Short-term efficacy and safety of second generation bipolar transurethral vaporization of the prostate (B-TUVP) for large benign prostate enlargement: Results from a retrospective feasibility study.

Takeshi Fukazawa,Hiroki Ito,Masato Takanashi,Tadashi Tabei,Francis X Keeley,Takashi Kawahara,Marcus J Drake,Kazuki Kobayashi,Risa Shinoki,Peter F.W.M Rosier

doi:10.1371/journal.pone.0261586

Takeshi Fukazawa, Hiroki Ito + Show 8 more

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https://doi.org/10.1371/journal.pone.0261586

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Abstract

BackgroundTo investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml.Materials and methods100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients’ characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml.Results17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients’ QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed.ConclusionsThis is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE.

Highlights

The European Association of Urology (EAU) and the American Urological Association (AUA) guidelines indicate mono/bi-polar transurethral resection of the prostate (TURP) as the standard option for the surgical treatment of moderate-to-severe lower urinary tract symptoms in men with prostate size of 30–80 ml [1, 2]
Endoscopic management of large (PV > 80–100 ml) benign prostatic enlargement remains a clinical scenario with limited available treatment options, including, but not limited to, Holmium laser enucleation of the prostate (HoLEP) [1, 2]
Main treatment outcomes were measured by International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (IPSS-QoL), overactive bladder symptom score (OABSS) [5], the Benign Prostatic Hyperplasia Impact Index (BII) [6], uroflowmetry tests and post-void residual urine volume (PVR) (at pre-operative baseline and 1, 3 and 6 post-operative months (POM))

Summary

Materials and methods

106 consecutive patients underwent second-generation B-TUVP with the oval-shaped electrode (Fig 1A and 1B) between July 2018 and July 2020 at Yokosuka Kyosai Hospital. Anticoagulant/antiplatelet therapy were stopped for B-TUVP if the physicians and anaesthetists decided the patient’s status allowed this, and medications were resumed if hematuria was absent. When they recommended continuing anticoagulant/antiplatelet therapy, we informed the patient thoroughly of possible higher risk of perioperative bleeding before B-TUVP. Main treatment outcomes were measured by IPSS, IPSS Quality of Life Index (IPSS-QoL), overactive bladder symptom score (OABSS) [5], the Benign Prostatic Hyperplasia Impact Index (BII) [6], uroflowmetry tests (voided volume and Qmax) and PVR (at pre-operative baseline and 1, 3 and 6 POM (post-operative months)). The BII is a self-administered questionnaire with 4 questions about urinary problems during the past month regarding physical discomfort, worry about health, how bothersome symptoms are, and whether the symptoms are interfering with doing usual activities

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