Abstract
Introduction and objectives: Bipolar plasma vaporization (BPV) has been introduced as an alternative to transurethral resection of the prostate (TURP). Promising short-term results but inferior mid-term results compared to TURP have been reported following first-generation bipolar electro-vaporization. Outcome data following second-generation BPV is still scarce. The aim of this investigation was to evaluate the intra- and post-operative outcome of contemporary BPV in a center with long-standing expertise on laser vaporization of the prostate. Methods: A consecutive series of 83 patients undergoing BPV in a tertiary referral center was prospectively evaluated. The investigated outcome parameters included the maximum flow rate (Qmax), postvoid residual volume, IPSS / Qol and PSA tests. Follow-up investigations took place after six weeks, six months and twelve months. Wilcoxon signed-rank test was used to compare pre- and post-treatment parameters. Results: The median (range) pre-operative prostate volume was 41ml (17-111ml). The pre-operative IPSS, Qol, Qmax and residual volume were 16 (2-35), 4 (0-6), 10.1ml/sec (3-29.3ml/sec) and 87ml (0-1000ml), respectively. One third of the patients were undergoing platelet aggregation inhibition. No intra-operative complications occurred. Post-operatively, 13 patients (15.7%) had to be re-catheterized. Three patients (3.6%) had clot retention and 28 patients (34%) reported any grade of dysuria. After six weeks, all outcome parameters improved significantly and remained improved over the twelve months observation period (IPSS: 3 (0-2); Qol: 1 (0-4); Qmax: 17.2ml/s (3.2-56ml/s); residual volume 11ml (0-190ml)). The PSA-reduction was 60% at study conclusion. Three patients (3.6%) developed a urethral stricture and four patients (4.8%) bladder neck sclerosis. Re-resections were not necessary. Conclusions: Contemporary BPV is a safe and efficacious treatment option even for patients undergoing platelet aggregation inhibition. Early urinary retention and temporary dysuria seem to be specific side effects of the treatment. Bleeding complications are rare. Long-term follow-up is needed to confirm these promising short-term results.
Kranzbühler, Benedikt