A retrospective analysis of transurethral vapor resection of the prostate versus transvesical prostatectomy for prostate greater than 50 ml

Abstract

We compared the safety and efficacy of transurethral vapor resection (TUVRP) and transvesical prostatectomy (TVP) for prostate > 50 ml in retrospective study. Ninety patients with urodynamic obstruction and prostate volume (PV) in range between 50 and 100 ml were analyzed according to the mode of operative treatment (TUVRP vs. TVP). Patients were assessed preoperatively and followed-up at 3 and 12 months postoperatively. All patients underwent general and urological standard evaluation before surgery, including urine analysis, urine culture, blood samples tests, with determination of PSA, DRE, abdominal and minor pelvis ultrasound (US), transrectal ultrasound (TRUS), maximal flow rate (Qmax), postvoid residual urine(PVR), and self assessment by International Prostate Symptom Score (IPSS) and Quality of Life Score (QoLS). Urethrocystoscopy was obligatory done before TUVRP. TRUS-guided biopsies of the prostate were performed in patients with PSA > 4 ng/ml, abnormal DRE, and/or suspicious echogenicity on TRUS. IPSS, QoLS, Qmax and PVR were obtained at each follow-up. Of 90 patients eligible to participate, 69 patients completed 12 months of follow-up (TUVRP, n=35; TVP, n=36). TUVRP procedure was not faster than TVP procedure (P=0.41); 43.6% and 84.8% of prostatic tissues were resected after TUVRP and TVP, respectively (P<0.001). In TVP group, IPSS, QoLS, Qmax and PVR volume were significantly better than those in TUVRP group at 3 and 12 months of followup. At 12 months postoperatively, IPSS improved 62.7% and 87.9% (P<0.001), QolS decrease by 41.9% and 71.9% (P<0.001), mean Qmax increased by 6.3 ml/s (102.0%) and 11.4 ml/s (230.2%) (P=0.001) and mean PVR volume decreased by 65.4 ml (70.5%) and 71.2 ml (88.6%) (P=0.001) in TUVRP and TVP ApstraktProvedena je retrospektivna analiza efikasnosti transuretralne vapor resekcije (TUVRP) i transvezikalne prostatektomije (TVP) kod prostata > 50 ml. Devedeset pacijenata sa znacima urodinamske opstrukcije i volumenom prostate (VP) između 50 i 100 mL, su analizirani u zavisnosti od metode operativnog tretmana (TUVRP prema TVP). Pacijenti su imali određivanje kliničkih parametara preoperativno i prilikom praćenja na 3 i 6 meseci postoperativno. Svi pacijenti su imalu opštu i standarnu urološku evaluaciju pre hirurškog lečenja uključujući analizu urina, urinokulturu, analizu krvi sa određivanjem PSA, rektalni pregled prostate (RT), ultrazvuk abdomena i male karlice (UZ), transrektalni ultrazvuk prostate (TRUZ), određivanje maksimalnog protoka urina (MPU), rezidualnog urina posle mokrenja (RU), Internacionalnog Prostata Simptom Skora (IPSS), i ocenu kvaliteta života (KŽ). Uretrocistoskopija je obavezno rađena pre TUVRP. TRUZ-vođena biopsija prostate je rađena kod pacijenata sa vrednostima PSA > 4 ng-ml, abnormalnim RT i/ili sumnjivim nalazom na TRUZ. IPSS, KŽ. MPU i RU su određivani pri svakoj kontroli. Od 90 pacijenata podesnih sa evaluaciju, 69 pacijenata je kompletiralo lečenje za period od 12 meseci (TUVRP, n = 35; PTV, n = 36). TUVRP procedura nije bila brža (P=0.41)...