Bipolar plasma vaporization of the prostate: ready to replace GreenLight? A systematic review of randomized control trials.

Abstract

Monopolar transurethral resection of the prostate (TURP) and open surgery remain associated with significant morbidity in contemporary series and are constantly challenged by new endoscopic treatments. Our aim was to conduce a systematic review of randomized controlled trials (RCTs) assessing the efficacy and safety of bipolar plasma vaporization of the prostate (BPVP) in the management of bladder outlet obstruction due to benign prostatic hyperplasia. A MEDLINE database search was performed, and a list of relevant publications was established with the consensus of all authors. RCTs comparing BPVP to any other kind of surgical treatment were included. All studies assessing hybrid techniques (combination with bipolar resection or bipolar vaporization) were excluded. The end points were functional outcomes and treatment-related adverse events. Seven different RCTs including a total of 1,071 study participants were selected. BPVP had superior hemostatic efficiency as compared to TURP resulting in shorter catheterization time (42.5 vs. 77.5 h) and shorter hospital stay (3.1 vs. 4.4 days). BPVP also had slightly better short-term functional outcomes as compared to TURP (mean IPSS at follow-up: 5.7 vs. 8.3). Selected RCTs were suggesting a better hemostatic efficiency of the BPVP as compared to TURP and similar short-term functional outcomes. But due to the lack of multicentric data and to the fact that most of the published studies had been conducted in one single institution, BPVP may not be recommended as an alternative to TURP in everyday practice.