Short-term efficacy and safety of second generation bipolar transurethral vaporization of the prostate (B-TUVP) for large benign prostate enlargement: Results from a retrospective feasibility study

Abstract

Background To investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml. Materials and methods 100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients’ characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml. Results 17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients’ QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed. Conclusions This is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE.

Comparison of the short-term efficacy and safety of bipolar transurethral electro vaporization and holmium laser enucleation of the prostate for moderate and large benign prostatic enlargement

“…Irrigation with normal saline was performed using a 26 Fr resectoscope, utilizing the transurethral resection in saline (TURis) system by Olympus and operating on cutting/coagulation settings at 200 W/120 W. After completing vaporization and coagulation, an 18 Fr three-way transurethral catheter was installed, only to be removed when hematuria had resolved (approximately on 2-4 POD). 3 Alternatively, HoLEP was performed using a 120 W holmium YAG laser (VersaPulse PowerSuite, Lumenis Surgical, San Jose, CA, USA) with a 550 nm end-ring ber (SlimLine, Lumenis). A 26 Fr continuous-ow resectoscope with saline irrigation was used.…”

“…Operative procedures of B-TUVP were described previously 3 . Brie y, under spinal or general anesthesia, the patient was placed in the lithotomy position and sterile draped.…”

“…The two centers shared the same surgical indications and management of elevated prostate-speci c antigen (PSA) value and anticoagulant/antiplatelet therapy, which were described in previous studies 3 . Brie y, surgical indications were International Prostate Symptoms Score (IPSS) > 7, maximum ow rate (Q max ) < 10 ml/s, persistent or recurrent urinary retention or bladder stones.…”

Comparison of the short-term efficacy and safety of bipolar transurethral electro vaporization and holmium laser enucleation of the prostate for moderate and large benign prostatic enlargement

“…A previous paper did not support the long-term advantage of TUVP over TURP for BPE treatment [ 3 , 4 ]. However, we have several reasons for performing B-TUVP instead of TURP including favorable learning curve, lower costs, better safety profile in anticoagulated patients on the basis of our previous papers [ 5 , 6 ].…”

“…Recently, we introduced the second-generation B-TUVP using an oval electrode (certification number: 29ABBZX00048000,26th Jun. 2017, Olympus, Japan) and demonstrated its efficacy and safety for large BPE (PV ≥ 100 ml) [ 5 ]. Our findings revealed that the second-generation B-TUVP facilitated more efficient vaporization owing to the wider surface of its oval electrode.…”