Electrovaporization of the Prostate: Electrosurgical Modification of Standard Transurethral Resection in 93 Patients with Benign Hyperplasia

Abstract

To determine the safety and efficacy of transurethral vaporization of the prostate (TVP) in the management of men with lower urinary tract symptoms, we reviewed the records of 93 consecutive patients (mean age 65.2 +/- 5.7 years) with mild to moderate lower urinary tract symptoms who underwent TVP since August 1994. The patients were assessed at baseline for both safety and efficacy and in follow-up at 1 week (N = 93) and 1 (N = 87), 3 (N = 71), 6 (N = 59), 9 (N = 44), and 12 (N = 33) months. The mean American Urological Association Symptom Score decreased from 18.6 preoperatively to 8.9, 7.9, 8.1, and 6.3 at 1, 3, 6, and 12 months, respectively (P < 0.01). The peak uroflow rate (Qmax) increased from 7.9 mL/sec to 16.4, 14.1, 14.7, and 17.3 mL/sec at 1, 3, 6, and 12 months, respectively (P < 0.02). The mean operating time was 47.3 minutes; 96% of patients had the catheter removed within 24 hours and were discharged home the first postoperative day. There was a mean 1.1 mL/dL decrease in hematocrit and a 1.4 mEq/L decline in serum sodium. Complications included mild hematuria (46%), clot retention (5%) (all necessitating transient recatheterization), and distal bulbar urethral stricture (N = 1). There was an 8% incidence of significant postprocedure irritative symptoms. No previously potent patient reported erectile dysfunction, but there was a 92% rate of retrograde ejaculation. Transurethral vaporization is a potentially useful modification of transurethral resection. There has been significant clinical improvement maintained with minimal morbidity. This early clinical experience highlights several potential advantages of TVP, including significantly lower cost and minimal postoperative irritative symptoms. Currently, a multicenter clinical trial is under way to determine the long-term efficacy and safety of TVP.