A Prospective, Randomized Trial Comparing Conventional Transurethral Prostate Resection With PlasmaKinetic® Vaporization of the Prostate: Physiological Changes, Early Complications and Long-Term Followup
- 1 July 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 176 (1), 205-209
- https://doi.org/10.1016/s0022-5347(06)00492-7
Abstract
We compared standard transurethral prostate resection with bipolar PlasmaKinetic® prostate vaporization for bladder outflow obstruction using a Gyrus® PlasmaKinetic® Plasma V™ bar. A total of 160 men were enrolled in a prospective, randomized trial. Those at higher risk for cancer were excluded by prostate specific antigen and digital rectal examination with or without transrectal ultrasound biopsy. A total of 81 men underwent prostate vaporization and 79 underwent transurethral prostate resection. Preoperative International Prostate Symptom Score and quality of life score, uroflowmetry, post-void residual urine and transrectal ultrasound prostate volume were recorded. Preoperative and postoperative serum hemoglobin, hematocrit and sodium were measured. Perioperative fluid absorption was calculated using weighing on table and blood loss using the Hemocue® system. Longer followup of International Prostate Symptom Score and quality of life score, uroflowmetry and post-void residual urine was available in 149 men, including 76 who underwent prostate vaporization and 73 who underwent transurethral prostate resection. Data were analyzed using the 1 or 2-sample t and chi-square tests. The 2 groups were comparable in all preoperative parameters. Perioperative fluid absorption, intraoperative blood loss, preoperative and postoperative serum hematocrit, and sodium changes were not statistically different. Mean resection time was 4 minutes shorter for transurethral prostate resection (28.5 vs 32.6 minutes, p = 0.08). Patients with transurethral prostate resection showed a greater hemoglobin decrease (1.39 vs 0.8 gm/dl, p = 0.002) and required more irrigation postoperatively (28.3 vs 20.4 l, p = 0.001). Four patients with transurethral prostate resection required transfusion compared with none who underwent prostate vaporization. After transurethral prostate resection hospital stay was longer (3.36 vs 3.02 days, p = 0.03). Cancer was detected in 8 patients with transurethral prostate resection (10%), of whom 7 are under prostate specific antigen surveillance and 1 received radical radiotherapy. Mean long-term followup was 258 days (range 82 to 884). Prostate vaporization and transurethral prostate resection were equally effective at followup, as evidenced by changes in maximum urine flow, International Prostate Symptom Score, quality of life score and post-void residual urine. The 2 operations are highly effective in experienced hands. PlasmaKinetic® prostate vaporization resulted in less postoperative bleeding and a slightly shorter hospital stay. The lack of a histological specimen with this version of PlasmaKinetic® prostate vaporization may mean that clinically significant cancers are missed.Keywords
This publication has 16 references indexed in Scilit:
- Transurethral electrovaporization vs transurethral resection for symptomatic prostatic obstruction: a meta‐analysisBJU International, 2004
- 5-year outcome of a prospective randomized trial to compare transurethral electrovaporization of the prostate and standard transurethral resectionUrology, 2003
- Transurethral electrovaporization of the prostate: is it any better than conventional transurethral resection of the prostate?BJU International, 2003
- Is transurethral vaporesection of the prostate better than standard transurethral resection?European Urology, 2001
- Operative Factors and the Long-Term Incidence of Acute Myocardial Infarction after Transurethral Resection of the ProstateEpidemiology, 1996
- Symptoms of the Transurethral Resection Syndrome Using Glycine as the IrrigantJournal of Urology, 1995
- A method of measuring fluid balance during transurethral resection of the prostateBritish Journal of Urology, 1995
- Transurethral resection of the prostateamong medicare beneficiaries in the United States: time trends and outcomesUrology, 1994
- Patterns of Irrigating Fluid Absorption During Transurethral Resection of the Prostate as Indicated by EthanolJournal of Urology, 1993
- Transurethral Resection SyndromeEuropean Urology, 1992