Completeness and efficiency of prostate tissue removal: loop resection compared with a new operative technique of transurethral electrovaporization

Abstract

Objective To compare the completeness and eBciencyResults There was no diCerence in the reduction in TRUS-PV at 3 months (23.9 cm3 vs 21.45 cm3, of the removal of prostatic adenomatous tissue between transurethral resection (TURP) and a new P<0.9), or in the operative duration (45 min vs 52.5 min, P<0.2), between TURP and TUEVAP, operative technique of electrovaporization (TUEVAP) using a modified roller electrode.respectively. The TRUS-PV of tissue removed exceeded the actual dry resected weight after TURP (15 g) by a Patients and methods In a prospective double-blind study, patients with moderate to severe lower urinary factor of 1.59. After applying this factor to the TRUS-PV reduction for the TUEVAP group, the calcutract symptoms and objective evidence of obstruction, were randomized to undergo either TURP (using a lated dry weight of tissue removed for this group was 13.49 g (P<0.55); the diCerence in tissue removal standard cutting-wire loop) or TUEVAP (performed with a new operative technique and the spiked-bar rate by TRUS criteria was 0.48 cm3/min vs 0.37 cm3/min (P<0.15). electrode). The prostate volume measured using transrectal ultrasonography (TRUS-PV) was used toConclusions These data suggest an equivalent completeness of removal of adenomatous prostate tissue assess the completeness of tissue clearance after treatment. Results were compared using group median between TURP and TUEVAP. The eBciency of tissue removal for TUEVAP was slightly less than that of values. For the TURP group, the TRUS-PV estimate of tissue removed was divided by the dry resected weight regular loop resection, but this diCerence was not statistically significant. These results are specific to the to derive a correction factor for any discrepancy between the values. This factor was applied to the combination of electrode, electrosurgical unit and operative technique used in this study, and may diCer TRUS-PV reduction in the TUEVAP group (where there was no tissue to be weighed) to estimate the actual if any of these variables are altered.

Randomised evaluation of alternative electrosurgical modalities to treat bladder outflow obstruction in men with benign prostatic hyperplasia

“…There is therefore little to be gained from the routine measurement of prostate size reduction after surgery, although it may be that tissue removal might predict longevity of effect. 37 In order to examine this hypothesis further, accurate measurement of prostate volume pre-and postoperatively is required. Prostate volume can be measured in a number of ways, including ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).…”

Is Transurethral Vaporesection of the Prostate Better Than Standard Transurethral Resection?

“…This technique has been shown to reduce blood loss, postoperative catheter time and hospital stay while operative time is longer compared to standard TURP [6, 7, 8]. However, there is no cutting and removal of tissue with TVP/TUEVP and thereby histological examination is not possible, although a completeness of adenomatous tissue removal almost equivalent to TURP has been reported [9]. However, the technique is somewhat difficult in larger prostates >50 g and ‘sandwich techniques’ (combining TVP with conventional TURP) have been advocated to solve this problem [10].…”

Transurethral electrovaporization and vapour‐resection of the prostate: an appraisal of possible electrosurgical alternatives to regular loop resection

“…These tags are a nuisance, for once created they are dif®cult to engage for subsequent vaporization and attempts to do so at the apex can risk sphincter damage from inadvertent electrode contact. Gallucci et al [16] recommended switching to a regular loop to remove apical tissue. Our alternative to leaving apical tissue untreated or using two separate electrodes is to modify the operative technique at the apex using à spot-vaporization' technique.…”

“…In our studies, prostate size was unrestricted and patients were strati®ed for prostate volume before randomization. We also developed a new operative technique for TUEVAP, different from the technique of TURP [16], and used a computer-controlled electrosurgical generator (Valleylab Force FX) which allowed the use of equivalent power settings for TURP and TUEVAP (130±180 W). There was no difference in operative duration (probably as a result of using an impedance-independent generator with¯at power curves, compared to one in which the power output decreases with increasing impedance, .…”