Plasma vaporization found superior to TURis, TURP for BPH

August 9, 2013

As follow-up lengthens in a prospective, randomized, controlled trial, men who underwent bipolar plasma vaporization of the prostate for BPH using the “button” vapo-resection electrode continue to demonstrate significantly better symptom scores and voiding characteristics compared to their counterparts treated by bipolar transurethral resection in saline or monopolar transurethral resection of the prostate.

 

San Diego-As follow-up lengthens in a prospective, randomized, controlled trial, men who underwent bipolar plasma vaporization of the prostate (BPVP) for BPH using the “button” vapo-resection electrode (PlasmaButton, Olympus, Center Valley, PA) continue to demonstrate significantly better symptom scores and voiding characteristics compared to their counterparts treated by bipolar transurethral resection in saline (TURis) or monopolar transurethral resection of the prostate (TURP).

The study, presented at the AUA annual meeting in San Diego, enrolled 510 men who were equally randomized into the three study arms. Eligible patients had a “medium-sized” prostate with a volume between 30 mL and 80 mL, along with an International Prostate Symptom Score (IPSS) over 19 and a maximum flow rate (Qmax) below 10 mL/s. Postoperatively, patients were evaluated at 1, 3, and 6 months and every 6 months thereafter by IPSS, quality of life (QoL) score, Qmax, and post-void residual urinary volume (PVR). Additionally, PSA level and prostate volume (measured by transurethral ultrasound) were assessed every 6 months.

Consistent improvements seen in IPSS, Qmax

Beginning at the first follow-up visit and with clinical data now available from the 36 months’ check-up, men treated by BPVP consistently demonstrated significantly superior improvements in both mean IPSS and Qmax compared to the TURis and TURP groups. At 1 month in the plasma vaporization and bipolar and monopolar resection series, the mean IPSS scores were 4.6, 7.2, and 7.2, respectively, and the mean Qmax values were 24.8 mL/s, 21.7 mL/s, and 20.9 mL/s, respectively. At 36 months, when about 60% of the initially enrolled patients were evaluated, there were still significant differences favoring BPVP over TURis and TURP in mean IPSS values (5.4 vs. 8.6 and 8.7) and Qmax (23.2 mL/s vs. 20.2 mL/s and 19.5 mL/s). Throughout the entire follow-up period, there were no significant differences among the groups in mean PSA level, PVR parameters, or QoL scores.

“We’ve performed more than 1,200 BPVP procedures, and therefore we can say that our experience is one of the most extensive anywhere in the world so far. Naturally, supplementary data is required in order to definitively establish the long-term efficacy and retreatment rates for BPVP. However, we have more than enough reasons to believe the PlasmaButton technique just might make it in BPH endoscopic treatment,” said senior author Petrisor Geavlete, MD, PhD, chief of urology, St. John Emergency Clinical Hospital, Bucharest, Romania.

“BPVP seems to represent a viable alternative in BPH endoscopic treatment, apparently able to challenge the ‘gold-standard’ status of monopolar TURP and to bring significant improvements to the bipolar electrosurgical approach,” said first author Bogdan Geavlete, MD, PhD, assistant professor of urology, St. John Emergency Clinical Hospital.

As previously reported in Urology (2011; 78:930-5), BPVP had similar BPH tissue removal capabilities when compared to TURis and TURP. However, in that study, the bipolar vaporization approach was characterized by a significantly shorter operative time than its comparators (39.7 vs. 52 and 55 minutes.) as well as reduced perioperative morbidity and faster postoperative recovery. The intraoperative bleeding rate and mean hemoglobin level decrease were both significantly lower subsequent to BPVP than after TURis or TURP, and the PlasmaButton procedure also displayed significantly lower postoperative hematuria and blood transfusion rates.

Hospital stay also shorter for BPVP group

“Most importantly,” said Dr. Bogdan Geavlete, “the mean catheterization period and hospital stay were also significantly shorter for patients undergoing BPVP than in the other surgical groups.”

There were no significant differences among the three study arms concerning the frequency of irritative symptoms. The rate of bladder neck sclerosis was significantly lower among men who underwent BPVP when compared to TURis and TURP (2.4% vs. 5.9% and 6.5%), while the re-treatment rate was significantly lower due to PlasmaButton vaporization by comparison to bipolar and monopolar resection (1.8% vs. 4.7% and 5.3%).

Drs. Petrisor and Bogdan Geavlete are speakers for and have received honorariums from Olympus.UT

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