Background and purpose
Bipolar plasma kinetic (BP) transurethral resection of prostate (TURP) has been proved to be a safe and effective treatment for benign prostatic enlargement (BPE). However, the role of bipolar TURP on large prostates over 100 g compared with open suprapubic prostatectomy (SP) in elderly patients (>65 years) has not ever been studied before.
Patients and methods
A retrospective analysis of patients’ medical records between 2007 and 2012 was performed. A total of 102 patients who underwent SP (n = 44) or BP-TURP [Gyrus Plasma Kinetic™ (Gyrus ACMI, USA)] (n = 58) for obstructive lower urinary tract symptoms due to BPE were included in this retrospective study. Inclusion criteria were age ≥65 years, prostate volume ≥100 g, International Prostate Symptom Score (IPSS) ≥18, and peak urinary flow rate (PFR) ≤15 ml/s. Exclusion criteria were urethral stricture, known history of neurogenic bladder due to neural disorders, previous prostate and/or urethral surgery, bladder stone, bladder cancer, and known prostate cancer. Operation time, hospitalization, and catheter removal times were noted. Patients were re-evaluated at postoperative 3rd and 12th months. Evaluated parameters were IPSS, quality of life (QoL), simplified International Index of Erectile Function-5 (IIEF-5), PFR, post-voiding residual urinary volume (PVR). Statistical significance was set at 0.05 and all tests were two-tailed.
Preoperative IPSS, PVR, IIEF-5, QoL, and prostate volume were not statistically significantly different between two groups except for PFR. Mean follow-up for BP-TURP and SP groups were 15.0 ± 5.8 (R: 11–38), 22.1 ± 11.2 (R: 11–59) months, respectively (p < 0.001). When compared with SP, mean catheter removal time (p < 0.001) and median hospitalization time (p < 0.001) were significantly shorter in BP-TURP group. However, mean operative time was significantly (p < 0.001) longer than SP group and also median resected material weight was significantly lower in the BP-TURP group (p < 0.001). IPSS, QoL, PFR, PVR, and IIEF-5 scores at postoperative 3rd and 12th month were not significantly different between the two groups (p > 0.05). Thirty-three patients had perioperative complications according to the modified Clavien–Dindo system. Thirteen patients (22.4 %) in BP-TURP group and 20 patients (45.4 %) in SP group had complications. In 12th month follow-up visit, four patients presented with urethral stricture, three patients (5.1 %) were in BP-TURP group, and one patient (2.3 %) in SP group (p = 0.455). All strictures were treated with internal urethrotomy.
BP-TURP is a safe and highly effective treatment modality for BPE in the elderly patients with prostate glands over 100 g. Clinical efficacy and postoperative 12th month’s results were similar to SP. Larger studies with longer follow-up are needed in order to confirm our findings.
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McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, Foster HE Jr, Gonzalez CM, Kaplan SA, Penson DF, Ulchaker JC, Wei JT (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185(5):1793–1803
Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50(5):969–979 (discussion 980)
Hon NH, Brathwaite D, Hussain Z, Ghiblawi S, Brace H, Hayne D, Coppinger SW (2006) A prospective, randomized trial comparing conventional transurethral prostate resection with PlasmaKinetic vaporization of the prostate: physiological changes, early complications and long-term followup. J Urol 176(1):205–209
Mebust WK, Holtgrewe HL, Cockett AT, Peters PC (2002) Transurethral prostatectomy: immediate and postoperative complications. a cooperative study of 13 participating institutions evaluating 3,885 patients,1989. J Urol 167(2 Pt 2):999–1003 (discussion 1004)
Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, Scarpa RM, de la Rosette JJ (2012) Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate. BJU Int 109(2):240–248
Mamoulakis C, Trompetter M, de la Rosette J (2009) Bipolar transurethral resection of the prostate: the ‘golden standard’ reclaims its leading position. Curr Opin Urol 19(1):26–32
Mendez-Probst CE, Nott L, Pautler SE, Razvi H (2011) A multicentre single-blind randomized controlled trial comparing bipolar and monopolar transurethral resection of the prostate. Can Urol Assoc J 5(6):385–389
Condie JD Jr, Cutherell L, Mian A (1999) Suprapubic prostatectomy for benign prostatic hyperplasia in rural Asia: 200 consecutive cases. Urology 54(6):1012–1016
Gratzke C, Schlenker B, Seitz M, Karl A, Hermanek P, Lack N, Stief CG, Reich O (2007) Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J Urol 177(4):1419–1422
Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58(3):384–397
McAllister WJ, Karim O, Plail RO, Samra DR, Steggall MJ, Yang Q, Fowler CG (2003) Transurethral electrovaporization of the prostate: Is it any better than conventional transurethral resection of the prostate? BJU Int 91(3):211–214
Giulianelli R, Brunori S, Gentile BC, Vincenti G, Nardoni S, Pisanti F, Shestani T, Mavilla L, Albanesi L, Attisani F, Mirabile G, Schettini M (2011) Comparative randomized study on the efficaciousness of treatment of BOO due to BPH in patients with prostate up to 100 gr by endoscopic gyrus prostate resection versus open prostatectomy. Preliminary data. Archivio italiano di urologia, andrologia: organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica/Associazione ricerche in urologia 83(2):88-94
Gupta NP, Anand A, Mishra S (2009) Transurethral vapor resection of prostate–an alternative treatment for benign prostatic hyperplasia >100 g. J Endourol Endourol Soc 23(11):1883–1886
Gu X, Vricella GJ, Spaliviero M, Wong C (2012) Does size really matter? The impact of prostate volume on the efficacy and safety of GreenLight HPS laser photoselective vaporization of the prostate. J Endourol Endourol Soc 26(5):525–530
Elmansy H, Baazeem A, Kotb A, Badawy H, Riad E, Emran A, Elhilali M (2012) Holmium laser enucleation versus photoselective vaporization for prostatic adenoma greater than 60 ml: preliminary results of a prospective, randomized clinical trial. J Urol 188(1):216–221
Chen YB, Chen Q, Wang Z, Peng YB, Ma LM, Zheng DC, Cai ZK, Li WJ, Ma LH (2013) A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup. J Urol 189(1):217–222
Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R (2011) Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose? J Endourol Endourol Soc 25(8):1347–1352
Lee SW, Choi JB, Lee KS, Kim TH, Son H, Jung TY, Oh SJ, Jeong HJ, Bae JH, Lee YS, Kim JC (2013) Transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement: a quality and meta-analysis. Int Neurourol J 17(2):59–66
Kuntz RM, Lehrich K (2002) Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm.: a randomized prospective trial of 120 patients. J Urol 168(4 Pt 1):1465–1469
Elzayat EA, Elhilali MM (2006) Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy. Eur Urol 49(1):87–91
Kuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 53(1):160–166
Mamoulakis C, Ubbink DT, de la Rosette JJ (2009) Bipolar versus monopolar transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol 56(5):798–809
Kan CF, Tsu HL, Chiu Y et al (2014) A prospective study comparing bipolar endoscopic enucleation of prostate with bipolar transurethral resection in saline for management of symptomatic benign prostate enlargement larger than 70 g in a matched cohort. Int Urol Nephrol 46(3):511–517
Zhu G, Xie C, Wang X, Tang X (2012) Bipolar plasmakinetic transurethral resection of prostate in 132 consecutive patients with large gland: three-year follow-up results. Urology 79(2):397–402
Otsuki H, Kuwahara Y, Kosaka T, Tsukamoto T, Nakamura K, Shiroki R, Hoshinaga K (2012) Transurethral resection in saline vaporization: evaluation of clinical efficacy and prostate volume. Urology 79(3):665–669
Neyer M, Reissigl A, Schwab C, Pointner J, Abt D, Bachmayer C, Schmid HP, Engeler DS (2013) Bipolar versus monopolar transurethral resection of the prostate: results of a comparative, prospective bicenter study–perioperative outcome and long-term efficacy. Urol Int 90(1):62–67
De Nunzio C, Lombardo R, Autorino R et al (2013) Contemporary monopolar and bipolar transurethral resection of the prostate: prospective assessment of complications using the Clavien system. Int Urol Nephrol 45(4):951–959
Wein AJ, Kavoussi, L, Novick AC, Partin AW, Peters CA (2012) Campbell-Walsh urology, vol 3, 10th edn, pp 2695–2703
Pu X, Wang X, Wang H, Hu L (2006) Erectile dysfunction after PlasmaKinetic vaporization of the prosatate: incidence and risk factors. J Endourol 20(9):693–697
Zhao Z, Ma W, Xuan X et al (2012) Impact of plasmakinetic enucleation of the prostate (PKEP) on sexual function: results of a prospective trial. J Sex Med 9(5):1478–1481
Issa MM (2008) Technological advances in transurethral resection of the prostate: bipolar versus monopolar TURP. J Endourol 22:1587–1595
Zhoo Z, Zeng G, Zhong W et al (2010) A prospective randomised trial comparing plasmakinetic enucleation to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: three year follow-up results. Eur Urol 58:8
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Coskuner, E.R., Ozkan, T.A., Koprulu, S. et al. The role of the bipolar plasmakinetic TURP over 100 g prostate in the elderly patients. Int Urol Nephrol 46, 2071–2077 (2014). https://doi.org/10.1007/s11255-014-0803-1
- Open prostatectomy