Benign prostatic hyperplasia (BPH) is the most common nonmalignant disorder of the prostate, affecting more than 50% of the aging male population. (Gianni et al., 2007).
For several decades, transurethral resection of prostate (TURP) was viewed as the most common surgical intervention for lower urinary tract symptoms due to benign prostatic enlargement. (Marteinsson., 2002).
However, the Agency for Health Care Policy and Research Review (AHCPR) reported that TURP was associated with a morbidity rate of 7% to 43%. The major morbidities are perioperative bleeding, transurethral-resection syndrome, urinary incontinence, retrograde ejaculation, infection, and erectile dysfunction. TURP has well-documented complications, with an inpatient rate of 10% and a mortality rate of 0.2%.
Additionally, the relatively long hospital stay associated with the TURP operation adds to its cost. ( Ehab RT., 2009).
Although significant technical improvements in TURP during the past 15 years have reduced intra- and postoperative adverse events, there are still concerns regarding complications, such as transurethral resection (TUR) syndrome, bleeding, and urethral strictures. A prospective multicenter study on 10654 patients with BPH treated with TURP showed that mortality has decreased (0.1%) but that morbidity, although reduced, continues to be high (11.1%) (Reich et al., 2008).
The most significant recent technical modification of TURP is the incorporation of bipolar technology. Bipolar TURP (B-TURP) addresses a fundamental of monopolar TURP (M-TURP) by allowing performance in normal saline, and the technique seems to be promising (Mamoulakis et al., 2009).
A bipolar vaporization technique was developed recently. It derives from plasmakinetic bipolar resection of the prostate and utilizes well-known electrical principles. (Reich et al., 2010).
This innovative feature produces important advantages. For one thing, the sodium chloride solution is better tolerated by the patient’s body and the risk of TUR syndrome, a main complication of conventional TUR-P, is significantly reduced. Second, the high-frequency current employed reduces tissue denaturation to a minimum because the current is not discharged through the patient plate, but the resectoscope and electrode themselves function as the neutral electrode that completes the circuit. The current flows locally and controlled, thereby reducing leakage current by 70% as compared to monopolar resection. This means that irritation of the obturator nerve and denaturation of surrounding tissue is diminished significantly, whilst showing a demonstrable reduction of the risk of postoperative complications (EUT Congress news, 2009).
In a study led by Ning Hong Chan,2008; plasma vaporization of the prostate produced very good treatment results that were comparable with those of open prostatectomy even in patients with large-volume prostates (> 100 g). In the plasma vaporization group, the mean pre-interventional prostate size of 119.3 g was reduced by 49%. In the prostatectomy group, the mean size was 122.5 g, with an 82% reduction being achieved.
The bipolar-guided high-frequency current surrounding the electrode generates a high-energy plasma field. First, this causes the isotonic irrigation fluid to vaporize and form a thin vapor pocket over the tissue. The electrode glides over this pocket in what is called the hovering technique. Then, a short initial electrical impulse turns the gas into a constant plasma field by plasma ignition. The energy emitted by the plasma is directed at the first cell layers of the prostate tissue. There, the energy leads to locally circumscribed vaporization of unwanted tissue by gently dissolving the accumulation of cells. Thermal damage to the surrounding tissue – a problem with previous monopolar vaporization methods – is prevented. With plasma vaporization, heat penetrates about 0.2 mm into the tissue, a depth that is thus smaller than with monopolar standard TUR-P. In effect, this advanced plasma technology offers targeted and controlled vaporization of the upper tissue layers. Because virtually no heat is generated, the procedure is also referred to as “cold vaporization” (EUT Congress news, 2009).
Despite its innovative nature, the plasma vaporization electrode does not involve great expense for hospitals. The bipolar transurethral resection in saline (TURis) cutting electrodes can simply be replaced by the new vaporization electrode. Not only are the costs for the upgrade significantly lower than with standard laser vaporization procedures, but the costs for the single-use electrode are also lower. Alongside the low material costs, the procedure’s short learning curve adds to its excellent cost effectiveness. In contrast to other modern minimally invasive procedures, the technique is very similar to the commonly practiced standard TUR-P method and can be easily adapted. Extensive schooling and training phases are thereby eliminated. (EUT Congress news, 2009).
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