP and S-BPVP series. Substantially decreased mean catheterization periods (24.1 and 23.8 versus 73.6 hours) and hospital stays (2.1 and 2.2 versus 4.5 days) were described for the C-BPVP and S-BPVP groups. At the 1, 3, 6 and 12 months check-ups, significantly improved IPSS and Qmax measurements were determined in the two bipolar vaporization study arms, while the QoL and PVR features remained similar. Statistically equivalent postoperative prostate volume decreases (73.1%, 71.7% and 69.1%) and PSA level reductions (78.4%, 77.5% and 76.1%) were established in the C-BPVP, S-BPVP and TURP series.
Conclusions: The continuous plasma vaporization advancement provided a substantial reduction in surgical time by an average proportion of 20% and respectively 40%. Similar prostatic tissue removal capabilities were emphasized for the 3 techniques.  The surgical safety profile, perioperative morbidity, postoperative recovery and medium term follow-up symptom scores and voiding parameters remained superior in both C-BPVP and S-BPVP groups when compared to standard resection.