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What's known on the subject? and What does the study add?• According to the EAU Guidelines 2012, large size benign prostatic hyperplasia (BPH) cases (>80 mL) continue to have open prostatectomy as the first line treatment alternative, despite the substantial peri-operative morbidity and extended catheterization and convalescence periods related to this undoubtedly invasive approach. During the past two decades, holmium laser enucleation of the prostate was constantly described as a successful choice for this category of patients. According to rather numerous studies, the technique displayed superior results in terms of surgical safety and postoperative recovery compared with the open procedure. On the other hand, the concept of electrosurgical enucleation of the prostate, using either a monopolar or bipolar cutting current, materialized into several technical applications that eventually failed to gain general acknowledgement as reliable alternatives to the BPH transurethral approach.• While keeping in mind the already proved advantage of enucleating substantial quantities of BPH tissue, bipolar plasma enucleation of the prostate was introduced as a novel endoscopic approach in cases of large prostates. The present trial represents the first prospective, medium-term, randomized comparison to be published of this innovative technique with standard open prostatectomy. Basically, the premises for a viable alternative relied on the practical advantages provided by the 'button' electrode, mainly the large surface creating the conditions for a fast enucleation process, continuous vaporization and concomitant haemostasis. Eventually, it was concluded that the plasma enucleation procedure distinguished itself as a successful treatment option in large BPH patients, characterized by good surgical efficiency, significantly reduced complications, faster postoperative recovery, similar prostatic tissue ablation capabilities and satisfactory follow-up results compared with the open technique. Most importantly, plasma-button enucleation patients benefited from a similar 12 months' outcome from the perspectives of symptom scores and voiding parameters when drawing a parallel with open surgery results, thus underlining the reliable viability of this type of endoscopic approach. Objectives• To evaluate the viability of bipolar plasma enucleation of the prostate (BPEP) by comparison with open transvesical prostatectomy (OP) in cases of large prostates with regard to surgical efficacy and peri-operative morbidity.• To compare the medium-term follow-up parameters specific for the two methods. Patients and Methods• A total of 140 benign prostatic hyperplasia (BPH) patients with prostate volume >80 mL, maximum flow rate (Qmax) <10 mL/s and International Prostate Symptom Score (IPSS) >19 were randomized in the two study arms.• All cases were assessed preoperatively and at 1, 3, 6 and 12 months after surgery by IPSS, Qmax, quality of life score (QoL) and post-voiding residual urinary volume (PVR).• The prostate volume and prostate speci...

4 9What ' s known on the subject? and What does the study add? HAL fl uorescence cystoscopy is known to improve tumour detection in NMIBC cases and to have a potentially favourable impact concerning the recurrence rates.The present trial assessed the advantages of HAL cystoscopy with regard to postoperative treatment changes and 2 years ' recurrence rates, subjects that are poorly evaluated in the literature. OBJECTIVES• To evaluate in a prospective, randomized study the impact of hexaminolevulinate blue-light cystoscopy (HAL-BLC) on the diagnostic accuracy and treatment changes in cases of non-muscle invasive bladder cancer (NMIBC) compared with standard whitelight cystoscopy (WLC).• To compare the long-term recurrence rates in the two study arms. PATIENTS AND METHODS• In all, 362 patients suspected of NMIBC were included in the trial based on positive urinary cytology and/or ultrasonographic suspicion of bladder tumours and underwent transurethral resection of bladder tumours.• A single postoperative mytomicin-C instillation was performed in all cases, intravesical chemotherapy for intermediate-risk patients and BCG instillations for high-risk cases.• The follow-up protocol consisted of urinary cytology and WLC every 3 months for 2 years.• Only fi rst-time recurrences after the initial diagnosis were considered. RESULTS• In the 142 patients with NMIBC in the HAL-BLC series, tumour detection rates signifi cantly improved for carcinoma in situ , pTa andoverall cases.• In 35.2% of the cases, additional malignant lesions were found by HAL-BLC and consequently, the recurrence-and progression-risk categories of patients and subsequent treatment improved in 19% of the cases due to fl uorescence cystoscopy.• In all, 125 patients in the HAL-BLC group and 114 of the WLC group completed the follow-up.• The recurrence rate at 3 months was lower in the HAL-BLC series (7.2% vs 15.8%) due to fewer ' other site ' recurrences when compared with the WLC series (0.8% vs 6.1%).• The 1 and 2 years recurrence rates were signifi cantly decreased in the HAL-BLC group compared with the WLC group (21.6% vs 32.5% and 31.2% vs 45.6%, respectively). CONCLUSIONS• HAL-BLC was better than WLC for detecting NMIBC cases and improved tumour detection rates .• HAL-BLC signifi cantly modifi ed the postoperative treatment of cases.• The 3 months, 1 and 2 years recurrence rates were signifi cantly improved in the HAL-BLC arm. KEYWORDShexaminolevulinate blue-light cystoscopy , non-muscle invasive bladder cancer , diagnostic accuracy , treatment changes , recurrence rates Study Type -Therapy (individual cohort) Level of Evidence 2b

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