Transurethral Resection In Saline Research Articles

MP29-12 TRANSURETHRAL BIPOLAR ENUCLEATION (TUBE): IMPROVED OUTCOMES VERSUS STANDARD BIPOLAR TRANSURETHRAL PROSTATE RESECTION (TURIS) WITHOUT A SIGNIFICANT LEARNING CURVE MAY EASE ADOPTION OF ENUCLEATION TECHNIQUES INTO CLINICAL PRACTICE

You have accessJournal of UrologyCME1 May 2022MP29-12 TRANSURETHRAL BIPOLAR ENUCLEATION (TUBE): IMPROVED OUTCOMES VERSUS STANDARD BIPOLAR TRANSURETHRAL PROSTATE RESECTION (TURIS) WITHOUT A SIGNIFICANT LEARNING CURVE MAY EASE ADOPTION OF ENUCLEATION TECHNIQUES INTO CLINICAL PRACTICE Zachary Tully, Brian Barnes, Ryan Steinberg, and Bradley Erickson Zachary TullyZachary Tully More articles by this author , Brian BarnesBrian Barnes More articles by this author , Ryan SteinbergRyan Steinberg More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite ample evidence of safety and superiority, transurethral enucleation procedures, most commonly with the holmium laser (HOLEP), have not been widely adopted (<5% in US), likely due to a combination of a steep learning curve and technological barriers. Herein we present our experience with transurethral enucleation using the Olympus® bipolar electrode, a technology with wide availability, use, and surgeon familiarity. METHODS: We reviewed consecutive transurethral outlet procedures using bipolar energy for benign prostatic hyperplasia (BPH) from a single institution from 2010-20 and divided them into two cohorts: standard transurethral resection in saline (TURis; n = 383) and transurethral bipolar enucleation (TUBE; n = 208). All TUBE procedures were performed by a single surgeon. Perioperative characteristics between the two cohorts were compared with unpaired two-tailed t-tests and Chi-squared tests. A separate learning curve analysis was performed for the TUBE procedures that determined the impact that case number had on operative time and tissue resection. RESULTS: Comparisons are shown in the Table. The TUBE cohort was more likely to be catheter dependent pre-operatively and have a higher pre-op PSA. TURis operative time was 10 minutes less on average, but TUBE tissue resection weights were significantly greater. Hospital and catheter times were statistically similar. Post-operatively, TUBE led to a greater reduction in PSA, catheter dependence and BPH medication use. De novo incontinence and need for secondary outlet procedures were higher in TURis. De novo PDE-5 use was greater in TUBE. Cancer detection was greater after TURis. The variability in TUBE operative time (r2 = 0.0024) and resection weight (r2 = 0.007) was not related to surgery number/surgeon experience. CONCLUSIONS: Utilizing the same instrumentation and electrodes, the TUBE technique offers significant advantages to a standard TURis loop resection without an appreciable learning curve. Widespread instrument familiarity, as well as the ability to perform both resection and enucleation maneuvers in the same case, may increase the likelihood of adoption into clinical practice for those hesitant to learn HOLEP. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e473 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Tully More articles by this author Brian Barnes More articles by this author Ryan Steinberg More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF DownloadLoading ...

Usefulness of bicarbonate Ringer's solution as perfusate during transurethral resection of the prostate

Transurethral resection of the prostate (TURP) is the most common standard surgical procedure used for benign prostatic hyperplasia. Transurethral resection in saline (TURis) is a bipolar electrosurgery system used to prevent TURP (or TUR) syndrome. The bicarbonate Ringer's solution is not generally used as perfusate for TURP. Hence, we compared the efficacy of the bicarbonate Ringer's solution with that of physiological saline as perfusate during TURP. This prospective, multicenter, cooperative study was conducted on 40 adult patients admitted to a medical college hospital. After obtaining informed consent from all the patients, they were divided into two groups (20 patients per group). For patients of one group, bicarbonate Ringer's solution, and for other group, physiological saline was used as perfusate. Compared to the physiological saline, the electrolyte composition of the bicarbonate Ringer's solution was closer to that of plasma. Hence, the group using bicarbonate Ringer's solution as perfusate was exhibited less variation in plasma electrolytes and blood gas data. The primary endpoints were adverse events of grade 1 or higher according to the JCOG postoperative complication criteria ver. 2.0, unintended diseases, or related signs in patients who underwent the protocol therapy. The secondary endpoints were changes in blood pH, bicarbonate ion level, anion gap (AG), base excess (BE), and chloride (C1), which occurred during and after the surgeries. Therefore, bicarbonate Ringer's solution has superior with that of physiological saline as perfusate during TURP which is directly administered into the blood vessels as an infusion solution.Bicarbonate Ringer's solution is directly administered into the blood vessels as an infusion solution.

PD61-10 RANDOMIZED TRIAL OF BIPOLAR RESECTION VS. HOLMIUM LASER ENUCLEATION VS. GREENLIGHT LASER VAPO-ENUCLEATION OF THE PROSTATE FOR TREATMENT OF LARGE SIZED BENIGN PROSTATE OBSTRUCTION; 3-YEARS OUTCOME

INTRODUCTION AND OBJECTIVE:To assess the noninferiority of transurethral resection in saline (TURis) and Greenlight laser Vapo-Enucleation of the prostate (GL.PVEP) to Holmium laser enucleation of ...

Systemic Tumor Seeding Secondary to Peritonitis due to the Immediate Postoperative Intravesical Instillation of Pirarubicin After Intravesical Explosion Induced Bladder Perforation During Bipolar Transurethral Resection of Bladder Tumors

An 82-year-old man with multiple nonmuscle-invasive bladder cancer underwent transurethral resection (TUR) of bladder tumor by using the transurethral resection in saline (TURis) system. Intravesical explosion occurred during the resection of a tumor of the bladder dome, but no bladder perforation was detected. Immediate postoperative intravesical instillation of 30 mg pirarubicin in 30 mL saline was administered after the TURis. After this procedure, the patient complained of severe lower abdominal pain. A computed tomography (CT) scan after cystography revealed a collection of fluid in the abdominal cavity with signs of urine leakage. It was determined that instillation of pirarubicin led to leakage outside the bladder through a near perforation on the bladder that occurred during TURis. An indwelling 20 Fr Foley catheter was placed for 8 days. His condition improved without additional surgery. After the patient was discharged, gross hematuria appeared. A residual tumor was confirmed near the perforation area. Therefore, 3.5 months after the first TURis, he underwent a second TURis. Dyspnea appeared 1 month after the second TURis. Positron emission tomography and computed tomography (PET/CT) imaging revealed systemic tumor seeding. Five months after surgery, the patient died because of acute respiratory failure. J Med Cases. 2019;10(4):101-105 doi: https://doi.org/10.14740/jmc3277

Efficacy of bipolar transurethral resection of the prostate using TURIS: our short term experience

Background: Objective of the study was to report our short term experience regarding efficacy of bipolar transurethral resection of prostate using TURIS (transurethral resection in saline) system.Methods: Between May 2016 to April 2017 49 consecutive patients underwent bipolar transurethral resection of prostate (B-TURP) at our institute. All patients were evaluated preoperatively by physical examination, ultrasonography and laboratory studies, including measurement of hemoglobin, serum sodium, and prostate specific antigen levels. Patients were assessed postoperatively at three, six and 18 months.Results: The mean age of the patients was 64.83±7.47 years and mean preoperative prostate volume was 64.73±13.59 ml. The mean preoperative hemoglobin was 13.32±0.9 g/l and mean postoperative hemoglobin was 12.09±1.11 g/l. The mean resection time was 57.02±14.37 minutes and mean resected specimen weight was 41.69±12.15 gm. The mean preoperative maximum urinary flow rate (Qmax) was 8.6±1.17 ml/s and mean Qmax at three, six and 18 months follow up was 18.85±2.15, 19.43±1.49 and 18.98±1.6 ml/s respectively. The mean preoperative international prostate symptom score (IPSS) was 26.32±2.69 and mean IPSS at three, six and 18 months follow up was 6.68±1.36, 6.47±0.79 and 6.30±0.9 respectively. Only one patient developed urethral stricture during follow up.Conclusions: The B-TURP is efficacious and results in significant improvement in IPSS and Qmax. The urethral stricture rate after B-TURP is not different from monopolar TURP.

Systemic Tumor Seeding Secondary to Peritonitis due to the Immediate Postoperative Intravesical Instillation of Pirarubicin After Intravesical Explosion Induced Bladder Perforation During Bipolar Transurethral Resection of Bladder Tumors

An 82-year-old man with multiple nonmuscle-invasive bladder cancer underwent transurethral resection (TUR) of bladder tumor by using the transurethral resection in saline (TURis) system. Intravesical explosion occurred during the resection of a tumor of the bladder dome, but no bladder perforation was detected. Immediate postoperative intravesical instillation of 30 mg pirarubicin in 30 mL saline was administered after the TURis. After this procedure, the patient complained of severe lower abdominal pain. A computed tomography (CT) scan after cystography revealed a collection of fluid in the abdominal cavity with signs of urine leakage. It was determined that instillation of pirarubicin led to leakage outside the bladder through a near perforation on the bladder that occurred during TURis. An indwelling 20 Fr Foley catheter was placed for 8 days. His condition improved without additional surgery. After the patient was discharged, gross hematuria appeared. A residual tumor was confirmed near the perforation area. Therefore, 3.5 months after the first TURis, he underwent a second TURis. Dyspnea appeared 1 month after the second TURis. Positron emission tomography and computed tomography (PET/CT) imaging revealed systemic tumor seeding. Five months after surgery, the patient died because of acute respiratory failure. J Med Cases. 2019;10(4):101-105 doi: https://doi.org/10.14740/jmc3277

82] Efficacy of bipolar photovaporisation of prostate median lobe enlargement using the transurethral resection in saline (TURis) system

ObjectiveTo evaluate the efficiency of a vaporisation-resection of prostate median lobe enlargement in benign prostatic hyperplasia (BPH) using the transurethral resection in saline (TURis) system. Bipolar photovaporisation of the prostate has proven to be effective in the treatment of BPH symptoms with maximum safety and without increasing the complication rate or length of stay.

40] Day surgery prostate resection by bipolar photovaporisation using the transurethral resection in saline (TURis) system: First experience in Africa

ObjectiveTo prospectively evaluate the efficacy, safety and postoperative complications of prostate resection for benign prostate hypertrophy (BPH) by bipolar photovaporisation using the transurethral resection in saline (TURis) system (BPV) in a day surgery setting.

Day-case surgery is possible in the majority of men undergoing transurethral resection of the prostate – a report on over 1000 cases

Objective: We describe our experience of performing bipolar transurethral resection in saline (Olympus Medical) as a day-case procedure over an initial five-year period. Patients and methods: All procedures coded as transurethral resection of the prostate over a 60-month period were analysed to determine whether the procedure was planned as a day-case or as an inpatient admission, and whether post-operative discharge proceeded as intended. Re-admission rates, reasons for re-admission and transfusion rates were also recorded. Results: Of the 1035 operations, 689 (66.57%) were planned as a day-case procedure (mean age 70.5 years) with 176 (25.5%) requiring inpatient admission, and 346 (33.43%) were planned for inpatient admission (mean age 73.6) but 58 (16.8%) were discharged the same day. Overall 571 (55.17%) procedures were performed as day cases. Readmission rates for day-case and inpatient procedures were 7.4%, and 6.3% respectively ( p=0.48). Transfusion rates were lower in the day-case group (0.7% vs 3.7%, p&lt;0.05). Day-case rates improved from 48.70% in 2011 to 75.22% in 2016. Conversion from day case to inpatient fell from 34.6% in 2011 to 14.8% in 2016. Conclusions: Our experience indicates that day-case transurethral resection of the prostate can be performed safely in appropriately selected patients, without increased rates of re-admission or complications. Level of evidence: 4 (Oxford Centre for Evidence-Based Medicine (CEBM)).

MP62-12 THE 3 YEARS' TEST OF TIME IN LARGE PROSTATE SURGERY – BIPOLAR PLASMA VAPORIZATION, RESECTION AND ENUCLEATION VERSUS OPEN PROSTATECTOMY IN A PROSPECTIVE, RANDOMIZED-CONTROLLED CLINICAL SETTING

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2018MP62-12 THE 3 YEARS' TEST OF TIME IN LARGE PROSTATE SURGERY – BIPOLAR PLASMA VAPORIZATION, RESECTION AND ENUCLEATION VERSUS OPEN PROSTATECTOMY IN A PROSPECTIVE, RANDOMIZED-CONTROLLED CLINICAL SETTING Bogdan Geavlete, Cosmin Ene, Catalin Bulai, Georgiana Balan, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete More articles by this author , Cosmin EneCosmin Ene More articles by this author , Catalin BulaiCatalin Bulai More articles by this author , Georgiana BalanGeorgiana Balan More articles by this author , and Petrisor GeavletePetrisor Geavlete More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The study compared the transurethral resection in saline (TURis), transurethral vaporization in saline (TUVis), bipolar plasma enucleation of the prostate (BPEP), and open prostatectomy (OP) in a single center, prospective, randomized-controlled clinical setting exclusively involving severe lower urinary tract symptoms' large prostate patients. METHODS During a 4½ year enrollment period, 320 cases of prostate volume over 80 mL, maximum flow rate (Qmax) below 10 mL/second, International Prostate Symptom Score (IPSS) over 19 or urinary retention were included in the trial and equally randomized in the four study arms. Patients were assessed preoperatively, at the 1-, 3-, 6- and 12-month follow-up checkups and every 6 months up to 3 years after surgery using the IPSS, quality of life (QoL) score, Qmax, postvoiding residual urinary volume (PVR) and prostate-specific antigen (PSA). RESULTS Similar preoperative parameters were established in the four series. OP and BPEP were characterized by resembling operating times, while TURis and TUVis displayed prolonged surgical durations. TURis emphasized a substantially decreased mean resected tissue weight. TUVis showed the lowest mean hemoglobin level drop, followed by TURis and BPEP (equivalent results) and finally OP (highest bleeding). OP described the longest mean catheterization period and hospital stay, followed by TURis and afterwards by TUVis and BPEP (similar data). During the 3 years' follow-up period, statistically equivalent IPSS, QoL, Qmax and PVR outcomes were established for OP, BPEP, and TURis. TUVis displayed significantly smaller long term Qmax improvements but otherwise similar functional features. Significantly lower mean PSA levels were determined secondary to OP and BPEP when compared to bipolar resection and subsequently to vaporization up to the 36 months' postoperative assessment. CONCLUSIONS OP and BPEP emphasized the highest surgical efficiency (with prolonged postoperative recovery for open surgery), while TUVis displayed the lowest hemorrhagic risks. On the medium and long term, generally resembling functional outcomes were determined for the 4 techniques, with significantly decreased mean PSA values secondary to OP and BPEP. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e836-e837 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Bogdan Geavlete More articles by this author Cosmin Ene More articles by this author Catalin Bulai More articles by this author Georgiana Balan More articles by this author Petrisor Geavlete More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Clinical Effect of Bipolar Transurethral Resection in Saline of Benign Prostate Hyperplasia with Long Term Follow-Up

Transurethral resection of the prostate (TURP) is considered as the gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Long-term follow-up of the clinical effect of bipolar transurethral resection of the prostate (B-TURP) in saline for BPH is required. Objective: To compare, with long term follow-up, the efficacy and safety of B-TURP in the treatment of BPH with prostate gland volumes of 45 ml, and larger than 60 ml. Materials and Methods: From January 2006 to December 2016, 318 patients with a mean age of 69.45 ± 8.37 years and a median prostate volume of 42 cm3 (56.51 - 32.47) were treated with B-TURP by single urologist (SP) at the Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. We retrospectively analyzed the perioperative status of patients’ status follow-up for at least 6 months and up to 5 years. Post-void residual (PVR) and maximum flow rate (Qmax) were assessed preoperatively and postoperatively. Operative time, length of catheterization and hospitalization and complications were all reported. Results: The main indication for B-TURP was failure of medication (81.13%). Perioperative results showed no statistical significance among the groups in terms of catheterization days and the hospitalization length. During the follow-up, the improvement of postoperative parameters was compared with preoperative subscales, at different periods from baseline and after 24, 36, 48, and 60 months post treatment. PSA, Q max, PVR, and average flow rate were significantly different from pre-operation data (p 45 ml and larger than 60 ml.

Economic Value of the Transurethral Resection in Saline System for Treatment of Benign Prostatic Hyperplasia in England and Wales: Systematic Review, Meta-analysis, and Cost–Consequence Model

ContextMonopolar transurethral resection of the prostate (M-TURP) is the current UK surgical standard of care for benign prostatic hyperplasia, a condition estimated to affect >2 million men in the United Kingdom. Although M-TURP efficacy in prostate resection is established, potential perioperative complications and associated costs remain a concern. ObjectiveTo present up-to-date and robust evidence in support of bipolar transurethral resection in saline (TURis) as an alternative surgical option to M-TURP. Evidence acquisitionA systematic review (SR) of electronic databases (up to 2015) for randomised controlled trials (RCTs) comparing TURis with M-TURP was conducted, followed by evidence synthesis in the form of a meta-analysis of hospital stay, catheterisation time and procedure duration, transurethral resection (TUR) syndrome, blood transfusion, clot retention, and urethral strictures. An economic analysis was subsequently undertaken from the UK National Health Service hospital perspective with costs and resource use data from published sources. Evidence synthesisThe SR identified 15 good-quality RCTs, of which 11 were used to inform the meta-analysis. TURis was associated with improved safety versus M-TURP, eliminating the risk of TUR syndrome and reducing the risk of blood transfusion and clot retention (relative risks: 0.34 and 0.43, respectively; p<0.05). TURis also reduced hospital stay (mean difference: 0.56 d; p<0.0001). The economic analysis indicated potential cost savings with TURis versus M-TURP of up to £204 per patient, with incremental equipment costs offset by savings from reduced hospital stay and fewer complications. ConclusionsThe TURis system is associated with significant improvements in perioperative safety compared with M-TURP while ensuring equivalent clinical outcomes of prostate resection. The safety benefits identified may translate into cost savings for UK health services. Patient summaryOur review of bipolar transurethral resection in saline, the new prostate resection technique, indicates that it offers equal efficacy while reducing complications and length of hospital stay.

Биполярная трансуретральная резекция в физиологическом растворе при осложненных формах доброкачественной гиперплазии предстательной железы

Биполярная трансуретральная резекция в физиологическом растворе при осложненных формах доброкачественной гиперплазии предстательной железы

The TURis System for Transurethral Resection of the Prostate: A NICE Medical Technology Guidance.

The transurethral resection in saline (TURis) system was notified by the company Olympus Medical to the National Institute of Health and Care Excellence’s (NICE’s) Medical Technologies Evaluation Programme. Following selection for medical technologies guidance, the company developed a submission of clinical and economic evidence for evaluation. TURis is a bipolar surgical system for treating men with lower urinary tract symptoms due to benign prostatic enlargement. The comparator is any monopolar transurethral resection of the prostate (mTURP) system. Cedar, a collaboration between Cardiff and Vale University Health Board, Cardiff University and Swansea University in the UK, acted as an External Assessment Centre (EAC) for NICE to independently critique the company’s submission of evidence. Eight randomised trials provided evidence for TURis, demonstrating efficacy equivalent to that of mTURP for improvement of symptoms. The company presented meta-analyses of key outcome measures, and the EAC made methodological modifications in response to the heterogeneity of the trial data. The EAC analysis found that TURis substantially reduced the relative risks of transurethral resection syndrome (relative risk 0.18 [95 % confidence interval 0.05–0.62]) and blood transfusion (relative risk 0.35 [95 % confidence interval 0.19–0.65]). The company provided a de novo economic model comparing TURis with mTURP. The EAC critiqued the model methodology and made modifications. This found TURis to be cost saving at £70.55 per case for existing Olympus customers and cost incurring at £19.80 per case for non-Olympus customers. When an additional scenario based on the only available data on readmission (due to any cause) from a single trial was modelled, the estimated cost saving per case was £375.02 for existing users of Olympus electrosurgery equipment and £284.66 per case when new Olympus equipment would need to be purchased. Meta-analysis of eight randomised trials showed that TURis is associated with a statistically significantly reduced risk of transurethral resection syndrome and a reduced need for blood transfusion—two factors that may drive cost saving for the National Health Service. The clinical data are equivocal as to whether TURis shortens the hospital stay. Limited data from a single study suggest that TURis may reduce the rate of readmission after surgery. The NICE guidance supports adoption of the TURis technology for performing transurethral resection of the prostate in men with lower urinary tract symptoms due to benign prostatic enlargement.

Bipolar Vaporization, Resection, and Enucleation Versus Open Prostatectomy: Optimal Treatment Alternatives in Large Prostate Cases?

The study compared the transurethral resection in saline (TURis), transurethral vaporization in saline (TUVis), bipolar plasma enucleation of the prostate (BPEP), and open prostatectomy (OP) in a single-center, prospective, randomized controlled clinical setting exclusively involving large prostate patients. During a 4½ year enrollment period, 320 cases of prostate volume over 80 mL, maximum flow rate (Qmax) below 10 mL/second, International Prostate Symptom Score (IPSS) over 19, or urinary retention were included in the trial and equally randomized in the four study arms. Patients were assessed preoperatively as well as at the 1-, 3-, 6-, and 12-month follow-up checkups using the IPSS, quality of life (QoL) score, Qmax, postvoiding residual urinary volume (PVR), and prostate-specific antigen (PSA). Similar preoperative parameters were established in the four series. OP and BPEP were characterized by resembling operating times, while TURis and TUVis displayed prolonged surgical durations. TURis emphasized a substantially decreased mean resected tissue weight. TUVis showed the lowest mean hemoglobin level drop, followed by TURis and BPEP (equivalent results) and finally OP (highest bleeding). OP described the longest mean catheterization period and hospital stay, followed by TURis, and afterward by TUVis and BPEP (similar data). During the follow-up period, statistically equivalent IPSS, QoL, Qmax, and PVR outcomes were established for OP, BPEP, and TURis. TUVis displayed significantly smaller Qmax improvements, but similar other functional features. Significantly lower mean PSA levels were determined secondary to OP and BPEP when compared to bipolar resection and subsequently to vaporization. OP and BPEP emphasized the highest surgical efficiency (prolonged postoperative recovery for OP), while TUVis displayed the lowest hemorrhagic risks. On the medium term, generally resembling functional outcomes were determined for the four techniques, with significantly decreased mean PSA values secondary to OP and BPEP.

Comparison of outpatient versus inpatient transurethral prostate resection for benign prostatic hyperplasia: Comparative, prospective bi-center study.

We compare the symptomatic relief with urodynamic parameter change and operative safety of the outpatient transurethral resection in saline (TURIS-V) technique with inpatient transurethral resection of the prostate (TURP) for the management of benign prostatic hyperplasia (BPH). This prospective cohort comparison study enrolled patients who needed BPH surgery. Between January 2010 and June 2011, outpatient TURIS-V was performed at 1 centre and the results of the treatment were compared with inpatient TURP performed at a separate hospital. Preoperative characteristics, including prostate volume, were similar in both groups. Perioperative data and any treatment complications were recorded. The analysis compared postoperative outcomes, including a 6-month postoperative International Prostate Symptom Score (IPSS), a quality of life (QoL) evaluation and a record of any changes in uroflowmetry findings, between the 2 groups. In the TURIS-V patient group, 75 patients agreed to be in the study. Of these, 69 ultimately complete the study. In the TURP group, 76 patients agreed and 71 of these completed the study. Both study groups were well-matched for age, IPSS, QoL and uroflowmetry findings. The TURIS-V group experienced both shorter operation times (54.6 vs. 74.8 minutes) and shorter catheterization times (2.2 vs. 4.2 days) when compared to the TURP group. There were comparable improvements in the 6-month postoperative IPSS, QoL, and uroflowmetry findings between the 2 groups. There were also equally low incidence rates of procedural complications. Both TURIS-V and TURP relieve lower urinary tract symptoms in a similar way, with great efficacy and safety. Overall, TURIS-V had shorter operative and catheterization times compared to TURP. Notwithstanding the paper's limitations (non- randomized cohort comparison with possible selection or surgeon bias and small heterogeneous sample size), TURIS-V can be performed safely even in an outpatient setting.

A prospective study comparing bipolar endoscopic enucleation of prostate with bipolar transurethral resection in saline for management of symptomatic benign prostate enlargement larger than 70 g in a matched cohort

This study aims to compare the efficacy and safety of bipolar endoscopic enucleation of prostate with transurethral resection in saline for large BPE greater than 70 g. All patients from two urology centres who had bipolar enucleation or bipolar resection performed for large BPE greater than 70 g from December 2008 to April 2012 were prospectively assessed. The pre-operative and post-operative measures included IPSS, QOL score, uroflowmetry results, PSA and prostate volume. The perioperative measures were compared, and the post-operative complications/resumption of medical treatment for lower urinary tract symptoms were also assessed. There were 74 and 86 consecutive patients with bipolar enucleation and bipolar resection performed, respectively. No difference in pre-operative characteristics was observed between the two groups with mean prostate size 115 cc in each group. Comparing bipolar enucleation with bipolar resection, there was longer operative time (156 vs 87 min, p = 0.000), more haemoglobin drop (1.8 vs 1.1 g/dL, p = 0.006), but more prostate tissue resected (61.4 vs 45.7 g, p = 0.000). There was no difference in overall transfusion requirement and hospital stay. At 12 month after the procedure, patients with bipolar enucleation performed had better IPSS (6.4 vs 11.6, p = 0.032), QOL (1.7 vs 2.6, p = 0.040) and peak flow rate (19.5 vs 15.1 ml/s, p = 0.019). The post-operative complications had no significant difference between the two groups. For surgical treatment of big BPE, bipolar endoscopic enucleation of prostate provided superior functional outcome than bipolar resection but required longer operative time.

1965 THREE-YEAR PROSPECTIVE, RANDOMIZED COMPARISON OF THE BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE, MONOPOLAR AND BIPOLAR RESECTION IN MEDIUM SIZE BPH PATIENTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (I)1 Apr 20131965 THREE-YEAR PROSPECTIVE, RANDOMIZED COMPARISON OF THE BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE, MONOPOLAR AND BIPOLAR RESECTION IN MEDIUM SIZE BPH PATIENTS Bogdan Geavlete, Razvan Multescu, Georgescu Dragos, Florin Stanescu, Marian Jecu, Cristian Moldoveanu, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete Bucharest, Romania More articles by this author , Razvan MultescuRazvan Multescu Bucharest, Romania More articles by this author , Georgescu DragosGeorgescu Dragos Bucharest, Romania More articles by this author , Florin StanescuFlorin Stanescu Bucharest, Romania More articles by this author , Marian JecuMarian Jecu Bucharest, Romania More articles by this author , Cristian MoldoveanuCristian Moldoveanu Bucharest, Romania More articles by this author , and Petrisor GeavletePetrisor Geavlete Bucharest, Romania More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2384AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A prospective, long term, randomized trial was performed aiming to compare the bipolar plasma vaporization of the prostate (BPVP), the bipolar transurethral resection in saline (TURis) and the monopolar transurethral resection of the prostate (TURP) concerning the surgical efficacy, complication rate and follow-up results. METHODS A total of 510 benign prostatic hyperplasia (BPH) patients with prostate volume between 30 and 80 mL, maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19 were included in the trial. All cases were evaluated preoperatively as well as at 6 months' intervals after surgery by IPSS, Qmax, quality of life score (QoL), post-voiding residual urinary volume (PVR), postoperative prostate volume and PSA level. RESULTS The mean operation time (39.7 versus 52.1 and 55.6 minutes), catheterization period (23.5 versus 46.3 and 72.8 hours) and hospital stay (1.9 versus 3.1 and 4.2 days) were significantly shorter for BPVP patients. The mean hemoglobin drop (0.5 versus 1.2 and 1.6 g/dL), intraoperative bleeding (1.8% versus 8.2% and 13.5%) and capsular perforation (1.2% versus 7.1% and 9.4%) rates were significantly reduced in the BPVP series. The rate of early irritative symptoms was statistically similar in the 3 study arms (12.4% versus 11.2% and 10.6%, respectively). In the BPVP and TURis groups, significantly lower postoperative hematuria (2.9% and 4.7% versus 15.3%) and blood transfusion (1.2% and 1.8% versus 6.5%) rates were determined. During the long term follow-up, BPVP patients emphasized significantly superior parameters concerning IPSS and Qmax. On the other hand, the three-year evaluation protocol described statistically similar QoL score, PVR values, PSA level and the postoperative prostate volume in the 3 series of patients. CONCLUSIONS BPVP displayed superior surgical efficacy, reduced perioperative morbidity and faster postoperative recovery when compared to TURis and TURP. During the long term follow-up, the method provided significantly improved parameters regarding the symptom scores and voiding characteristics and similar BPH tissue removal capabilities. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e806-e807 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Geavlete Bucharest, Romania More articles by this author Razvan Multescu Bucharest, Romania More articles by this author Georgescu Dragos Bucharest, Romania More articles by this author Florin Stanescu Bucharest, Romania More articles by this author Marian Jecu Bucharest, Romania More articles by this author Cristian Moldoveanu Bucharest, Romania More articles by this author Petrisor Geavlete Bucharest, Romania More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Prospective, Randomized Clinical Trial Comparing Plasmakinetic Resection of the Prostate with Holmium Laser Enucleation of the Prostate Based on a 2-Year Followup

We compared plasmakinetic resection with holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia by analyzing 2-year followup data from a prospective randomized clinical trial. A total of 280 patients were randomly treated with plasmakinetic resection or holmium laser enucleation of the prostate. Perioperative and postoperative outcome data were obtained during a 2-year followup. No significant differences between the 2 surgical groups were observed in the preoperative data. Both groups displayed significant improvements after surgery. However, we identified no significant differences between the 2 groups in the 2-year followup data for I-PSS (International Prostate Symptom Score), quality of life scores or maximum flow rate values. Patients in the holmium laser enucleation group displayed a lower risk of hemorrhage, shorter bladder irrigation and catheter times, and shorter hospital stays. A larger amount of prostate tissue was retrieved in the holmium laser enucleation group, but the operation time was longer for this group than for the plasmakinetic resection group. Plasmakinetic resection and holmium laser enucleation of the prostate are effective and safe treatments for benign prostatic hyperplasia. Holmium laser enucleation of the prostate can be applied to prostates of all sizes, and involves less risk of hemorrhage, decreased bladder irrigation and catheter times, as well as reduced hospital stay. Thus, we believe holmium laser enucleation of the prostate should be proposed as a potential new gold standard surgical therapy instead of transurethral resection of the prostate for patients with benign prostatic hyperplasia.

Comparison of transurethral enucleation with bipolar and transurethral resection in saline for managing benign prostatic hyperplasia

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Transurethral enucleation with bipolar (TUEB) has been widely adopted as an alternative to standard TURP, although the surgical technique, efficacy and safety of TUEB have not been described so far. The present study provides illustrations of the TUEB technique, as well as peri-operative, 6-month and 12-month follow-up results of TUEB from a retrospective review of a single-institution experience comparing the efficacy and safety of TUEB and transurethral resection in saline for managing BPH. • To illustrate the transurethral enucleation with bipolar (TUEB) technique and compare the efficacy and safety of TUEB and transurethral resection in saline (TURis) for managing benign prostatic hyperplasia (BPH). • A retrospective review of a single-institution experience of 110 consecutive TUEB or TURis between 2008 and 2011 at our hospital was performed aiming to compare the efficacy and safety of TUEB and TURis for managing BPH (55 patients in each group). • Peri-operative data included operating time, resected tissue weight, changes in haemoglobin, duration of catheterization, hospital stay and early complications. • Postoperative outcomes included 6- and 12-month postoperative International Prostate Symptom Score (IPSS), and Quality of Life (QoL) score, uroflowmetry findings, change in serum prostate-specific antigen level and all late complications in the two groups. • Both groups were well matched for age, preoperative prostate volume, IPSS, QoL and uroflowmetry findings. • The change in haemoglobin at postoperative day 1 in the TUEB group was significantly less than in the TURis group (1.08 vs 1.60 g/dL; P < 0.001). • Catheterization time and hospital stay were significantly shorter in the TUEB group than in the TURis group and the mean retrieved tissue weight in the TUEB group was larger than that in the TURis group (41.3 vs 31.7 g; P = 0.007). • Patients in the two arms had comparable improvements in postoperative IPSS, QoL, maximum flow rate and postvoid residual urine volume. • The rates of complications were equally low with each procedure. • TUEB is superior to TURis, with less bleeding, as well as decreased catheter time and hospital stay, although showing equivalent efficacy at 12 months of follow-up.