Pure Bipolar Plasma Vaporization of the Prostate: The Zürich Experience

Benedikt Kranzbühler, Marian Severin Wettstein, Christian D. Fankhauser, Nico C. Grossmann, Oliver Gross, Cédric Poyet, Remo Largo, Boris Fischer, Matthias Zimmermann, Tullio Sulser, Alexander Müller, Thomas Hermanns
2013 Journal of endourology  
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 electrovaporization. Outcome data following second-generation BPV are still scarce. The aim of this investigation was to evaluate the intra-and postoperative outcomes of contemporary BPV in a center with
more » ... 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, International Prostate Symptom Score (IPSS)/quality of life (Qol), and prostate-specific antigen (PSA) tests. Follow-up investigations took place after 6 weeks, 6 months, and 12 months. The Wilcoxon signed-rank test was used to compare pre-and post-treatment parameters. Results: The median (range) preoperative prostate volume was 41 mL (17-111 mL). The preoperative IPSS, Qol, Qmax, and residual volume were 16 (2-35), 4 (0-6), 10.1 mL/s (3-29.3 mL/s), and 87 mL (0-1000 mL), respectively. One third of the patients were undergoing platelet aggregation inhibition (PAI). No intraoperative complications occurred. Postoperatively, 13 patients (15.7%) had to be recatheterized. Three patients (3.6%) had clot retention and 28 patients (34%) reported any grade of dysuria. After 6 weeks, all outcome parameters improved significantly and remained improved over the 12-month observation period [IPSS: 3 (0-2); Qol: 1 (0-4); Qmax: 17.2 mL/s (3.2-56 mL/s); residual volume 11 mL (0-190 mL)]. 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 PAI. 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. Abbreviations Used BPV ¼ bipolar plasma vaporization IPSS ¼ International Prostate Symptom Score PAI ¼ platelet aggregation inhibition PSA ¼ prostate-specific antigen Qmax ¼ maximum urinary flow rate Qol ¼ quality of life TURP ¼ transurethral resection of the prostate 1266 KRANZBÜ HLER ET AL.
doi:10.1089/end.2013.0335 pmid:23806049 fatcat:tdolfvmlyrbafoggcc3qqze5ty