Transurethral fulguration of the prostate with the roller ball

Abstract

Objectives To assess the histologic changes in the prostate and the clinical outcome in men with symptomatic benign prostatic hyperplasia (BPH) following transurethral fulguration of the prostate (TUFP) with the roller ball. Methods The study was conducted in two phases. In the first phase of the study, histologic changes in the prostate following fulguration with the roller ball were studied in 10 men with BPH who were already scheduled for transurethral resection of the prostate (TURP). In the second phase of the study, 20 male patients with symptomatic BPH underwent TUFP with the roller ball. All patients had preoperative assessment with history and physical examination, urinalysis, uroflow, transrectal ultrasound of the prostate, serum prostatespecific antigen, serum hemoglobin and electrolytes, and cystoscopy. The procedure was performed under general or spinal anesthesia using standard equipment and 3-mm roller ball. The patients were seen in follow-up at 1, 3, 6, 9, and 12 months. Results The results of the first phase of the study indicate that the coagulating current results in thermal destruction of prostatic tissue in the form of coagulative necrosis with minimal if any vaporization. The cutting current results in tissue vaporization with minimal coagulative necrosis. Twenty men have enrolled in the second phase of the study. Their mean age is 63.2 ± 7.5 years and their mean follow-up is 4.6 months (range, 1 to 12). Their mean American Urological Association (AUA) symptom score declined from 22.9 ± 4.2 preoperatively to 6.4 ± 4.9, 5.3 ± 3.2, 4.3 ± 1.9, 6 ± 2.9, and 9 at 1, 3, 6, 9, and 12 months, respectively. The mean maximum flow rate (Q max) increased from 8.9 ± 3.4 mL/s preoperatively to 24.3 ± 1.9 mL/s at 3 months, 22 ± 4.4 mL/s at 6 months, 17.6 + 5 mL/s at 9 months, and 21 mL/s at 12 months postoperatively. The mean prostate volume was 31.9 ± 10 mL and the mean operative time was 44.9 ± 10 minutes. No significant changes were seen in serum hemoglobin and serum sodium. The mean hospital stay was 0.7 day (0 to 2). Nineteen patients had their catheters removed within 24 hours and 1 patient had his catheter removed 48 hours postoperatively. No patient experienced impotence, incontinence, urethral stricture, post-transurethral resection syndrome, or required blood transfusion. In 1 patient (5%) bladder neck stenosis developed at 9 months and 1 patient required TURP for residual apical adenoma at 3 months. Conclusions The nature and the degree of tissue changes in the prostate following fulguration with the roller ball are well controlled and predictable. When the cutting current is used, prostatic tissue can be removed safely and effectively. The clinical outcome after TUFP with the roller ball demonstrates significant improvement in subjective (AUA symptom score) and objective (Q max) parameters, with reduced morbidity and short hospital stay. These early results compare favorably with those seen after TURP and laser ablation of the prostate. Larger series with longer follow-up are necessary to establish the long-term efficacy of TUFP in the treatment of BPH.