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Bipolar vaporization of the prostate may cause higher complication rates compared to bipolar loop resection: a randomized prospective trial

  • Urology - Original Paper
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Abstract

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.

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Authors and Affiliations

  1. Urology Department, Benha University, Benha, Egypt

    Osama Abdelwahab

  2. Urology and Andrology Department, Elaj Medical Centers, Jeddah, Saudi Arabia

    Mohamed Habous

  3. Urology Department, Menoufia University, Al Minufya, Egypt

    Mohammed Aziz & Mohammed Sultan

  4. Urology Department, Al-Azhar Faculty of Medicine, Assiut, Egypt

    Mohammed Farag

  5. Detroit Medical Center, Michigan State University, Detroit, USA

    Richard Santucci

  6. Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, PO Box 36175, Riyadh, 11419, Saudi Arabia

    Saleh Binsaleh

Authors
  1. Osama Abdelwahab
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  2. Mohamed Habous
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  3. Mohammed Aziz
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  4. Mohammed Sultan
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  5. Mohammed Farag
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  6. Richard Santucci
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  7. Saleh Binsaleh
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Corresponding author

Correspondence to Saleh Binsaleh.

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All authors declare that there are no competing financial interests.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in this study.

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Abdelwahab, O., Habous, M., Aziz, M. et al. Bipolar vaporization of the prostate may cause higher complication rates compared to bipolar loop resection: a randomized prospective trial. Int Urol Nephrol 51, 2143–2148 (2019). https://doi.org/10.1007/s11255-019-02280-5

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  • DOI: https://doi.org/10.1007/s11255-019-02280-5

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