High-Energy TURP Using a Thick Loop

Abstract

A new thick electroresection loop has been developed for transurethral resection of the prostate (TURP) to allow simultaneous tissue resection, vaporization, and improved hemostasis. We describe the procedures of high-energy TURP using the thick loop, discuss its clinical efficacy as compared with the standard TURP using a thin loop, and present the results of a prospective randomized study. This study involved 53 patients with lower urinary tract symptoms and an enlarged prostate which was estimated to be over 30 ml. TURP was performed with a Bandloop on 25 patients and with a standard loop on 28 patients. The outcome of the surgery in the two groups was compared. Parameters of evaluation included the International Prostate Symptom Score (IPSS), resected prostatic weight, operating time, uroflowmetry, postvoid residual urine. postoperative catheterization period, time to disappearance of macrohematuria, serial changes of hemoglobin, and urinalysis. A total of 51 patients could be evaluaed, 23 in the Bandloop group and 28 in the standard loop group. There were no differences in the preoperative estimated prostatic volume (mean 44.7 vs 47.8 ml), resected prostatic weight (36.5 vs 29.4 g), and operating time (61 vs 60 min) between the standard loop and Bandloop groups. The ratio of the resected weight to the estimated prostatic volume was significantly greater in the standard loop group than in the Bandloop group (81.4% vs 61.9%). Postoperative changes in IPSS (−15.1 vs −15.9), maximum flow rate (11.8 vs 16.3 ml/s at 12 weeks), and residual volume (−31.6 vs −48.6ml at 12 weeks) showed no significant differences between the two groups; nor was there any difference in the intra-and postoperative bleeding estimated by serial changes in serum hemoglobin and urinalysis after surgery. No patient had major complications or required transfusion in either group. High-energy TURP using the thick loop is as safe and effective in achieving subjective and objective improvements as the standard TURP. However, our randomized study indicates that the Bandloop affords no evident advantage in TURP over the standard loop electrode. The real advantage of high-energy TURP over the standard procedure, and the differences in efficacy of various types of thick loop, remain to be elucidated by further randomized control studies.