Transurethral Resection in Saline and Plasma Vaporization of the Prostate: Clinical Evaluation of Safety and Short-term Results
Dan Vasile Stanca, Mihaly Zoltan Attila, Andrei Boc, Ionut Juravle, Sergiu Nicolescu, Ioan Coman
EndoPlus Urological Clinic Cluj-Napoca, Romania
Introduction and Objective
The morbidity of transurethral resection of the prostate necessitates constant attempts at modifications of the standard equipment and technique. We evaluated our results with transurethral resection in saline and bipolar plasma electro vaporization of the prostate (TURIS-PVP) for treatment of bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH).
Material and Methods
Between January and December 2012 TURIS-PVP was performed in 123 men with BOO due to BPH. The preoperative investigation protocol included digital rectal examination (DRE), prostatic specific antigen (PSA), International Prostate Symptom Score (IPSS), quality of life (QoL) score and abdominal ultrasonography assessing prostate volume and post-voiding residual urinary volume (PVR). The patients were evaluated 6 weeks after surgery using IPSS, QoL and PVR. We recorded the necessity of blood transfusion and early complications.
The median age of the patients was 65.5 years (51-82 years, SD 7.28). The average BPH size was 62 ml, the mean operating time was 75 minutes (35-150 minutes, SD 23.2). The majority of the patients were discharged after 24 hours (34%) or 36 hours (56%). The rest were discharged at 3 or four days (6 and 4% respectively). The catheterization time was 7 days (the catheter was removed at the same visit when the pathological result of the resected tissue was obtained and communicated to the patient). Preoperatively, the mean value of IPSS was 19, the mean QoL score was 4, the mean RV was 80 ml. Twenty patients were on chronic bladder catheterization. During the interventions 5 patients required blood transfusions; there were no other significant intraoperative complications. Postoperatively one patient required re-catheterization for 7 days. We recorded 15 patients with mild early postoperative urinary incontinence (4 patients still incontinent at 6 weeks). The mean postoperative IPSS score was 7 and the mean PVR 10 ml.
The transurethral resection in saline and bipolar plasma electro vaporization of the prostate is a safe and effective treatment for BOO due to BPH. The intraoperative and early postoperative complications rate is very low. The procedure has a fast postoperative recovery time, good short-term functional outcome and good haemostatic efficiency. The main postoperative complication was early urinary incontinence, with a tendency to spontaneous cure in the following weeks.