Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP

Siavash Falahatkar, Gholamreza Mokhtari, Keivan Gholamjani Moghaddam, Ahmad Asadollahzade, Alireza Farzan, Elaheh Shahab, Ali Ghasemi, Aliakbar Allahkhah, Samaneh Esmaeili

Objective: To compare the outcomes of bipolar transurethral vaporization of the prostate (TUVP) with bipolar transurethral resection of the prostate (TURP). Materials and Methods: In a prospective randomized trial, 88 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent bipolar TUVP (N = 39) or bipolar TURP (N = 49) from October 2010 to November 2011. The inclusion criteria were age > 50 years, prostate volume of 30-80mL, serum PSA < 4ng/mL, IPSS ≥ 20, Qmax ≤ 10mL/s and failed medical therapy. The perioperative and postoperative outcomes were evaluated and the IPSS and Qmax were assessed preoperatively and 3 months after procedure in all cases. Results: Both groups were similar in patient age, prostate volume, preoperative IPSS and Qmax. The TUVP group had significantly lower mean values of operative time, hospital stay, catheterization period, irrigation fluid volume and serum hemoglobin, creatinine, sodium and potassium changes compared with TURP group. No significant differences were seen between two groups regarding complications (TUVP = 10.3%; TURP = 12.2%) and modified Clavien classification of complications. No TUR syndrome, obturator reflex or epididymitis occurred in both groups. Re-hospitalization and transfusion due to clot retention (N = 2) and urethral stricture (N = 1) were reported only in the TURP group. Three patients experienced urinary retention after catheter removal in the TUVP group. Two patients were re-catheterized temporarily and one patient required repeat bipolar TUVP. Three months after surgery, two groups had significant improvement in IPSS and Qmax. But the TUVP group had significantly lower IPSS and higher Qmax than TURP group. Conclusions: Bipolar TUVP is a safe, effective and low cost procedure among minimally invasive surgeries of BPH. Compared with bipolar TURP, the bipolar TUVP had similar complications, better perioperative and postoperative outcomes, superior hemostasis and higher efficacy.