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POD04.02 A Prospective Randomized Study Between Transurethral Vaporisation Using Plasmakinetic Energy and Transurethral Resection of Prostate: 8 Years' Follow-Up
... The first monopolar transurethral resection of the prostate (M-TURP) was introduced in 1963 by Maximilian Sterm and remains the gold standard for surgical treatment of benign prostatic hyperplasia (BPH) 1 but still has some limitations, especially when prostate size is over 80 ml. 2,3 BPH can result in bleeding and transurethral resection of prostate (TURP) syndrome 4,5 with can cause serious complications. The bipolar TURP (B-TURP) was introduced to reduce the risk of TURP syndrome by using saline as the irrigation fluid but this does not reduce the risk of intra-operative bleeding, especially in surgery involving a large prostate gland. ...
Objective: To compare the result of bipolar transurethral enucleation and resection of the prostate with morcellation (B-TUERP-M) and without morcellation (B-TUERP) in treatment of benign prostatic hyperplasia. Materials and Methods: This was a prospective single centre cohort study of 101 patients with prostate enlargement of more than 60 ml who underwent B-TUERP by a single surgeon between January 2020 and June 2022. Patients were divided into two groups, a B-TUERP group of 49 patients and a second group of 52 patients classed as B-TUERP-M. The perioperative outcomes followed up at 1, 3 and 6 months after surgery were evaluated. Results: There were no significant differences in the preoperative parameters of the two groups. Comparisons between the two groups showed a shorter operative time (63.94 ± 12.01 vs 77.77 ± 11.80 min, p-value 0.000), more resected prostate tissue (65.73 ± 14.67 vs 60.73 ± 5.45 gm, p-value 0.027) and a higher post-operative hematocrit level (35.16 ± 3.97 vs 33.18 ± 3.22%, p-value 0.007) in the patients who underwent B-TUERP with morcellation. At 6 months after the procedure, better results were found in patients who had undergone B-TUERP-M regarding urine flow rate (26.33 ± 5.33 vs 20.66 ± 5.08 ml/sec, p-value 0.000), post-void residual urine volume (24.19 ± 10.93 vs 36.04 ± 16.90 ml, p-value 0.000), post-operative PSA (0.72 ± 0.43 vs 1.22 ± 0.54 mg/ml, p-value 0.000) and International Prostate Symptom Scores (5.01 ± 1.36 vs 5.71 ± 1.33, p-value 0.001). Conclusion: Better outcomes occurred following B-TUERP with morcellation with regard to operative time, resection weight of prostatic adenoma, post-operative urine flow rate, Post-void residual urine volume, PSA and International Prostate Symptom Score than in patients treated with B-TUERP without morcellation.
... To the present day, it remains the standard therapy for obstructive prostatic hypertrophy, and it is the surgical treatment of choice and the standard of care when other methods fail. TURP has long been the standard treatment, but it still has some limitations, especially when resection size is over 80 ml (2,3) , such as bleeding and transurethral resection of prostate (TURP) syndrome (4,5) which can cause serious complications. The bipolar TURP system was introduced to reduce the risk of TURP syndrome, but it does not reduce the risk of intra-operative bleeding, especially in large prostate glands (6)(7)(8) . ...
Objective: To evaluate the outcomes and safety of the surgical technique transurethral anatomical enucleation of prostate (TUAEP) in patients with prostatic hyperplasia for whom surgery was indicated. Materials and Methods: The authors conducted a retrospective pilot study and analyzed the medical records of 80 patients who underwent TUAEP by a single surgeon between December 2016 and January 2018 in the Minimally-Invasive Surgery (MIS)-Urology Department in Rajavithi Hospital. Only 40 cases had complete review data, and these were included in the present study. The authors analyzed International Prostate Symptom Score, quality of life score, peak flow rate, and post-void residual urine volume pre-operatively, and then 1, 3 and 6 months postoperatively. The TUERP operative time, enucleated tissue weight, catheterization time, and post-operative complications were recorded. Results: The participants' mean age was 70.90+5.55 years. There were statistically significant differences between mean preoperative and postoperative hemoglobin (13.36+1.49 and 12.42+1.57), and hematocrit (%) (41.13+3.54 and 38.73+4.41), p<0.01. Mean blood transfusion was 0.10+0.37 units, mean prostatic specific antigen (PSA) decreased from 7.50 (0.90 to 35.50) postoperatively (p<0.001) to PSA 1.13+0.78 ng/ml at 3 months postoperatively (p<0.02) and to PSA 1.54+0.78 ng/ml at 6 months postoperatively (p<0.01). Maximum flow rate (Qmax), post void residual urine (PVR), international prostatic symptoms score (I-PSS) and quality of life (QOL) score improved significantly immediately after surgery and continued to improve up to follow-up at 6 months (p = 0.01). At 6 months, mean Qmax had increased from 9.05 to 21.19 ml/sec (p<0.01) and mean PVR had decreased from 124.30 to 61 ml (p<0.03). Mean I-PSS improved from 17.82 to 1.54 (p<0.01) and mean QOL score improved from 3.97 to 0.92 (p<0.01). There were no serious complications or incidences of TURP syndrome in any patient in the present study. Conclusion: TUAEP is a true anatomical enucleation and seems to be the best modern alternative to transurethral resection of the prostate and open prostatectomy for bladder outlet obstruction caused by benign prostatic hyperplasia. The long-term results in terms of efficacy and safety need to be validated in further prospective randomized controlled studies.
We evaluated transurethral enucleation and resection of the prostate in patients with urinary symptoms due to benign prostatic hyperplasia using the Plasmakinetic™ system.
We retrospectively analyzed the records of 1,100 patients who underwent transurethral enucleation and resection of the prostate between January 2003 and February 2009 at our institution. We assessed the International Prostate Symptom Score, quality of life score, peak flow rate and post-void residual urine volume preoperatively, 1, 3, 6 and 12 months postoperatively, and yearly thereafter. Enucleation and resection time, enucleated tissue weight, catheterization time, hospital stay and long-term complications were recorded.
No patient had significant blood loss or signs of the transurethral resection syndrome. Mean±SD patient age was 66.7±7.3 years and mean followup was 4.3 years. Mean preoperative prostate weight was 67.7±12 gm (range 35 to 256), mean enucleation time was 15.5 minutes (range 10 to 38), mean resection time was 46 minutes (range 20 to 65) and mean resected tissue weight was 42.8±7.7 gm (range 23 to 219). Mean catheter time was 1.8±0.4 days and mean hospital stay was 5.3±2.3 days. Transurethral enucleation and resection of the prostate induced significant, pronounced, immediate and lasting improvement in the International Prostate Symptom Score, quality of life, maximum urinary flow and post-void residual urine volume. Postoperative complications included meatal stenosis in 9 cases, incontinence in 56, urethral stricture in 12 and bladder neck contracture in 10.
Transurethral enucleation and resection of the prostate appears to be the modern alternative to transurethral resection of the prostate and open prostatectomy for bladder outlet obstruction due to benign prostatic hyperplasia. It may be done in glands up to 250 gm.
To evaluate the long-term efficacy and safety of transurethral resection of bladder tumor (TURBT) with bipolar plasmakinetic energy.
We reviewed the records of 121 patients with superficial transitional cell carcinoma of the bladder treated at our institute. Bipolar TURBT with plasmakinetic energy was performed for diagnostic and therapeutic purposes in all patients. Resected tissue was examined by a pathologist who recorded the number of tumors, tumor size, tumor shape, location, grade, invasion of the muscularis propria, and presence of muscular invasion. The operating time, length of hospital stay, blood loss, and intraoperative and postoperative complications were recorded by a urologist. Follow-up was 3 to 5.5 years after operation.
The median age of the patients was 61 years; 41 patients had multiple tumors and 80 had single tumors. The mean tumor size was 1.9 cm in diameter. The tumor was located in the lateral wall of the bladder in 67 patients. The mean operative time was (25 +/- 16) minutes and the mean postoperative hospitalization period was 3 days. Three (2.5%) patients had hematuria requiring blood transfusion and 2 (1.7%) patients had bladder perforation. Adductor contraction was noted in 6 patients (4.9%), and urethral strictures occurred in 5 patients (4.1%).
Transurethral resection of bladder tumors with bipolar plasmakinetic energy is safe and effective in the treatment of superficial bladder tumors.
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