Evaluation of transurethral vaporization of prostate with pressure-flow analysis and other clinical measures.

Abstract

Transurethral vaporization of the prostate (TUVP) is a promising new alternative modality for resection of obstructing adenomatous prostatic tissue. We evaluated the efficacy of TUVP for treatment of symptomatic benign hyperplasia (BPH) or urinary retention using pressure-flow analysis and other clinical measures. Twenty-seven men (mean age 72) with symptomatic BPH (N = 21) or urinary retention (N = 6) underwent TUVP using the VaporTrode loop. Patients were evaluated both preoperatively and postoperatively by subjective and objective criteria including AUA symptom score, uroflowmetry, postvoiding residual volume (PVR), and detrusor pressure (Pdet) at maximum flow. Complete follow-up data were available in 19 patients with an average follow-up of 9 weeks (range 4-32). The average symptom score was reduced from 19.9 to 5.58 (p < 0.0001). The average peak uroflow rate (Qmax) improved from 7.0 ml/sec to 18.1 mL/sec (p < 0.001). The average PVR was reduced from 163 mL to 14 mL (p < 0.003), and there was a similar reduction in Pdet at maximum flow from 96 cm H2O to 44 cm H2O (p < 0.001). The overall complication rate was 11%. These included meatal stenosis (N = 1), temporary urinary retention (N = 1), and residual prostate tissue causing obstruction (N = 1). In conclusion, TUVP with the VaporTrode yields a significant improvement in AUA symptom score, peak uroflow rate, PVR, and detrusor pressure at maximum flow, denoting relief of bladder outlet obstruction. This review of our experience with TUVP provides additional evidence for the use of the VaporTrode as a safe and effective alternative surgical modality for the treatment of symptomatic BPH.