Efficacy of Transurethral Electrovaporization of the Prostate with Respect to Standard Transurethral Resection

Abstract

Transurethral electrovaporization of the prostate (TVP) has been introduced as an alternative to standard transurethral resection of the prostate (TURP) with lesser morbidity. However, the efficacy of this new technique has not been well known. To compare the results of standard TURP and TVP, 76 patients with symptomatic benign prostatic hyperplasia (BFH) were divided into two groups in a randomized clinical trial. Preoperative assessment included AUA Symptom score, maximum flow rates (Qmax), digital rectal examination, serum prostate specific antigen, and transrectal ultrasonography, with biopsy if the patient was randomized to vaporization. Transrectal temperature measurements and the hemoglobin concentration of the irrigation fluid were investigated in all the patients during the procedure. Although the transrectal temperature was higher in the TVP group (0.53-1.27 degrees C; mean 0.83 degrees C), no associated complication were determined. However, blood loss was significantly lesser than with TURP (340 mL v 60 mL). Two patients in the TURP group required blood transfusions, and one had sphincteric incontinence, whereas one postoperative retention, one reoperation with bladder perforation, and one sphincteric incontinence were seen in the TVP group. On the other hand, 12-month follow-up demonstrated that the uroflow rates improved in a similar manner. The Qmax increased in the TURP and TVP groups from 8.8 and 8.3 mL/sec to 19.6 and 17.2 mL/sec, respectively. The mean AUA Symptom Score decreased from 13.7 to 7.9 and 6.1 at 6 and 12 months, respectively. In the TVP group and from 14.6 to 7.3 and 7.0 at 6 and 12 months, respectively, in the TURP group. There were significant differences in the mean catheterization time (P < 0.0001) and hospital stay (P < 0.0001) in favor of TVP. Our results suggest that TVP is a safe and effective alternative treatment for symptomatic BPH.

Transurethral electrovaporization of the prostate (TUVP) is effective, safe and durable

“…16 Long-term prospective randomized trials on TUVP vs TURP We reviewed six prospective randomized trials (PRT) comparing TUVP to TURP, which have reached 1 year follow-up. [17][18][19][20][21][22] The dial power settings for vaporization, types of electrodes and electrosurgical generators for these studies are summarized in Table 1.…”

“…Perioperative bleeding and fluid absorption (Table 2) In all the PRT reviewed comparing TUVP to TURP, [17][18][19][20][21][22] there was a significant decrease in blood loss in the vaporized patients compared to the resected patients.…”

“…TUR syndrome, reported to range between 0.5% in the UK NPA 3 and 2% in AHCPR 2 after TURP, has not yet been reported after TUVP. 9,[17][18][19][20][21][22]24 This suggests less fluid absorption during prostatic vaporization. In a prospective randomized trial comparing TUVP (15 patients) to TURP (15 patients) using 1.5% glycine labelled with 1% ethanol irrigating solution during the operation, Cetinkaya et al 25 found that at the end of surgery, the mean fluid absorption during TUVP was significantly less than during TURP (TUVP: 672 ml vs TURP: 1347 ml, Po0.05).…”

“…Cetinkaya et al 20 irrigated their TUVP patients with a mean of 16 l. The rest of the PRT studies did not mention whether their TUVP patients required postoperative irrigation. 18,19,21,22 Catheterization time and hospital stay ( Table 2) All six PRT prostate vaporization studies [17][18][19][20][21][22] were associated with significantly shorter catheterization time (mean 30 h) and consequently shorter hospital stays (mean 1.4 days) compared to TURP patients (61 h and 3.4 days respectively). Catheterization time in large TURP studies varies between a mean of 3 days 4 and 4 days.…”

“…17,18 Postoperative irritative symptoms (Table 2) Postoperative irritative symptoms after TUVP were variable in incidence. 17,18,21,22 Three of these studies 18,21,22 suggested that irritative symptoms were slightly more common postoperatively in the vaporized groups. However, most studies commented that these symptoms were of short duration and self-limiting, hence easily managed.…”