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International Urology and Nephrology

, Volume 51, Issue 12, pp 2143–2148 | Cite as

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

  • Osama Abdelwahab
  • Mohamed Habous
  • Mohammed Aziz
  • Mohammed Sultan
  • Mohammed Farag
  • Richard Santucci
  • Saleh BinsalehEmail author
Urology - Original Paper
  • 58 Downloads

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.

Keywords

Bipolar vaporization Prostate Bipolar loop resection Prospective trial 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that there are no competing financial interests.

Ethical approval

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.

Informed consent

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

References

  1. 1.
    Strope SA et al (2012) Population based comparative effectiveness of transurethral resection of the prostate and laser therapy for benign prostatic hyperplasia. J Urol 187(4):1341–1345CrossRefGoogle Scholar
  2. 2.
    Zhang X et al (2012) Photoselective vaporization versus transurethral resection of the prostate for benign prostatic hyperplasia: a meta-analysis. J Endourol 26(9):1109–1117CrossRefGoogle Scholar
  3. 3.
    Bucuras V, Bardan R (2011) Bipolar vaporization of the prostate: is it ready for the primetime? Ther Adv Urol 3(6):257–261CrossRefGoogle Scholar
  4. 4.
    Reich O et al (2010) Plasma vaporisation of the prostate: initial clinical results. Eur Urol 57(4):693–697CrossRefGoogle Scholar
  5. 5.
    Michielsen DP et al (2007) Bipolar transurethral resection in saline–an alternative surgical treatment for bladder outlet obstruction? J Urol 178(5):2035–2039 (discussion 2039)CrossRefGoogle Scholar
  6. 6.
    Tefekli A et al (2005) A hybrid technique using bipolar energy in transurethral prostate surgery: a prospective, randomized comparison. J Urol 174(4 Pt 1):1339–1343CrossRefGoogle Scholar
  7. 7.
    Reich O (2009) Bipolar transurethral resection of the prostate: what did we learn, and where do we go from here? Eur Urol 56(5):796–797CrossRefGoogle Scholar
  8. 8.
    Wendt-Nordahl G et al (2004) The Vista system: a new bipolar resection device for endourological procedures: comparison with conventional resectoscope. Eur Urol 46(5):586–590CrossRefGoogle Scholar
  9. 9.
    Djavan B et al (2010) Durability and retreatment rates of minimal invasive treatments of benign prostatic hyperplasia: a cross-analysis of the literature. Can J Urol 17(4):5249–5254PubMedGoogle Scholar
  10. 10.
    Van Hest P, D’Ancona F (2009) Update in minimal invasive therapy in benign prostatic hyperplasia. Minerva Urol Nefrol 61(3):257–268PubMedGoogle Scholar
  11. 11.
    Fagerstrom T, Nyman CR, Hahn RG (2011) Complications and clinical outcome 18 months after bipolar and monopolar transurethral resection of the prostate. J Endourol 25(6):1043–1049CrossRefGoogle Scholar
  12. 12.
    Ho HS et al (2007) A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline (TURIS) system. Eur Urol 52(2):517–522CrossRefGoogle Scholar
  13. 13.
    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):798–809CrossRefGoogle Scholar
  14. 14.
    Ho HS, Cheng CW (2008) Bipolar transurethral resection of prostate: a new reference standard? Curr Opin Urol 18(1):50–55CrossRefGoogle Scholar
  15. 15.
    Fagerstrom T, Nyman CR, Hahn RG (2010) Bipolar transurethral resection of the prostate causes less bleeding than the monopolar technique: a single-centre randomized trial of 202 patients. BJU Int 105(11):1560–1564CrossRefGoogle Scholar
  16. 16.
    Yoon CJ et al (2006) Transurethral resection of the prostate with a bipolar tissue management system compared to conventional monopolar resectoscope: one-year outcome. Yonsei Med J 47(5):715–720CrossRefGoogle Scholar
  17. 17.
    Kwon JS et al (2011) Comparison of effectiveness of monopolar and bipolar transurethral resection of the prostate and open prostatectomy in large benign prostatic hyperplasia. Korean J Urol 52(4):269–273CrossRefGoogle Scholar
  18. 18.
    McClelland M Jr (2011) Olympus PlasmaButton transurethral vaporization technique for benign prostatic hyperplasia. Can J Urol 18(2):5630–5633PubMedGoogle Scholar
  19. 19.
    Geavlete B et al (2011) Bipolar plasma vaporization vs monopolar and bipolar TURP-A prospective, randomized, long-term comparison. Urology 78(4):930–935CrossRefGoogle Scholar
  20. 20.
    Reich O, Gratzke C, Stief CG (2006) Techniques and long-term results of surgical procedures for BPH. Eur Urol 49(6):970–978 (discussion 978) CrossRefGoogle Scholar
  21. 21.
    Wendt-Nordahl G, Häcker A, Reich O, Djavan B, Alken P, Michel MS (2004) The Vista system:a new bipolar resection device for endourological procedures: comparison with conventional resectoscope. Eur Urol 46(5):586–590CrossRefGoogle Scholar
  22. 22.
    Kellow NH (1993) Pacemaker failure during transurethral resection of the prostate. Anaesthesia 48(2):136–138CrossRefGoogle Scholar
  23. 23.
    Mamoulakis C et al (2011) The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol 29(2):205–210CrossRefGoogle Scholar
  24. 24.
    El-Shaer W, Abou-Taleb A, Kandeel W (2017) Transurethral bipolar plasmakinetic vapo-enucleation of the prostate: is it safe for patients on chronic oral anticoagulants and/or platelet aggregation inhibitors? Arab J Urol 15(4):347–354CrossRefGoogle Scholar
  25. 25.
    Elsakka AM et al (2016) A prospective randomised controlled study comparing bipolar plasma vaporisation of the prostate to monopolar transurethral resection of the prostate. Arab J Urol 14(4):280–286CrossRefGoogle Scholar
  26. 26.
    Coskuner ER, Ozkan TA, Koprulu S, Dillioglugil O, Cevik I (2014) The role of the bipolar plasmakinetic TURP over 100 g prostate in the elderly patients. Int Urol Nephrol 46(11):2071–2077CrossRefGoogle Scholar
  27. 27.
    Dunsmuir WD et al (2003) Gyrus bipolar electrovaporization vs transurethral resection of the prostate: a randomized prospective single-blind trial with 1 y follow-up. Prostate Cancer Prostatic Dis 6(2):182–186CrossRefGoogle Scholar
  28. 28.
    Falahatkar S et al (2014) Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP. Int Braz J Urol 40(3):346–355CrossRefGoogle Scholar
  29. 29.
    Botto H et al (2001) Electrovaporization of the prostate with the Gyrus device. J Endourol 15(3):313–316CrossRefGoogle Scholar
  30. 30.
    Dincel C et al (2004) Plasma kinetic vaporization of the prostate: clinical evaluation of a new technique. J Endourol 18(3):293–298CrossRefGoogle Scholar
  31. 31.
    Otsuki H et al (2012) Transurethral resection in saline vaporization: evaluation of clinical efficacy and prostate volume. Urology 79(3):665–669CrossRefGoogle Scholar
  32. 32.
    Rassweiler J et al (2007) Bipolar transurethral resection of the prostate–technical modifications and early clinical experience. Minim Invasive Ther Allied Technol 16(1):11–21CrossRefGoogle Scholar
  33. 33.
    Ahyai SA et al (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):384–397CrossRefGoogle Scholar
  34. 34.
    Komura K, Inamoto T, Takai T, Uchimoto T, Saito K, Tanda N, Minami K, Uehara H, Takahara K, Hirano H, Nomi H, Kiyama S, Watsuji T, Azuma H (2014) Could transurethral resection of the prostate using the TURis system take over conventional monopolar transurethral resection of the prostate? A randomized controlled trial and midterm results. Urology 84(2):405–411CrossRefGoogle Scholar
  35. 35.
    Tan GH, Shah SA, Ali NM, Goh EH, Singam P, Ho CCK, Zainuddin ZM (2017) Urethral strictures after bipolar transurethral resection of prostate may be linked to slow resection rate. Investig Clin Urol 58(3):186–191CrossRefGoogle Scholar
  36. 36.
    Kumar BN, Srivastava A, Sinha T (2019) Urethral stricture after bipolar transurethral resection of prostate-truth vs hype: a randomized controlled trial. Indian J Urol 35(1):41–47PubMedPubMedCentralGoogle Scholar
  37. 37.
    Faul P, Fastenmeier K (2008) The role of lubrication in transurethral electrical resection. Urologe A 47(3):326–330CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Urology DepartmentBenha UniversityBenhaEgypt
  2. 2.Urology and Andrology DepartmentElaj Medical CentersJeddahSaudi Arabia
  3. 3.Urology DepartmentMenoufia UniversityAl MinufyaEgypt
  4. 4.Urology Department, Al-Azhar Faculty of MedicineAssiutEgypt
  5. 5.Detroit Medical CenterMichigan State UniversityDetroitUSA
  6. 6.Division of Urology, Department of Surgery, Faculty of MedicineKing Saud UniversityRiyadhSaudi Arabia

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