Bipolar Plasmakinetic Vaporization versus the Standard Monopolar Transurethral Resection of the Prostate for Management of Benign Prostate Hyperplasia: Long Term Follow-Up of a Randomized Controlled Study

Abstract

Background: Monopolar Transurethral resection of the prostate (TURP) has dominated the surgical treatment of lower urinary tract symptoms (LUTS) due to BPH with relatively high TUR associated morbidity. Due to advanced technology, spurred the development of new surgical alternatives as plasmakinetic vaporization of the prostate to overcome the TURP related morbidity. Aim: To compare the outcomes of bipolar plasmakinetic vaporization of the prostate (PKVP) in saline with the standard monopolar TURP in-patients with bothersome LUTS. Patients and Methods: Two hundred and six patients with bothering LUTS were randomly divided into two groups, PKVP (GI) or TURP (GII). Patients demographics and preoperative data were compared, including prostate volume, international prostate symptoms score (IPSS), quality of life (QOL), maximum flow rate (Qmax), post voiding residual volume (PVR), prostate-specific antigen (PSA). Postoperative adverse events and long-term reoperation rates were also compared. Results: Preoperatively, both groups were comparable in demographic data, prostate volume, IPSS, Qmax, and PVR. Both groups showed comparative functional improvement in IPSS, QOL, Qmax, and PVR. Compared to GII patients, GI patients had a significantly lower operative time (62.3±17 vs. 68.6±20 min, p =0.03), catheterization time (3.4±1.3 vs. 4.5±1.4 d), and hospital stay (2.7±1.1 vs 3.3±1.3 d). Reduction in hemoglobin and serum sodium was significantly higher in GII patients. Clot retention occurs in 3.4% in G1 vs. 7.7% in G2 while blood transfusion needed for 8.9% of patients in GII. After a 36-month follow-up, 10.5% and 7.7% of patients needed reoperation in GI and GII, respectively (p>0.05). Conclusion: Long-term results revealed comparable safety and efficacy of PKVP and monopolar TURP in the management of bothersome LUTS secondary to BPH. However, PKVP seems to have lower perioperative morbidity (i.e. reduced blood loss, shorter catheterization time, shorter hospital stay, comparable reoperation rate, and better alternative to monopolar TURP.