Comparative Study between Residual Prostatic Tissue Size after Bipolar Vaporization of The Prostate versus Transurethral Resection of Prostate in Saline

摘要

Objective: To compare the outcomes of plasmakinetic vaporization of the prostate (PKVP) with transurethral resection of the prostate in saline (TURis), mainly residual prostatic tissue size after 3 months . Materials and Methods: In a randomized controlled trials, 30 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent PKVP (N = 15) and TURis (N = 15) between 2017-2018. The inclusion criteria were age between 40 and 80 who were indicated and scheduled for prostatectomy, prostate volume of 30-90 ml, serum prostate specific antigen (PSA) 4 or free/total PSA 0.25, if total PSA between 4 and 10, IPSS (The International Prostate Symptom Score) 20, Qmax 10 mL/s, and failed BPH-related medical therapy. Exclusion criteria were abnormal digital rectal exam (DRE) or ultrasonography with suspicion of prostate cancer, history of prostate cancer, bladder cancer, serum PSA 10 ng/ml or free/total PSA ratio 0.25 if total PSA between 4 and 10, previous urethral or prostate surgery, urethral stricture, neurogenic bladder, bladder calculi, BPH-related hydronephrosis, preoperative hematuria due to any local or general cause, anticoagulant therapy or coagulation disorders. The perioperative and postoperative outcomes were evaluated and the residual prostatic tissue size, IPSS and Qmax were assessed preoperatively and 3 months after procedure in all cases. Results: Both groups were nearly similar in patient age, prostate volume, preoperative IPSS, Qmax, hospital stay and catheterization period. The PKVP group had significantly higher mean values of operative time, IPSS. Modified Clavien classification of complications was used to assess complications. No significant changes were seen between the two groups regarding complications (PKVP = 20%; TURis = 26.7%), no cases of TUR syndrome, obturator reflex, urethral stricture, clot retention or epididymitis occurred in both groups. In the transurethral resection in saline (TURis) group, 2 cases were presented by acute retention 2 weeks postoperative, only one case presented with mild to moderate dysuria 1 month post-operative, resolving with anti-inflammatory medication, mild hematuria was seen in 1 case 2 weeks postoperative. In plasma vaporization group, 1 patient had urinary retention which needed catheterization, urinary tract infection and significant bacteriuria occurred in one case which was treated by antibiotics and a mild to moderate dysuria after 1 month was seen in one case. Three months after surgery, two groups had significant improvement in IPSS (more in TURis group), post voiding volume, serum PSA, and mainly in residual prostatic tissue size. Conclusions: Bipolar electrosurgical technology is a promising modality for surgical treatment of BPH. Regarding bipolar prostatic surgeries we can conclude the following: No significant difference between bipolar plasma vaporization and TURis regarding residual prostatic tissue size, no TUR syndrome, less blood loss especially in vaporization technique, more easy learning curve either in vaporization technique or resection technique (no fear of TUR syndrome so time factor isn't an issue) enabling the surgeon to work slowly and to do adequate hemostasis, vaporization technique is ideal modality for high risk patients (multiple co morbidities, bleeding tendency and patient on anticoagulants). Large prostate volume can be treated either by resection or vaporization technique). We can conclude that the bipolar plasmakinetic energy will be the gold standard in surgical management of BPH in the near future if it not yet.