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Prostate volume reduction following pure transurethral bipolar plasma vaporization and conventional transurethral resection of the prostate: a prospective investigation using transrectal 3D ultrasound volumetry

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Abstract

Purpose

To evaluate and compare postoperative changes in prostate volume and clinical outcome after bipolar plasma vaporization (BPV) and conventional transurethral resection of the prostate (TURP).

Patients and methods

Consecutive series of patients undergoing BPV or TURP were included in this prospective, nonrandomized study. Planimetric volumetry after transrectal three-dimensional ultrasound of the prostate was performed preoperatively and postoperatively after 6 weeks, 6 months and 12 months. Additionally, changes in clinical outcome parameters were assessed and compared between the groups. The reduction ratio and analysis of covariance were used to compare volume changes between BPV and TURP. Multiple regression analysis was performed to assess a possible interaction between preoperative prostate volume and effect of therapy.

Results

A total of 157 patients were included (BPV: n = 68, TURP: n = 89). Median preoperative prostate volume was 43.1 ml in the BPV group and 45.9 ml in the TURP group (p = 0.43). Postoperatively, the prostate volumes decreased significantly in both groups. After catheter removal, the relative residual prostate volume was significantly higher in the BPV group (66.6 vs. 60.8 %; p = 0.02). Thereafter, significant differences were not detectable anymore (12 months: 46.6 vs. 47.1 %; p = 0.82). Regression analysis revealed that tissue ablation after BPV was superior to TURP in prostates <45 ml but inferior in prostates >45 ml. All clinical outcome parameters improved significantly and were not significantly different between the groups.

Conclusions

Volume reduction and short-term clinical outcome following pure BPV was excellent and comparable to conventional TURP. However, volume reduction seems to be limited in patients with larger prostates.

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Acknowledgments

The authors thank Alexandra Veloudios for the excellent patient care during this study.

Author contribution

B Kranzbühler was involved in data collection, data management, data analysis and manuscript writing/editing; O Gross, CD Fankhauser, MS Wettstein and NC Grossmann helped in data collection and data management; LJ Hefermehl was involved in protocol/project development and manuscript writing/editing; M Zimmermann collected the data; A Müller contributed to protocol/project development and data collection; T Sulser was involved in manuscript writing/editing; C Poyet helped in data collection and manuscript writing/editing; and T Hermanns was involved in protocol/project development, data collection, data management, data analysis and manuscript writing/editing.

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Authors and Affiliations

  1. Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland

    Benedikt Kranzbühler, Oliver Gross, Christian D. Fankhauser, Marian S. Wettstein, Nico C. Grossmann, Lukas J. Hefermehl, Matthias Zimmermann, Alexander Müller, Daniel Eberli, Tullio Sulser, Cédric Poyet & Thomas Hermanns

Authors
  1. Benedikt Kranzbühler
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  2. Oliver Gross
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  3. Christian D. Fankhauser
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  4. Marian S. Wettstein
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  5. Nico C. Grossmann
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  6. Lukas J. Hefermehl
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  7. Matthias Zimmermann
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  8. Alexander Müller
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  9. Daniel Eberli
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  10. Tullio Sulser
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  11. Cédric Poyet
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  12. Thomas Hermanns
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Corresponding author

Correspondence to Thomas Hermanns.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

Online Resource 1

Study profile (PDF 550 kb)

Online Resource 2

Changes in relative volume reduction (in %; y-axis) in relation to the initial prostate volume (ml; x-axis) 12 months after BPV (red line) and TURP (green line) (PDF 326 kb)

Online Resource 3

The spherical vaporization electrode before the procedure (A) and after BPV of a 50-ml prostate (B) (PDF 2050 kb)

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Kranzbühler, B., Gross, O., Fankhauser, C.D. et al. Prostate volume reduction following pure transurethral bipolar plasma vaporization and conventional transurethral resection of the prostate: a prospective investigation using transrectal 3D ultrasound volumetry. World J Urol 35, 429–435 (2017). https://doi.org/10.1007/s00345-016-1876-5

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  • DOI: https://doi.org/10.1007/s00345-016-1876-5

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