Introduction Transurethral resection of the prostate (TURP) by resection loop or vaporization button is becoming a standard
of care due to its better safety profile (less bleeding and less incidence of TUR syndrome). However, there are published
data showing bipolar vaporization may be associated with increased late complications. In this study, we compared results
of bipolar TURP using the resection loop versus vaporization button for treatment of benign prostatic hyperplasia (BPH) to
determine the relative safety profile.
Patients and methods Between January 2013 and March 2014, 89 patients with BPH were randomized to surgical intervention
either by Olympus (Gyrus) Bipolar loop TURP or Olympus (Gyrus) Bipolar button vaporization. Inclusion criteria were;
BPH with Q-max < 10 ml/s, IPSS > 18 and prostate volume > 40 g. All patients were evaluated preoperatively and at 1, 3
and 9 months. Evaluation included IPSS, uroflowmetry, prostate volume by ultrasound. Clavien complications and operative
time were recorded. Statistical analysis was done using Statistical Package of Social Science (SPSS) version 17 software.
Results 44 patients were included in bipolar TURP and 45 patients in vaporization arm. Preoperative mean prostate volume
(59 g versus 58 g, p = 0.52) and mean IPSS (19 versus 20, p = 0.38) were equivalent in both groups. Vaporization was associated
with a significant increase in operative time (mean of 81 ± 15 min range 40–110 versus 55 ± 10 min range 30–70 min,
p < 0.001), less blood loss (0.8% versus 2.0% drop in hemoglobin, p < 0.001) but increased postoperative urinary frequency
(80% versus 50%, p < 0.001), hematuria with clots up to 4 weeks post surgery (20% versus 2%, p < 0.001) and postoperative
urethral stricture (11% versus 0%, p < 0.001). Both techniques improved urine flow with Q-max (17 ml/s versus 18 ml/s
p = 0.22). Prostate volume (32 g versus 31 g, p = 0.31) and IPSS (6 versus 5, p = 0.22), were comparable in both treatment
arms.
Conclusions Bipolar vaporization of the prostate, despite being a technically robust, speedy and with less intraoperative
bleeding, appears to be associated with increased postoperative irritative symptoms, increased late-onset postoperative
bleeding and high urethral stricture rates. |
