Rotoresect for bloodless transurethral resection of the prostate: a 4‐year follow‐up

Abstract

OBJECTIVE To report the results and long‐term follow‐up of transurethral resection of the prostate (TURP) with a new resection device, the Rotoresect (Karl Storz, Tuttlingen, Germany). PATIENTS AND METHODS Most endoscopic resection techniques for benign prostatic tissue aim for high ablation rates and minimal bleeding. Available resection electrodes are effective, but cause high blood loss (loop electrode), or less bleeding but poorer ablation rates (electrovaporization). To resolve these conflicts the Rotoresect was developed in 1995; it consists of a specially designed rotating resection electrode, driven by a micromotor, and a high‐frequency current to enable simultaneous coagulation, vaporization and mechanical tissue removal during resection. To date, 84 patients with benign prostatic hyperplasia have had their prostate resected with this device (mean prostate size 46.0, sd 18.4 mL) and have been assessed for up to 4 years. RESULTS During resection there was very little bleeding, with no significant changes in haemoglobin or sodium levels. The mean (sd) duration of catheterization was 1.4 (1.1) days; the urinary peak flow rate was improved from 9.7 (3.2) to 24.2 (8.23) mL/s and the residual urine volume reduced from 187.3 (109.6) to 22.7 (19.5) mL. The International Prostate Symptom Score and quality‐of‐life index were both improved, from 24.0 (7.5) to 4.1 (2.7), and 4.2 (3.2) to 0.8 (0.9), respectively. Overall the results were stable during the 4 years of follow‐up. CONCLUSION The Rotoresect combines the advantages of standard resection (high ablation rate) by actively rotating the resection electrode, and the haemostatic effect of electrovaporization (minimal blood loss) by simultaneous tissue coagulation and vaporization.

Recent improvements in transurethral high‐frequency electrosurgery of the prostate

“…Roller bars vaporize the prostate with their grooved surface by direct application of a high temperature to the tissue, similar to that obtained with a laser. The rotoresect electrode represents another variety; an axial rotating resection electrode, driven by a micromotor, and application of high‐frequency current simultaneously enables coagulation, vaporization and mechanical tissue removal during resection [4].…”

Efficacy and Safety of Transurethral Columnar Balloon Dilation of the Prostate for the Treatment of Benign Prostatic Hyperplasia: A Multicenter Trial

“…Surgical treatment can fundamentally relieve clinical symptoms by removing part of the hyperplastic glands, especially the transurethral resection of the prostate which effectively treats BPH. However, surgery still has limitations, such as inducing adverse reactions (prostate resection syndrome, bleeding, postoperative urinary incontinence, and retrograde ejaculation) [ 24 – 26 ]. Rapid development of science and technology has witnessed emergence of new surgical methods for BPH, such as plasmakinetic resection [ 27 ], laser surgery [ 28 ], and enucleation surgery [ 29 ].…”

A 2‐year follow‐up after rotoresection of the prostate: a prospective study

“…Michel et al [14] in a porcine model; reported that the rate of tissue ablation with rotoresection was similar to that achieved by a standard resection loop, which is more than twice that obtained by conventional electrovaporization, and the rate of bleeding was much less than with standard loop resection. In a more recent report by Michel et al [15], 84 patients were followed up to 4 years. The number who completed the 4‐year follow‐up is not stated, but in those followed at 4 years, Q max continued to be significantly higher than before surgery (24.2 (8.2) vs 9.1 (4.9) mL/s).…”