Bipolar Transurethral Resection Of Prostate Research Articles

Comparative Study between Bipolar Transurethral Resection and Bipolar Transurethral Enucleation of the Prostate for Managing Benign Prostatic Hyperplasia

Introduction: Benign prostatic hyperplasia is considered a common disorder that occurs with advancing age inmales. The bladder outlet obstruction is the main complaint associated with this condition that could be managedwith different endoscopic approaches the traditional one is the transurethral prostatic resection and recently thetransurethral prostatic enucleation has emerged. This study aimed to compare between both techniques.Methods: This was a clinical trial performed at Ahmed Maher Teaching hospital. Patients were randomized toeither Group (1): (TUEP) patients subjected to the bipolar transurethral enucleation of prostate and Group (2):(TURP) patients subjected to the bipolar transurethral resection of the prostate. After the surgical procedures,the patients were compared regarding the success rate and the perioperative complications. Three months aftersurgery, assessment was done through uroflowmetry studies, post-voiding residual volume of urine and theInternational Prostate Symptom Score.Results: The mean duration of the procedure showed no significant differences between both groups in TUEP(82.8±8.4 min) vs (79.7±8.80 min) TURP (P=0.262). Post-operative drop of haemoglobin level was less in TUEPvs TURP (0.79±.14 vs 1.41±.42) g/dl (P=0.007), in addition to shorter time needed for catheters (46.10±10.18 vs56.65±13.14 hr; P=0.036) and less duration of hospital stay (53.70±9.13 vs 62.40±12.06 hr; P=0.001). A significantimprovement was observed between baseline and 3 months postoperatively regarding uroflowmetry (Qmax),IPSS and PVR in both groups.Conclusion: The mean operative time was nearly similar in both groups, however TUEP was associated with lessbleeding, shorter time needed for catheters, less time needed for hospital stay. After 3 month, uroflowmetry Qmax,PVR and IPSS were similar in both procedures.

USING THE MODIFIED CLAVIEN GARDING SYSTEM TO CLASSIFY COMPLICATIONS OF BIPOLAR TURP

introduction: TURP is considered gold standard treatment for BPH. TURP was first introduced in 1929 by Maximilian Stern. Complications in TURP are less but not absolute. Modified Clavien Dindo Grading System is well-established classification for post-operative complications. Objective of this study is to assess complications of BIPOLAR TURP by using the modified Clavien grading system. Objective: To assess the evaluation of complications after bipolar transurethral resection of prostate using the Modified Clavien grading system. Materials And Methods: 110 BIPOLAR TURP performed between April 2019 and March 2021 at Meenakshi mission hospital Madurai Tamilnadu India were reviewed retrospectively. All patients with various complications were graded using Modified Clavien grading system in 5 grades. Results: 110 cases were enrolled in our study out of them 21 (19.9%) patients developed complications there was no mortality. Out of 21; 11 (52.4%) grade I, 5 (23.8%) grade II, 2 (9.5%) grade IIIa, 1 ( 4.8%) grade IIIb, 1 (4.8%) in each grade IVa and IVb. Conclusion: Modified Clavien Grading System is an easy and feasible classification system for postoperative complications. In spite of various shortcomings, it is very useful to grade end-urological procedure BIPOLAR TURP short-term complications.

Daha Önce Holmiyum Lazer Prostat Enükleasyonu Ameliyatı Olan Bir Hastada Mesane Tümörünü Taklit Eden Rastlantısal Prostat Adenomu

Holmium laser enucleation of the prostate (HoLEP) surgery has been increasingly used in urology because of its advantages for benign prostatic hyperplasia (BPH) surgical treatment in recent years. But, there are insufficient data in literature about the true frequency of the incidental presence of prostatic adenoma within the bladder following HoLEP surgery. The case is here presented of a patient who underwent HoLEP surgery 5 years previously, then presented at our clinic with lower urinary tract symptoms. On ultrasonography, a suspicious 3×3 cm tumoral formation was determined within the bladder trigone. Cystoscopy was performed, and the freeform mass floating in the bladder was seen. The mass was excised with bipolar transurethral resection of the prostate. The pathology examination was reported as BPH. The current case demonstrates the need for surgeons to bear in mind that there could be incidental adenoma in patients with BPH who have not fully healed following HoLEP surgery.

Bipolar Transurethral Resection of the Prostate (B-TURP) Including Large Prostate Glands in Kinshasa, DR Congo

Bipolar Transurethral Resection of the Prostate (B-TURP) Including Large Prostate Glands in Kinshasa, DR Congo

EDITORIAL COMMENT

In this issue of Urology, Wymer et al report on the cost effectiveness of different surgical treatment strategies for benign prostatic hyperplasia (BPH) as measured by Medicare cost, quality-adjusted life years, and incremental cost-effective ratios at 5 years after surgery. Specifically, they compared holmium laser enucleation of the prostate (HoLEP), bipolar transurethral resection of the prostate (B-TURP), water vapor thermal therapy (WVTT), and prostatic urethral lift (PUL) for prostates under 80 g and HoLEP versus simple prostatectomy (SP) for glands larger than 80 grams.

Применение препарата экстракта простаты у пациентов после трансуретральной биполярной резекции по поводу доброкачественной гиперплазии

The purpose of the study is to study the efficacy and safety of the prostate extract (GEROFARM LLC, Russia) in the postoperative period in patients after transurethral bipolar resection of the prostate.The clinical study included 127 men aged 50 to 78 years with grade II benign prostatic hyperplasia (adenoma) who underwent a typical bipolar transurethral resection of the prostate. Patients of the main (n=60) group received tamsulosin 0.4 mg/day for 30 days in the postoperative period in combination with prostate extract 10 mg rectally for 21 days. In the control group (n=67) - tamsulosin 0.4 mg/day for 30 days as monotherapy. To assess the results of treatment, the questionnaire of the international system of total assessment of symptoms in prostate diseases (IPSS) with the definition of quality of life (QoL), the international index of erectile function (IIEF-5) and uroflowmetry were used. The control was carried out in terms of 1 and 3 months after the operation.In the main group, in the observation period of 1 and 3 months after the operation, a decrease in the average IPSS score by 40.2% and 52.9% was revealed, and an improvement in the quality of life by 45% and 64.7%, respectively, was noted. In the control group, at the same time of observation, a decrease in the average IPSS score by 34% and 44.7%, respectively, was revealed, and the quality of life improved by 25.5% and 37.3%, respectively. The increase in the average rate of urination in the main group by the end of 1 and 3 months of treatment was 59.2% and 85.7%, respectively, and in the control group, these figures were 40.5% and 50%. The positive effect of the proposed combination therapy on erectile function in the main group by the end of 1 and 3 months of treatment was 5.2% and 9.2%, respectively, and in the control group, these figures were 2.9% and 5.2%.There is a significant decrease in the symptoms of the lower urinary tract in the group of patients who received the drug Prostateks (GEROFARM LLC, Russia).The efficacy results of Prostatex (GEROFARM LLC, Russia) (reduced symptom severity on IPSS (11.7 1.2 ) and QoL (2.3 0.3)) scales are comparable to those of Vitprost Plus which allows you to evaluate the effectiveness of two drugs equally.

The first case of bipolar transurethral resection of the prostate for giant prostatic hyperplasia: A case report.

We admitted an 89-year-old male patient diagnosed with benign prostatic hyperplasia and a prostate volume of approximately 522 ml measured by magnetic resonance imaging. He had previous hypertension, diabetes, and coronary artery disease. Giant prostatic hyperplasia. We opted for bipolar transurethral resection of the prostate (BTURP). The urinary flow rate was detected 1 week after surgery, with a peak flow rate of 17 mL/s and a voided volume of 156 mL. The follow-up was 11 months, with an international prostate symptom score of 7 and a quality of life (QOL) of 1. Complete removal of the prostate is not our goal; reducing the risk of surgery and improving the quality of life of the patient is the theme.

Comparative assessment of the intra- and early postoperative period in patients of elderly and old age after various methods of surgical treatment of large benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men. Its significance is determined not only by a decrease in the quality of life of men, but also by the development of a number of complications as a result of infravesical obstruction. About 70% of patients with symptomatic BPH require surgical treatment due to the ineffectiveness of conservative therapy. At the moment, there are many methods of surgical treatment of this pathology in the arsenal of urologists, but there is no consensus on the choice of one or another method of surgical treatment of BPH.
 Aim. To study the results of modern and most common surgical methods of large BPH in patients of the older age group.
 Materials and methods. The study included 243 patients who were hospitalized at Saint Petersburg City Hospital No. 15 for BPH in the period from November 2019 to November 2021. Control examination after surgery was carried out on days 57, 3 and 6 months after surgery.
 Results. The first group of patients underwent bipolar transurethral resection of the prostate (n=67), the second group underwent bipolar plasma-kinetic enucleation of prostate adenoma (n=69), the third group of patients underwent thulium laser enucleation (n=75), and the fourth group of patients performed laparoscopic adenomectomy (n=32). An assessment of intraoperative parameters was carried out: the duration of the operation, the duration of postoperative irrigation, bladder catheterization, bed-day spent in the hospital. In the late postoperative period (after 3 and 6 months), patients were invited for a follow-up examination. In comparison with the initial values, a significant increase in indicators was determined, characterizing the improvement in the quality of life of patients.
 Conclusion. In the study, thulium laser enucleation proved to be the most effective and sparing method of BPH surgery in age-related comorbid patients, demonstrating a relatively short operation time, radical method, reduced hospital stay, early rehabilitation of patients, and high efficiency in the late postoperative period.

SC80 - Bipolar transurethral resection of the prostate (TURP) for large (>80 CC) benign prostatic enlargement (BPE)

SC80 - Bipolar transurethral resection of the prostate (TURP) for large (>80 CC) benign prostatic enlargement (BPE)

A Study on Bipolar Transurethral Resection of Prostate (TURP) versus Transurethral Resection and Electrovaporization (TURP-TUVP) Sandwich Procedure

Background: TURP is the gold standard for the endoscopic treatment of BPH. Nonetheless, it remains associated with significant morbidity, especially in terms of hemorrhage leading to possible blood transfusion and delayed hospital discharge. TUVP is associated with reported improvements in subjective and objective measures but a high rate of postoperative irritative symptoms and lack of tissue for histologic examination. The concept behind TURP and TUVP sandwich procedure is to overcome the drawbacks of the two procedures. Objective: To compare the outcome of bipolar transurethral resection of prostate (TURP) and bipolar transurethral resection and electrovaporization of prostate (TURP-TUVP) sandwich procedure in patient with benign prostatic hyperplasia. Methods: This quasi experimental study was conducted in the Department of Urology, National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh from July 2017 to June 2019 over a period of 2 years. Sixty patients with BOO caused by benign prostatic hyperplasia scheduled for transurethral resection of prostate were included in this study. Patients were selected first by purposive sampling and were grouped into A and B with randomization. Group A patients underwent bipolar TURP while group B patients underwent sandwich method. Perioperative findings as well as IPSS Qmax and PVR after 3 months of operation were compared. Results: Operative time was significantly longer in TURP-TUVP group than in TURP group (P value 0.036).Post operative hospital stay was significantly longer in TURP group (P value <0.001). Catheterization time was significantly higher in TURP group (P value <0.001).Intra-operative irrigation was significantly higher in TURP-TUVP group (P value 0.001). Post operative irrigation time was significantly longer in TURP group (P value <0.001). Hemoglobin decrease was significantly higher in TURP group (P value <0.001). Similarly, sodium decrease was higher in TURP group than that of TURP-TUVP group but not statistically significant (P value 0.81).Clot retention was 2 (6.7%) in TURP group. Short-term follow up at 3 month showed no significant difference in IPSS in TURP and TURP-TUVP groups (P value 0.349), significantly higher Qmax in TURP-TUVP group (P value 0.022) and significantly higher PVR in TURP group (P value0.005) Conclusion:. TURP-TUVP procedure has higher operative time and intraoperative irrigation, but has significantly lower catheterization time, postoperative irrigation time, hemoglobin change and hospital stay. Bangladesh J. Urol. 2021; 24(2): 161-165

The incidence of urethral stricture and bladder neck contracture with transurethral resection vs. holmium laser enucleation of prostate: A matched, dual-center study.

Urethral strictures (US) and bladder neck contracture (BNC) are common, long-term complications of transurethral prostate surgery. We aimed to compare transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) regarding incidence of US or BNC and identify possible risk factors. A retrospective review of patients who underwent TURP and HoLEP with followup data of at least one year in two separate institutions was performed. The incidence of postoperative US or BNC in both groups was compared. Bivariate and multivariate analysis of risk factors in both cohorts with US or BNC were performed. The study included 208 patients: 101 and 107 patients in the TURP and HoLEP arms, respectively. The two groups were matched for age and prostate size. Eight (7.92%) and five (4.72%) patients in the TURP and HoLEP arms, respectively, developed US (p=0.3423), while two (1.87%) patients in the HoLEP arm had BNC (p=0.2634). Of the eight patients with the US in the TURP arm, six (9.8%) had bipolar TURP, while two (5%) had monopolar TURP. Multivariate analysis showed that larger prostate volume (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.05, 1.41, p=0.0066) and longer operative time (HR 1.84, 95% CI 1.76, 1.93, p=0.0015) were associated with risk of US/BNC. There is no significant difference between TURP and HoLEP regarding incidence of US or BNC, although there is a tendency towards a higher rate of US associated with bipolar TURP. Increased prostate volume and operative time are possible risk factors.

UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update.

Lower urinary tract symptoms (LUTS) commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), or prostatic urethral lift using the UroLift system. The UroLift system implants to pull excess prostatic tissue away so that it does not narrow or block the urethra. In this way, the device is designed to relieve symptoms of urinary outflow obstruction without cutting or removing tissue. National guidance recommending the use of UroLift in the UK NHS was first issued in 2015 by the National Institute for Health and Care Excellence (NICE MTG26). We now report on the process to update the economic evaluation of UroLift, leading to updated NICE guidance published in May 2021 (NICE MTG58). The conclusions of the available clinical evidence were mixed and suggested that whilst UroLift improves symptoms over time, this improvement is smaller than that of TURP for symptom severity (IPSS) and urological outcomes. However, UroLift appears to be superior to Rezum for symptom severity and measures of erectile dysfunction and ejaculatory dysfunction. The updated economic model estimated that using UroLift as a day-case procedure for people with prostate of volume 30–80 mL creates a saving of £981 per person compared with bipolar TURP, £1242 compared with monopolar TURP, and £1230 compared with HoLEP.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40258-022-00735-y.

Is Group and Saving Before the Modern Bipolar Transurethral Resection of the Prostate Still Necessary?

Introduction: Group and save (G&S) sampling is commonplace for patients undergoing transurethral resection of the prostate (TURP) due to the historically high risk of bleeding. However, modern adjustments to the procedure, including the advent of bipolar TURP in saline, have significantly reduced this risk. This study assessed whether routinely performing G&Ss before the modern TURP is still appropriate. Materials and Methods: This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. In addition, data was collected on G&S samples, blood products, and postoperative complications such as clot retention or if patients required a blood transfusion. Results: All patients had G&S samples taken before their operation. Only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of <70g/L(8). Six patients were also noted to develop clot retention following the catheter removal. Discussion and Conclusion: This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples before this procedure should be reviewed. This would give a financial benefit and relieve patients of the unnecessary test. We would recommend thorough optimisation of patients before surgery, including review of anticoagulation and correction of any preoperative anaemia.

The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis

This meta-analysis was to evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with large volume. PubMed, Embase, and Cochrane Library databases (until March 2022) were used to search related randomized controlled trials. A total of 11 studies including 1,258 patients were involved. HoLEP could significantly decrease the length of hospital stay and accelerate recovery. In subanalysis, HoLEP had better perioperative outcomes than bipolar transurethral resection of the prostate (B-TURP) and bipolar transurethral enucleation of the prostate (BPEP). The improvement in operative time and enucleation time was better in thulium laser enucleation of the prostate (ThuLEP) than HoLEP. In the follow-up period, the HoLEP decreased post-void residual urine (PVR) in short-term intervals and improved patients’ maximum flow rate (Qmax) and prostate-specific antigen (PSA) in mid- and long-term intervals. In subanalysis, HoLEP presented significant improvements in Qmax, PSA, and quality of life (QoL) than B-TURP, and HoLEP could also improve Qmax than ThuLEP after 6 months of surgery. The HoLEP reduced the risk of postoperative bleeding compared with other surgeries in safety. In our study, we confirmed the advantages of HoLEP in treating BPH when the prostate size was larger than 80 mL, which indicated that HoLEP could be the best choice for treatment of large volume of prostate.

Cluster Analysis Assessment in Proposing a Surgical Technique for Benign Prostatic Enlargement.

Benign prostatic enlargement (BPE) is a common disease in men over 50 years old. The phenotype of patients with BPE is heterogenous, regarding both baseline patient characteristics and disease-related parameters. Treatment can be either medical-conservative or surgical. A great variety of surgical techniques are available for surgical management, with three of the most common being monopolar transurethral resection of the prostate (mTUR-P), bipolar transurethral resection of the prostate (bTUR-P), and bipolar transurethral vaporization of the prostate (bTUVis). The selection of each one of these depends on surgeon reasoning, equipment availability, patient characteristics, and preferences. Since all of these techniques are available in our Urology Department, and surgeons are skilled to perform each one of them, we performed a clustering analysis according to patient pre-operative characteristics, using the k-means algorithm, to compare clustering-related technique assignment with the real-life technique used.

The Efficacy and Safety of Laser and Electrosurgical Transurethral Procedures for the Treatment of BPO in High-Risk Patients: A Systematic Review.

ObjectiveTo compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO).MethodsWe conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age >80 years and/or significant comorbidity. Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints.ResultsA total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2−29 falling to 2.3−10.8 for IPSS, 0−19 mL/s increasing to 7.5−34.1 mL/s for Qmax and 41.4−954 mL falling to 5.1−138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP.ConclusionsLaser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.

MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY

You have accessJournal of UrologyCME1 May 2022MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY Kirby R. Qin, William Wang, Damien Bolton, and Gregory Jack Kirby R. QinKirby R. Qin More articles by this author , William WangWilliam Wang More articles by this author , Damien BoltonDamien Bolton More articles by this author , and Gregory JackGregory Jack More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) surgery is typically performed under general (GA) or spinal anaesthesia (SA). SA is considered the anaesthetic of choice for as it facilitates early identification of transurethral resection of prostate (TURP) syndrome. However, SA may be associated with longer time spent in the recovery room. Previous studies have compared GA and SA in regards to post-operative pain, but not post-operative recovery. We compare post-operative recovery metrics after GA and SA for BPH surgery. METHODS: This was a retrospective review of 500 consecutive patients from March 2019 to July 2021 who underwent surgical management of BPH at Austin Health in Melbourne, Australia. Our institution performs greenlight laser photoselective vaporisation of prostate (PVP), monopolar and bipolar TURP. All continuous variables were normally distributed, presented as mean±SD, and compared using the Student’s T-test and mean difference (MD) [95% CI]. Categorical variables were compared with the Chi-square test. Comparison of recovery time was achieved using multivariate linear regression. RESULTS: In total, 186 (37.2%) underwent SA for monopolar TURP (n=144, 77.4%), bipolar TURP (n=9, 4.8%) and PVP (n=33, 17.7%). In contrast, 314 (62.8%) underwent GA for monopolar TURP (n=213, 67.8%), bipolar TURP (n=6, 1.9%) and PVP (n=95, 30.3%). SA patients were older than GA patients (73.1±8.9 vs 71.2±8.9 years, MD 1.9 [0.3-3.5], p=0.02), but similar in terms of ASA (p=0.17) and prostate volume (67.3±35.0 cc vs 67.7±38.3 cc, p=0.91). As expected, anaesthetic time was longer for SAs (31.5±11.7 vs 26.6±25.3 minutes, MD 4.9 [2.8-7.0], p<0.001), but total operating room time was similar (76.7±26.6 vs 75.7±29.3 minutes, p=0.72). TURP syndrome amongst SAs and GAs were identical (1.6% vs 1.6%, p=0.99). Recovery room time (82.8±57.2 vs 74.7±42.7 minutes, p=0.07) and length-of-stay (2.5±2.0 vs 2.3±3.3 days, p=0.42) were similar after SA and GA. In multivariate analysis, higher ASA score (p<0.001), PVP surgery (p=0.03), longer resection time (p=0.04) and TURP syndrome (p=0.008) were associated with greater time spent in the recovery room, but choice of anaesthetic was non-significant (p=0.37). CONCLUSIONS: Although our study does not prove if SA can facilitate early identification of TURP syndrome, we have shown that the method of anaesthesia does not significantly impact time spent in the operating room and recovery room or inpatient length-of-stay. This may further support the ongoing use of SA for BPH surgery. Source of Funding: Nil © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e476 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kirby R. Qin More articles by this author William Wang More articles by this author Damien Bolton More articles by this author Gregory Jack More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD45-07 PROSPECTIVE COMPARISON OF FUNCTIONAL OUTCOMES AFTER ENDOSCOPIC SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: THE ROLE OF EJACULATION-SPARING ANATOMIC PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (ESA-PVP)

You have accessJournal of UrologyCME1 May 2022PD45-07 PROSPECTIVE COMPARISON OF FUNCTIONAL OUTCOMES AFTER ENDOSCOPIC SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: THE ROLE OF EJACULATION-SPARING ANATOMIC PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (ESA-PVP) Mattia Sibona, Paolo Destefanis, Federico Vitiello, Eugenia Vercelli, Gabriele Montefusco, Alessandro Mara, Andrea Bosio, Alessandro Bisconti, and Paolo Gontero Mattia SibonaMattia Sibona More articles by this author , Paolo DestefanisPaolo Destefanis More articles by this author , Federico VitielloFederico Vitiello More articles by this author , Eugenia VercelliEugenia Vercelli More articles by this author , Gabriele MontefuscoGabriele Montefusco More articles by this author , Alessandro MaraAlessandro Mara More articles by this author , Andrea BosioAndrea Bosio More articles by this author , Alessandro BiscontiAlessandro Bisconti More articles by this author , and Paolo GonteroPaolo Gontero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ejaculatory Dysfunction (EjD) is still a common event after Benign Prostatic Hyperplasia (BPH) surgery, causing significant bother to younger and sexually active patients (pts). Recently, several ejaculation-sparing techniques were described. Ejaculation-sparing anatomic Photoselective Vaporization of the Prostate (ESa-PVP) with LBO laser has been proposed as a sexual function-sparing evolution of the anatomic PVP technique, showing promising preliminary results. The aim of our study was to present a prospective comparison of functional outcomes from a cohort of ESa-PVP pts versus standard PVP and Transurethral Resection of the Prostate (TUR-P). METHODS: Local Ethics Committee approval was obtained (n. 643/2018). Our study was conceived as a prospective, observational analysis. From 03/2018 to 06/2020, we enrolled pts undergoing endoscopic surgery for BPH at our institution (Molinette Hospital, Turin). Inclusion criteria: age > 50, sexually active, moderate to severe Lower Urinary Tract Symptoms (LUTS) [IPSS > 8]. Urinary and sexual function data were collected at baseline and at 6 and 12 month after surgery. Validated questionnaires were used to assess functional results (IPSS, IIEF5, MSHQ-Ej). Included pts were divided into groups, according to the type of intervention: bipolar TUR-P (group A); standard PVP (group B); ESa-PVP (group C). RESULTS: Globally, 95 pts were included (46 in group A, 26 in group B, 23 in group C). Median (IQR) age was 66 (60-71) years. Median prostate volume was 63 (50-90) cc. Median baseline IPSS score within groups was 25 vs 24.5 vs 28 (p=0.442); median IIEF-5 score was 21 vs 23.5 vs 20 (p=0.339); median MSHQ-Ej score was 30 vs 33.5 vs 34 (p=0.137). Baseline antegrade ejaculation rate was 84.78% vs 80.77% vs 91.30% (p=0.579). At 6-month follow-up, urinary and sexual function scores changed as follows: median IPSS: 6 vs 5 vs 1 (p=0.019); median IIEF5: 21 vs 21.5 vs 19 (p=0.750); median MSHQ-Ej: 4 vs 2 vs 15 (p=0.001). 6-month antegrade ejaculation rate was 28.89% vs 23.08% vs 60.87% (p=0.010). 12 months after surgery, no significant differences in IPSS and IIEF5 scores were detected within groups. Instead, median MSHQ-Ej score was 2 vs 2 vs 25 (p=0.006) and antegrade ejaculation rate was 26.09% vs 13.04% vs 58.82% (p=0.007). At a multivariable logistic regression analysis, pre-operative MSHQ-Ej score was identified as an independent predictor of antegrade ejaculation preservation both at 6 and 12 months, while surgical technique appeared as a significant predictor of the same outcome at 6 months. CONCLUSIONS: The Ejaculation-Sparing anatomic PVP technique (ESa-PVP) showed superiority over standard PVP and TUR-P in preserving antegrade ejaculation both at 6 and 12 month follow-up after BPH surgery. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e785 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mattia Sibona More articles by this author Paolo Destefanis More articles by this author Federico Vitiello More articles by this author Eugenia Vercelli More articles by this author Gabriele Montefusco More articles by this author Alessandro Mara More articles by this author Andrea Bosio More articles by this author Alessandro Bisconti More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP095 - A prospective comparative study on the operative outcomes between monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: An institutional experience

MP095 - A prospective comparative study on the operative outcomes between monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: An institutional experience

Bipolar versus monopolar transurethral resection for benign prostatic hypertrophy: a prospective comparative study

Background: The transurethral resection of the prostate (TURP) is a well-known surgical procedure for treating benign prostatic hypertrophy in males. Monopolar TURP (MTURP) has been used in the past, however the morbidity associated with MTURP has led to the development of new surgical procedures. Energy is restricted between electrodes at the resectoscope site in bipolar TURP (BTURP), permitting the use of physiological irrigation medium. In terms of patient outcomes, there is still some doubt about the distinctions between various surgical procedures. This study aims to evaluate the efficacy of monopolar (M-TURP) and bipolar (B-TURP) TURP.Methods: In this prospective comparison trial, 100 patients were enrolled and table randomized to either M-TURP or B-TURP surgery for prostatic hyperplasia. Prostate size, post-void volume and hemoglobin were recorded pre and postoperatively. Resection time was noted.Results: Patients were divided into two groups, namely M-TURP and B-TURP. The mean age of patients was comparable between both groups. There is a significantly lower mean resection time in M-TURP compared to B-TURP. Drop-in hemoglobin levels (g/dl) in M-TURP patients were higher than in B-TURP. The M-TURP group showed a higher reduction in post-void residual volume than the B-TURP group. B-TURP group had a larger reduction in gland size than the M-TURP group.Conclusions: M-TURP and B-TURP are safe and effective procedures for treating BPH.