Bipolar Plasmakinetic Transurethral Resection Research Articles

The Safety and Efficacy of Bipolar Plasma-Kinetic Transurethral Resection of The Prostate in Patients Taking Low-Dose Aspirin.

To explore the safety and efficacy of bipolar plasma-kinetic transurethral resection of the prostate in patients taking low-dose aspirin. Benign prostatic hyperplasia (BPH) patients who underwent surgical treatment from November 2018 to May 2020 were retrospectively analyzed, and divided into two groups according to whether taking 100mg aspirin daily aspirin or not. The perioperative indexes, complications and sequelae also were used to evaluate safety. The efficacy was evaluated by the functional outcomes in 3,6,12 months. There were no statistical differences in the baseline characteristics or perioperative indicators and complications and sequelae, except for a longer operative time(90.49 ± 14.34 vs 84.95 ± 15.49; 95%CI: 0.26-10.83; P = .040) and a shorter hospital stay time(HST) (8.52 ± 1.55 vs 9.09 ± 1 .50; 95% CI: 0.21-1.11; P = .042) in the non-aspirin group. During the 12-months follow-up period, the functional outcomes of the two groups were significantly improved except International Index of Erectile Function (IIEF-5). Based on our research results, PKRP a safe and effective method for patients with BPH who taking 100mg aspirin daily.

Application of Two New Feature Fusion Networks to Improve Real-time Prostate Capsula Detection.

Excess prostate tissue is trimmed near the prostate capsula boundary during transurethral plasma kinetic enucleation of prostate (PKEP) and transurethral bipolar plasmakinetic resection of prostate (PKRP) surgeries. If a large portion of the tissue is removed, a prostate capsula perforation can potentially occur. As such, real-time accurate prostate capsula (PC) detection is critical for the prevention of these perforations. This study investigated the potential for using image denoising, image dimension reduction and feature fusion to improve real-time prostate capsula detection with two objectives. First, this paper mainly studied feature selection and input dimension reduction. Secondly, image denoising was evaluated, as it is of paramount importance to transient stability assessment based on neural networks. Two new feature fusion techniques, maxpooling bilinear interpolation single-shot multibox detector (PBSSD) and bilinear interpolation single shot multibox detector (BSSD) were proposed. Before original images were sent to the neural network, they were processed by principal component analysis (PCA) and adaptive median filter (AMF) for dimension reduction and image denoising. The results showed that the application of PCA and AMF with PBSSD increased the mean average precision (mAP) for prostate capsula images by 8.55% and reached 80.15%, compared with single shot multibox detector (SSD) alone. Application of PCA with BSSD increased the mAP for prostate capsula images by 4.6% compared with SSD alone. Compared with other methods, ours were proven to be more accurate for real-time prostate capsula detection. The improved mAP results suggest that the proposed approaches are powerful tools for improving SSD networks.

A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications

ABSTRACTObjective:To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH).Materials and Methods:Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests.Results:Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is “rigorous” (Jadadscale) and has a low risk of bias (Cochrane-Handbook).Conclusions:Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.

Bipolar plasmakinetic transurethral enucleation and resection versus bipolar plasmakinetic transurethral resection for surgically treating large (≥60 g) prostates: a propensity score-matched analysis with a 3-year follow-up.

Background There are extremely limited published studies comparing bipolar plasmakinetic transurethral resection of prostate (BP-TURP) and bipolar plasmakinetic transurethral enucleation and resection of prostate (BP-TUERP) for enlarged prostates. Our purpose is to evaluate the safety and efficiency of BP-TUERP and BP-TURP for large (≥ 60 g) prostates with a 3-year follow-up. Methods We retrospectively identified 229 patients according to inclusion criteria between 2014 and 2016. After applying propensity score matching method, preoperative results and three-year follow-up outcomes in International Prostate Symptom Score (IPSS), urinary peek flow rate (Qmax), postvoid residual urine (PVRU) volume and quality of life (QoL) score were compared. Results Finally, within the well-balanced matched cohort, the BP-TUERP was significantly associated with longer mean operating time (OT) (p = 0.039), shorter mean catheter time (CT) (p = 0.001) and lower mean hemoglobin decrease (p = 0.002) with more prostatic tissue removed (p = 0.001) than the BP-TURP, but the median hospital stay lengths and the short- and long-term complication rates were similar between the two series. The patients in the BP-TUERP group had better long-term outcomes in IPSS, Qmax and PVRU volume than these in the BP-TURP group, but not in QoL score. Conclusions For patients with large (≥ 60 g) prostates, BP-TUERP and BP-TURP are safe options, but the former is a more effective choice in long-term follow-up outcomes. BP-TUERP is related to reduced CT and hemoglobin decrease with more removal of prostatic tissue at the expense of longer OT than BP-TURP.

Comparative Study of the Effectiveness and Safety of Transurethral Bipolar Plasmakinetic Enucleation of the Prostate and Transurethral Bipolar Plasmakinetic Resection of the Prostate for Massive Benign Prostate Hyperplasia (>80 ml).

BackgroundThe aim of this study was to compare the clinical safety and effectiveness of transurethral bipolar plasmakinetic enucleation of the prostate (PKEP) vs. transurethral bipolar plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostate hyperplasia (BPH) more than 80 ml.Material/MethodsFrom June 2015 to February 2019, 179 BPH patients with prostate volume greater than 80 ml were enrolled and separated into a PKEP (n=81) group and a PKRP group (n=98). The patients in the 2 groups were followed up for 6 months. We collected and analyzed data from the international Prostate Symptom Score (IPSS), residual urine volume (RUV), quality of life (QOL), maximum urine flow rate (Qmax), and international erectile function index (ILEF-5). The clinical data collected during and after the operation and surgical complications were compared between the 2 groups.ResultsThe PKEP group had significantly shorter operation time, bladder flushing time, indwelling catheter time, and hospitalization time, and has less intraoperative blood loss, intraoperative blood transfusion, postoperative secondary hemorrhage, bladder neck contracture, capsule perforation, and retrograde ejaculation (P<0.05). Compared with the PKRP group, the postoperative IPSS and QOL scores were significantly lower in the PKEP group (P<0.05), while the excision glandular tissue weight and Qmax were significantly improved (P<0.05). There were no significant differences in ILEF-5 scores, RUV, urethral stricture, urinary incontinence, or erectile dysfunction between the 2 groups (p>0.05).ConclusionsPKEP treatment of BPH with a large volume (>80 ml) has the advantages of complete gland resection, good surgical effect, improved surgical safety, and reduced intraoperative and postoperative complications.

AB018. The effect of immediate surgical bipolar PlasmaKinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention

BackgroundIn the present study, we evaluated the safety and efficacy of immediate surgical bipolar PlasmaKinetic transurethral resection of the prostate (PK-TURP) for patients with benign prostatic hyperplasia (BPH) with acute urinary retention (AUR).MethodsWe conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1,126 BPH patients were divided #I# AUR (n=348) and non-AUR groups (n=778).ResultsAfter the urethral catheters were removed, the urine white blood cell (WBC) count in the AUR group significantly increased compared with the non-AUR group (P<0.01). However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group (P<0.001). A total of 87.1% (303/348) patients in the AUR group and 84.1% (654/778) patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group (P<0.01). The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3–12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-K-URP.ConclusionsIn conclusion, immediate PK-URP surgery on patients accompanied by AUR was safe and effective.

The effect of immediate surgical bipolar plasmakinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention.

In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate (PK-TURP) for patients with benign prostatic hyperplasia (BPH) with acute urinary retention (AUR). We conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1126 BPH patients were divided into AUR (n = 348) and non-AUR groups (n = 778). After the urethral catheters were removed, the urine white blood cell (WBC) count in the AUR group significantly increased compared with the non-AUR group (P < 0.01). However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group (P < 0.001). A total of 87.1% (303/348) patients in the AUR group and 84.1% (654/778) patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group (P < 0.01). The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3–12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-PK-TURP. In conclusion, immediate PK-TURP surgery on patients accompanied by AUR was safe and effective.

Transurethral bipolar plasma kinetic resection of ejaculatory duct for treatment of ejaculatory duct obstruction

To evaluate the efficacy of transurethral bipolar plasma kinetic resection of ejaculatory duct for ejaculatory duct obstruction. The clinical information of 42 cases of ejaculatory duct obstruction was analyzed between July 2008 and June 2012. The diagnostic criteria included semen analysis, fructose and neutral α-glucosidase measurement in seminal plasma, transrectal ultrasonography, magnetic resonance imaging and vasography necessarily. Endoscopic procedure with bipolar plasma kinetic resection of ejaculatory duct was performed in all patients. Among these cases followed up 6 ≈ 24 months after operation, 38 patients (90.5%) had improved semen parameters, 23 azoospermic patients (60.5%) had sperm in the semen and 13 patients' wife (31%) achieved pregnancies in 42 cases of bipolar plasma kinetic resection of ejaculatory duct. Postoperative complications ensued as epididymitis in 1 case, watery ejaculate in 1, but no serious complication was observed. Bipolar plasma kinetic resection of ejaculatory duct appears to represent a promising endoscopic treatment alternative for ejaculatory duct obstruction patients, with high efficacy, less complications, quicker recovery and satisfactory follow-up parameters.

Transurethral Bipolar Plasmakinetic Resection Combined with 2 μm Continuous Wave Laser Vaporization: A New Method for the Treatment of Large Volume Benign Prostatic Hyperplasia

The aim of this study was to evaluate the safety and efficiency of transurethral bipolar plasmakinetic resection of the prostate (PKRP) combined with 2 μm laser vaporization in the management of large prostates (>80 mL). The safety and efficiency of transurethral vaporesection of the prostate with benign prostatic hyperplasia (BPH), using a 2 μm laser system, have been verified. However, this method does still not manage large volume prostates efficiently. From October 2009 to June 2010, 120 BPH patients with a median prostatic volume of 106.7 (±16.7) mL (range, 82.5-156.8 mL) were randomized for surgical treatment with PKRP combined with 2 μm laser vaporization (n=58) or PKRP only (n=62). All patients were preoperatively assessed with subjective symptoms score. Preoperative and perioperative parameters at 3-, 6-, and 9-month follow-up were also evaluated. All complications were recorded. PKRP combined with 2 μm laser vaporization was significantly superior to PKRP alone in terms of operative time, irrigation time, catheterization time, hospital stay, and hemoglobin decrease. The blood transfusion and urinary tract infection observed in the PKRP combined with 2 μm laser vaporization group was significantly less than that of the groups that received PKRP only. Both groups were similar with respect to resected tissue weight, transient incontinence, urethral stricture and retrograde ejaculation in the postoperative period. Both groups showed a significant improvement from baseline in terms of International Prostate Symptom Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and pulmonary vascular resistance unit (PVRU) values. However, no significant difference was found between them. PKRP combined with 2 μm laser vaporization, which combines the advantages of both PKRP and 2 μm laser, is superior for its shorter operation time, less bleeding, and better efficiency. It may be a safer and more effective method for the treatment of BPH in large prostates.

Bipolar Plasmakinetic Transurethral Resection of Prostate in 132 Consecutive Patients With Large Gland: Three-year Follow-up Results

To assess the safety, efficacy, and medium-term durability of bipolar plasmakinetic transurethral resection of the prostate (PK-TURP) for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia in a prospective study. From March 2007 to May 2008, 132 consecutive patients underwent PK-TURP at our institution. All patients were assessed perioperatively and followed up at 1, 3, 6, 12, 18, 24, and 36 months postoperatively. The parameters included the International Prostate Symptom Score, quality of life scores, maximal urinary flow rates, transrectal ultrasonography, postvoid residual urine volume, and serum prostate-specific antigen level. The mean patient age was 64.55±4.03 years. The prostate volume was 79.66±12.36 g. The operative time was 78.83±17.41 minutes, and the resected weight was 58.12±7.29 g. The catheterization time was 69.00±17.99 hours, and the hospital stay was 117.00±17.99 hours. The decrease in hemoglobin and sodium was 1.55±0.48 g/dL and 1.57±0.38 mmol/L, respectively. A significant improvement occurred in the maximal urinary flow rate (22.34±3.1 mL/s), International Prostate Symptom Score (2.90±1.60), and quality of life (1.12±0.60) at the 3-year follow-up compared with baseline (P<.001). Of the 132 patients, 6 (4.5%) required reoperation. PK-TURP represents an effective surgical intervention for the treatment of bladder outlet obstruction for large prostates. Furthermore, the functional results at 3 years demonstrated durability. Therefore, the PK-TURP technique could play an important role in the surgical treatment of patients with symptomatic benign prostatic hyperplasia with a large prostate gland.

Perioperative nursing of transurethral bipolar plasmakinetic resection of prostate

Objective To evaluate the perioperative nursing of transurethral bipolar plasmakinetic resection of prostate(TUPKRP).Methods One hundred and thirty BPH patients underwent transurethral prostatectomy with the bipolar plasmakinetic technique.All patients received preoperative mental nursing,holistic nursing care and health education before operation.Results All patients passed through the surgery and were given nursing intervention.They were discharged after rehabilitation.Conclusions TUPKRP is an important miro-invasion operation for treatment of BPH.The important points are preoperative mental nursing,rational use of drug,postoperative bladder irrigation and prevention of hemorrhage. Key words: Transurethral bipolar plasmakinetic resection of prostate; Nursing care; Perioperative period

Decreasing Electrosurgical Transurethral Resection of the Prostate Surgical Volume During Graduate Medical Education Training is Associated With Increased Surgical Adverse Events

In the United States the numbers of electrosurgical transurethral prostate resection procedures have been decreasing. Since electrosurgical transurethral resection of the prostate is a difficult procedure to master, we hypothesized that recent residents are lacking in training for this procedure. We used summary case log information provided by the Accreditation Council for Graduate Medical Education to determine if the number of electrosurgical transurethral prostate resection procedures performed by graduating chief residents has decreased and if there has been an increase in surgical adverse events. In addition, we investigated whether the increased number of laser procedures impacted the rate of adverse events. Summary operative data from graduating chief resident case logs were provided by the Accreditation Council for Graduate Medical Education for academic years 2001 to 2007. The numbers of electrosurgical transurethral prostate resection procedures, laser procedures and procedures for adverse events were recorded for each year. The number of electrosurgical transurethral prostate resection procedures performed by graduating chief residents has steadily decreased from 58 in 2001 to 43 in 2007. Conversely the number of laser procedures started increasing in 2004. The rate of procedures for adverse events as a percentage of electrosurgical transurethral resection of the prostate procedures increased during the study period (from 3% in 2001 to 6% in 2007), and as a percentage of electrosurgical transurethral resection of the prostate and laser procedures the rate increased until 2005 and subsequently started decreasing. The rate of surgical adverse events, as measured by the need for subsequent procedures, has increased during the last 7 years. However, when laser procedures are accounted for, it appears that adverse events have recently started trending down as an increasing number of laser procedures started being performed.

Trausurethral bipolar plasmakinetic resection in treating urethral stricture:a clinical analysis in 46 cases

Objective To investigate the safety and effectiveness of transurethral bipolar plasmakinefic resection in treating urethral stricture. Methods Totally 46 patients with urethral stricture were treated with transurethral bipolar plasmakinetic resection, and they were followed up for 3～12 months to observe the clinical effects. Results The segments of urethral scar were accurately incised and resected in all the 46 cases,24～26F bougies could pass through the urethra smoothly, and miction should be kept unobstructed. Totally 41 cases were followed up postoperatively, the maximal flow rate(Qmax) was ( 18.6±4.1 ) ml/s, which was obviously ameliorated as compared with that before operation(t=14.25, P＜0.05);sexual function had no obvious changes before and after operation;no serious complications of urethral massive bleeding, urinary incontinence, fistula of urethral diverticulum,urethral perforation, rectal injury, etc. was observed. Conclusion Transurethral bipolar plasmakinetic resection is an effective method for treating urethral stricture, because it has fewer complications, faster postoperative recovery and lower recurrence. Key words: Urethral stricture; Endoscopy; Electrocoagulation

Rapid Communication: Bipolar PlasmaKinetic Transurethral Resection of the Prostate: Reliable Training Vehicle for Today's Urology Residents

With the improvement of medical therapy and minimally invasive surgical treatments for benign prostatic hyperplasia, the number of transurethral resections of the prostate (TURPs) done in training is decreasing. With fewer TURPs being performed, proficiency in this basic urologic technique has decreased, causing longer resection times. This often leads to a higher risk of fluid absorption, water toxicity, and hyponatremia (TUR syndrome). We examined the safety of bipolar electrocautery TURP (saline TURP) with the Gyrus PlasmaKinetic system using normal saline as irrigant. Twenty-one men aged 54 to 85 years (median 70.0 years) underwent saline Plasma- Kinetic TURP from June 2002 to August 2003. Serum sodium, chloride, hemoglobin, and hematocrit were measured 1 hour prior to and 1 hour after TURP. Resection time, tissue weights, hospital stay, and catheter time were recorded and analyzed. The median preresection and postresection sodium concentrations were 139.0 mEq/mL and 140.0 mEq/L, respectively (ranges 130-142 mEq/L and 134-143 mEq/L). The corresponding chloride values were 106.5 mEq/L and 109.0 mEq/L (ranges 102-114 mEq/L and 106-116 mEq/L), and the hemoglobin and hematocrit values were 13.4 g/dL and 40.1 g/dL (8.7-15.2 g/dL and 33.7-46.7 g/dL) and 12.0 g/dL and 36.6 g/dL (8.2-14.4 g/dL and 27.5-43.7 g/dL), respectively. The median resection time was 65 minutes (range 45-140 minutes), and the median resected tissue weight was 20 g (range 5-61 g). There was no statistically significant difference between the preresection and postresection sodium concentrations, and no patient exhibited any clinical sign of TUR syndrome. Gyrus PlasmaKinetic TURP using normal saline as the irrigant is a safe alternative to and is technically no different from traditional monopolar TURP. The system also provides the longer time needed to train urology residents without compromising patient safety.