Prostate volume reduction following pure transurethral bipolar plasma vaporization and conventional transurethral resection of the prostate: a prospective investigation using transrectal 3D ultrasound volumetry.

Abstract

To evaluate and compare postoperative changes in prostate volume and clinical outcome after bipolar plasma vaporization (BPV) and conventional transurethral resection of the prostate (TURP). Consecutive series of patients undergoing BPV or TURP were included in this prospective, nonrandomized study. Planimetric volumetry after transrectal three-dimensional ultrasound of the prostate was performed preoperatively and postoperatively after 6weeks, 6 months and 12months. Additionally, changes in clinical outcome parameters were assessed and compared between the groups. The reduction ratio and analysis of covariance were used to compare volume changes between BPV and TURP. Multiple regression analysis was performed to assess a possible interaction between preoperative prostate volume and effect of therapy. A total of 157 patients were included (BPV: n=68, TURP: n=89). Median preoperative prostate volume was 43.1ml in the BPV group and 45.9ml in the TURP group (p=0.43). Postoperatively, the prostate volumes decreased significantly in both groups. After catheter removal, the relative residual prostate volume was significantly higher in the BPV group (66.6 vs. 60.8%; p=0.02). Thereafter, significant differences were not detectable anymore (12months: 46.6 vs. 47.1%; p=0.82). Regression analysis revealed that tissue ablation after BPV was superior to TURP in prostates <45ml but inferior in prostates >45ml. All clinical outcome parameters improved significantly and were not significantly different between the groups. Volume reduction and short-term clinical outcome following pure BPV was excellent and comparable to conventional TURP. However, volume reduction seems to be limited in patients with larger prostates.