Transurethral resection TUR in saline pl (1)
2010 THE AUTHORS. JOURNAL COMPILATION
Lower Urinary Tract
2010 BJU INTERNATIONAL
TURis-PVP VS STANDARD TURP FOR BPE
GEAVLETE
et al.
BJUI
Transurethral resection (TUR) in saline plasma
vaporization of the prostate vs standard TUR of
the prostate: ‘the better choice’ in benign
prostatic hyperplasia?
BJU INTERNATIONAL
Bogdan Geavlete, Razvan Multescu, Mihai Dragutescu, Marian Jecu,
Dragos Georgescu and Petrisor Geavlete
Department of Urology, ‘Saint John’ Emergency Clinical Hospital, Bucharest, Romania
Accepted for publication 29 January 2010
Study Type – Therapy (RCT)
Level of Evidence 1b
OBJECTIVE
To evaluate the efficiency, safety and shortterm outcome of transurethral resection in
saline plasma vaporization of the prostate
(TURis-PVP), and to compare it to the
standard TUR of the prostate (TURP).
PATIENTS AND METHODS
In all, 155 patients with benign prostatic
enlargement (BPE) secondary to benign
prostatic hyperplasia (BPH), with a maximum
urinary flow rate (Qmax) of 19 and prostate volume of 30–80 mL
were enrolled in this prospective,
INTRODUCTION
BPH represents an important health
problem in contemporary society and is
the most common disease in male
urological pathology, with a prevalence of
60% for patients aged 61–70 years, 70%
for those aged 71–80 years and 80% for
those aged >80 years [1,2]. Although
benign, this disease with progressive
evolution has a negative impact on the
health-related quality of life (HRQL) of the
patients, marked by obstructive and
irritative LUTS. Surgical treatment for
benign prostatic enlargement (BPE)
continues to represent the second most
frequent major surgical procedure in older
©
randomized trial. All patients were evaluated
preoperatively and at 1, 3 and 6 months after
surgery by IPSS, health-related quality of life
(HRQL) score, Qmax and postvoid residual
urine volume (PVR).
and the Qmax was 22.3 vs 20.0 mL/s at 3
months; and the IPSS was 5 vs 9.1 and the
Qmax was 21.8 vs 19.3 mL/s at 6 months (All
P < 0.05).
RESULTS
CONCLUSIONS
Patients from both series had similar
preoperative characteristics. TURis-PVP and
TURP were successfully performed in all
cases (75 and 80, respectively). The operative
duration, catheterization period and hospital
stay were significantly shorter for TURis-PVP
patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and
47.6 vs 93.1 h, respectively (all P < 0.05).
At the 1, 3 and 6 months follow-ups,
improvements in the variables measured
were better in the TURis-PVP group: the IPSS
was 4.4 vs 8.3 and the Qmax was 22.7 vs
20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6
TURis-PVP represents a valuable endoscopic
treatment alternative for patients with BPE,
with superior efficacy, short-term results
and complication rates compared with
monopolar TURP.
men, with three out of 10 men undergoing
such an intervention.
consist of bleeding, sepsis and TUR syndrome
from fluid absorption.
The BPE endoscopic approach has used
various therapeutic methods. According to
the European Association of Urology (EAU)
Guidelines 2009, monopolar TURP is the
treatment of choice for prostates sized
30–80 mL [3]. However, this ‘gold-standard’
is marred by a significant morbidity and
mortality rate, at 18% and 0.2%, respectively
[4].
Bipolar electrosurgical technology made
transurethral electro-vaporization
increasingly popular, especially after the
development of the Gyrus® PlasmaKinetic®
Tissue Management System (Gyrus Medical
Ltd, Bucks, UK). This technique had already
proved to be as effective as TURP for BOO, as
it provided good long-term results and
implied fewer early complications [5].
Recently, several alternatives have been
introduced, aiming to improve the
performances of TURP and to reduce its
associated complications, which mainly
A new development of this technique, the
TURis®-PVP using the Olympus® UES-40
Surgmaster generator (Olympus, Tokyo,
Japan) and the ‘mushroom’ vapo-resection
KEYWORDS
transurethral resection in saline plasma
vaporization of the prostate, transurethral
resection of the prostate, benign prostatic
hyperplasia
2010 THE AUTHORS
JOURNAL COMPILATION
©
2 0 1 0 B J U I N T E R N A T I O N A L | 1 0 6 , 1 6 9 5 – 1 6 9 9 | doi:10.1111/j.1464-410X.2010.09433.x
1695
G E AV L E T E ET AL.
FIG. 1. Initial aspect at the beginning of the TURisPVP.
FIG. 2. Bladder neck (left) and median lobe (right) plasma vaporization.
electrode was recently introduced in clinical
practice.
FIG. 3. Plasma vaporization of the anterior region of the prostate (left) and haemostasis (right).
In the present study, we aimed to evaluate the
efficiency, safety and short-term results of
this new procedure and to compare it to
standard TURP.
PATIENTS AND METHODS
A prospective, randomized study was
performed to compare the short-term
outcome of TURis-PVP and conventional
TURP in patients with BPE with indications for
surgery. The study was approved by the Local
Ethics and Research Committee. In all, 155
patients with a mean (range) age of 66 (53–
81) years diagnosed with BPE and severe LUTS
were enrolled (under approved written
informed consent properly explaining the
aims, methods, anticipated benefits, potential
hazards and any other aspect of the study
relevant to the patient’s decision to
participate) and randomized by means of
sealed envelopes containing consecutive
numbers. In accordance with the informed
consent, all patients were ‘blinded’ to
treatment.
The inclusion criteria were represented by: a
maximum urinary flow rate (Qmax) of 19 and a prostate volume
(measured by TRUS) of 30–80 mL. The
exclusion criteria consisted of: severe
comorbidities, previous prostate surgery,
history of prostate cancer, abnormal DRE and/
or increased PSA level.
A standard investigative protocol, which
included general clinical examination with
DRE, blood tests, PSA level measurement,
urine culture, IPSS, HRQL, uroflowmetry
1696
(evaluating Qmax) and abdominal
ultrasonography was applied in all cases. All
patients received spinal anaesthesia and were
operated on by the same surgeon after
randomization.
During the follow-up, both the patients as
well as the urologists performing the
investigations were unaware of the treatment
method applied in each case, to assure
complete objectivity of the evaluation.
Conventional TURP was performed in 80 cases
using a 26 F Storz continuous flow monopolar
resectoscope with a single wire loop and
sterile water as irrigation fluid.
The 1, 3 and 6 months follow-ups assessed
the IPSS, HRQL, Qmax and postvoid residual
urine volume (PVR) in all patients, and
compared them between the series.
TURis-PVP, using the Olympus SurgMaster
UES-40 bipolar generator, the special
‘mushroom’ type vapo-resection electrode
and saline continuous flow irrigation was
performed in 75 patients (Fig. 1). The
spherical shape of the new type of electrode
displaying a plasma corona on its surface was
gradually moved into direct contact with the
BPE tissue (the ‘hovering’ technique), thus
producing a virtually blood-less vaporization
at 280–320 W (Fig. 2). Several prostatic
fragments were resected for pathological
analysis. Coagulation of any haemorrhagic
sources was practically concomitant, while
larger vessels’ haemostasis was achieved by
reducing the power of the generator to
120–140 W (Fig. 3). In all cases, a 20 F Foley
catheter was placed at the end of the
procedure.
For statistical analysis of the data the
Student’s t-test and the chi-squared tests
were used, with P < 0.05 considered to
indicate statistical significance.
RESULTS
Table 1 shows the characteristics of the
patients before surgery, which were similar
between the groups.
TURis-PVP and TURP were successfully
performed in all cases. Capsular perforation
(P = 0.037) and significant intraoperative
bleeding (P = 0.013) were more frequent
during TURP (Table 1). The operative duration
(P = 0.002), catheterization period (P =
0.002) and hospital stay (P = 0.012) were
©
JOURNAL COMPILATION
©
2010 THE AUTHORS
2010 BJU INTERNATIONAL
TURis-PVP VS STANDARD TURP FOR BPE
TABLE 1 The preoperative and operative characteristics and complication rates
Variable
No. of patients
Preoperative
Mean (range):
Prostate volume, mL
IPSS
HRQL
Qmax, mL/s
PVR, mL
Haemoglobin level, g/dL
PSA level, ng/mL
Operative
n/N (%)
Capsular perforation
Intraoperative bleeding
Mean (range):
Haemoglobin decrease, g/dL
Operative duration, min
Catheterization time, h
Hospital stay, h
Complications
n/N (%):
Haematuria
Blood transfusion
Clot retention
UTI
Re-hospitalization:
Secondary haemorrhage
Acute urinary retention
Dysuria
Urgency
Frequency
TURis-PVP
75
TURP
80
P
56.2 (32–79)
24.2 (21–32)
4.4 (3–5)
6.2 (4.2–9.1)
84.8 (0–165)
13.9 (11.5–14.9)
1.82 (0.55–3.7)
55.8 (31–78)
24.4 (20–32)
4.2 (3–5)
6.3 (4.3–9.5)
85.3 (0–176)
14.2 (11.9–15.1)
1.85 (0.42–3.54)
0.47
0.595
0.507
0.878
0.712
0.106
0.501
1/75 (1.33)
2/75 (2.66)
7/80 (8.75)
11/80 (13.75)
0.037
0.013
0.6 (0.1–1.3)
35.1 (18–56)
23.8 (18–36)
47.6 (24–72)
1.5 (0.3–2.2)
50.4 (24–78)
71.2 (48–96)
93.1 (72–120)
0.002
0.002
0.002
0.018
13/80 (16.25)
5/80 (6.25)
4/80 (5)
9/80 (11.25)
0.012
0.028
0.049
0.561
2/80 (2.5)
2/80 (2.5)
5/80 (6.25)
4/80 (5)
4/80 (5)
0.167
0.600
0.416
0.052
0.278
3/75 (4)
0
0
6/75 (8)
0
1/75 (1.33)
7/75 (9.33)
4/75 (5.33)
5/75 (6.66)
FIG. 4. Left (left) and right (right) prostatic lobes vaporization by the plasma corona produced by the
‘mushroom’ type electrode.
significantly shorter for TURis-PVP than for
standard TURP and monopolar TURP caused a
higher decrease of the haemoglobin level (P =
0.002; Table 1).
The rate of complications represented by
haematuria, UTIs and re-hospitalization for
©
acute urinary retention was higher for the
TURP than for TURis-PVP (Table 1). Blood
transfusion necessity, clot retention and rehospitalization for secondary haemorrhage
only occurred in the TURP group, with a rate
of 6.25% (P = 0.028), 5% (P = 0.049) and 2.5%
(P = 0.167), respectively (Table 1). The early
severe irritative complications were slightly
more frequent in the TURis-PVP group
(Table 1). The pathological analysis confirmed
the BPH diagnosis in all cases, with no
associated malignancy.
At the 1 month follow-up improvements in all
the measured variables were better in the
TURis-PVP group than the TURP group
(Table 2). The differences remained stable and
significant in all regards at the 3- and 6month follow-ups At the 6-month evaluation
of prostate volume by TRUS there were similar
improvements for patients from both series,
consisting of a decrease in prostate volume of
70.1% for TURis-PVP and 66.8% for TURP
(Table 2). The PSA level measured at 1, 3 and 6
months also displayed a similar response in
the two groups (Table 2).
DISCUSSION
Despite conventional monopolar TURP
remaining the first-line treatment option for
prostates of 30–80 mL, plasma energy in a
saline environment is mentioned in the EAU
Guidelines 2009 as a viable alternative [3].
The basis of TURis-PVP is represented by the
ability of the UES-40 bipolar electrosurgical
generator to produce a plasma corona on the
surface of the spherical shape ‘mushroom’
type electrode. Plasma vaporization occurs by
direct gentle contact with the tissue surface
and performs concomitant haemostasis
(Fig. 4).
Subjectively, this type of vaporization does
not alter the visual characteristics of the
tissues, enabling the surgeon to differentiate
the adenomatous tissue, the muscular fibres
of the prostatic capsula and the anatomical
boundaries of the operating area with
increased accuracy. Due to the lack of
bleeding, visibility remains excellent
throughout the procedure. The vaporization
area emphasizes a remarkably smooth surface
and sharp margins, with no irregularities
or debris and no supplementary thermal
lesions of the subjacent tissue (Fig. 5). The
postoperative aspects of the prostatic fossa
revealed a large passage, without obstruction,
in every case (Fig. 6).
Some of the stages of conventional TURP
were significantly reduced (concomitant
vaporization and haemostasis, quick
evacuation of the few resected tissue
fragments), with the actual vaporization
2010 THE AUTHORS
JOURNAL COMPILATION
©
2010 BJU INTERNATIONAL
1697
G E AV L E T E ET AL.
FIG. 5. Smooth surface of the prostatic capsula after
plasma vaporization.
TABLE 2 Results at the 1-, 3- and 6-months follow-ups
Results, mean (range)
IPSS
1 month
3 months
6 months
HRQL
1 month
3 months
6 months
Qmax, mL/s
1 month
3 months
6 months
PVR, mL
1 month
3 months
6 months
Prostate volume, mL
6 months
PSA level, ng/mL
1 month
3 months
6 months
TURis-PVP
TURP
P
4.4 (1–8)
4.8 (1–9)
5 (1–9)
8.3 (2–14)
8.6 (3–16)
9.1 (3–17)
Lower Urinary Tract
2010 BJU INTERNATIONAL
TURis-PVP VS STANDARD TURP FOR BPE
GEAVLETE
et al.
BJUI
Transurethral resection (TUR) in saline plasma
vaporization of the prostate vs standard TUR of
the prostate: ‘the better choice’ in benign
prostatic hyperplasia?
BJU INTERNATIONAL
Bogdan Geavlete, Razvan Multescu, Mihai Dragutescu, Marian Jecu,
Dragos Georgescu and Petrisor Geavlete
Department of Urology, ‘Saint John’ Emergency Clinical Hospital, Bucharest, Romania
Accepted for publication 29 January 2010
Study Type – Therapy (RCT)
Level of Evidence 1b
OBJECTIVE
To evaluate the efficiency, safety and shortterm outcome of transurethral resection in
saline plasma vaporization of the prostate
(TURis-PVP), and to compare it to the
standard TUR of the prostate (TURP).
PATIENTS AND METHODS
In all, 155 patients with benign prostatic
enlargement (BPE) secondary to benign
prostatic hyperplasia (BPH), with a maximum
urinary flow rate (Qmax) of 19 and prostate volume of 30–80 mL
were enrolled in this prospective,
INTRODUCTION
BPH represents an important health
problem in contemporary society and is
the most common disease in male
urological pathology, with a prevalence of
60% for patients aged 61–70 years, 70%
for those aged 71–80 years and 80% for
those aged >80 years [1,2]. Although
benign, this disease with progressive
evolution has a negative impact on the
health-related quality of life (HRQL) of the
patients, marked by obstructive and
irritative LUTS. Surgical treatment for
benign prostatic enlargement (BPE)
continues to represent the second most
frequent major surgical procedure in older
©
randomized trial. All patients were evaluated
preoperatively and at 1, 3 and 6 months after
surgery by IPSS, health-related quality of life
(HRQL) score, Qmax and postvoid residual
urine volume (PVR).
and the Qmax was 22.3 vs 20.0 mL/s at 3
months; and the IPSS was 5 vs 9.1 and the
Qmax was 21.8 vs 19.3 mL/s at 6 months (All
P < 0.05).
RESULTS
CONCLUSIONS
Patients from both series had similar
preoperative characteristics. TURis-PVP and
TURP were successfully performed in all
cases (75 and 80, respectively). The operative
duration, catheterization period and hospital
stay were significantly shorter for TURis-PVP
patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and
47.6 vs 93.1 h, respectively (all P < 0.05).
At the 1, 3 and 6 months follow-ups,
improvements in the variables measured
were better in the TURis-PVP group: the IPSS
was 4.4 vs 8.3 and the Qmax was 22.7 vs
20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6
TURis-PVP represents a valuable endoscopic
treatment alternative for patients with BPE,
with superior efficacy, short-term results
and complication rates compared with
monopolar TURP.
men, with three out of 10 men undergoing
such an intervention.
consist of bleeding, sepsis and TUR syndrome
from fluid absorption.
The BPE endoscopic approach has used
various therapeutic methods. According to
the European Association of Urology (EAU)
Guidelines 2009, monopolar TURP is the
treatment of choice for prostates sized
30–80 mL [3]. However, this ‘gold-standard’
is marred by a significant morbidity and
mortality rate, at 18% and 0.2%, respectively
[4].
Bipolar electrosurgical technology made
transurethral electro-vaporization
increasingly popular, especially after the
development of the Gyrus® PlasmaKinetic®
Tissue Management System (Gyrus Medical
Ltd, Bucks, UK). This technique had already
proved to be as effective as TURP for BOO, as
it provided good long-term results and
implied fewer early complications [5].
Recently, several alternatives have been
introduced, aiming to improve the
performances of TURP and to reduce its
associated complications, which mainly
A new development of this technique, the
TURis®-PVP using the Olympus® UES-40
Surgmaster generator (Olympus, Tokyo,
Japan) and the ‘mushroom’ vapo-resection
KEYWORDS
transurethral resection in saline plasma
vaporization of the prostate, transurethral
resection of the prostate, benign prostatic
hyperplasia
2010 THE AUTHORS
JOURNAL COMPILATION
©
2 0 1 0 B J U I N T E R N A T I O N A L | 1 0 6 , 1 6 9 5 – 1 6 9 9 | doi:10.1111/j.1464-410X.2010.09433.x
1695
G E AV L E T E ET AL.
FIG. 1. Initial aspect at the beginning of the TURisPVP.
FIG. 2. Bladder neck (left) and median lobe (right) plasma vaporization.
electrode was recently introduced in clinical
practice.
FIG. 3. Plasma vaporization of the anterior region of the prostate (left) and haemostasis (right).
In the present study, we aimed to evaluate the
efficiency, safety and short-term results of
this new procedure and to compare it to
standard TURP.
PATIENTS AND METHODS
A prospective, randomized study was
performed to compare the short-term
outcome of TURis-PVP and conventional
TURP in patients with BPE with indications for
surgery. The study was approved by the Local
Ethics and Research Committee. In all, 155
patients with a mean (range) age of 66 (53–
81) years diagnosed with BPE and severe LUTS
were enrolled (under approved written
informed consent properly explaining the
aims, methods, anticipated benefits, potential
hazards and any other aspect of the study
relevant to the patient’s decision to
participate) and randomized by means of
sealed envelopes containing consecutive
numbers. In accordance with the informed
consent, all patients were ‘blinded’ to
treatment.
The inclusion criteria were represented by: a
maximum urinary flow rate (Qmax) of 19 and a prostate volume
(measured by TRUS) of 30–80 mL. The
exclusion criteria consisted of: severe
comorbidities, previous prostate surgery,
history of prostate cancer, abnormal DRE and/
or increased PSA level.
A standard investigative protocol, which
included general clinical examination with
DRE, blood tests, PSA level measurement,
urine culture, IPSS, HRQL, uroflowmetry
1696
(evaluating Qmax) and abdominal
ultrasonography was applied in all cases. All
patients received spinal anaesthesia and were
operated on by the same surgeon after
randomization.
During the follow-up, both the patients as
well as the urologists performing the
investigations were unaware of the treatment
method applied in each case, to assure
complete objectivity of the evaluation.
Conventional TURP was performed in 80 cases
using a 26 F Storz continuous flow monopolar
resectoscope with a single wire loop and
sterile water as irrigation fluid.
The 1, 3 and 6 months follow-ups assessed
the IPSS, HRQL, Qmax and postvoid residual
urine volume (PVR) in all patients, and
compared them between the series.
TURis-PVP, using the Olympus SurgMaster
UES-40 bipolar generator, the special
‘mushroom’ type vapo-resection electrode
and saline continuous flow irrigation was
performed in 75 patients (Fig. 1). The
spherical shape of the new type of electrode
displaying a plasma corona on its surface was
gradually moved into direct contact with the
BPE tissue (the ‘hovering’ technique), thus
producing a virtually blood-less vaporization
at 280–320 W (Fig. 2). Several prostatic
fragments were resected for pathological
analysis. Coagulation of any haemorrhagic
sources was practically concomitant, while
larger vessels’ haemostasis was achieved by
reducing the power of the generator to
120–140 W (Fig. 3). In all cases, a 20 F Foley
catheter was placed at the end of the
procedure.
For statistical analysis of the data the
Student’s t-test and the chi-squared tests
were used, with P < 0.05 considered to
indicate statistical significance.
RESULTS
Table 1 shows the characteristics of the
patients before surgery, which were similar
between the groups.
TURis-PVP and TURP were successfully
performed in all cases. Capsular perforation
(P = 0.037) and significant intraoperative
bleeding (P = 0.013) were more frequent
during TURP (Table 1). The operative duration
(P = 0.002), catheterization period (P =
0.002) and hospital stay (P = 0.012) were
©
JOURNAL COMPILATION
©
2010 THE AUTHORS
2010 BJU INTERNATIONAL
TURis-PVP VS STANDARD TURP FOR BPE
TABLE 1 The preoperative and operative characteristics and complication rates
Variable
No. of patients
Preoperative
Mean (range):
Prostate volume, mL
IPSS
HRQL
Qmax, mL/s
PVR, mL
Haemoglobin level, g/dL
PSA level, ng/mL
Operative
n/N (%)
Capsular perforation
Intraoperative bleeding
Mean (range):
Haemoglobin decrease, g/dL
Operative duration, min
Catheterization time, h
Hospital stay, h
Complications
n/N (%):
Haematuria
Blood transfusion
Clot retention
UTI
Re-hospitalization:
Secondary haemorrhage
Acute urinary retention
Dysuria
Urgency
Frequency
TURis-PVP
75
TURP
80
P
56.2 (32–79)
24.2 (21–32)
4.4 (3–5)
6.2 (4.2–9.1)
84.8 (0–165)
13.9 (11.5–14.9)
1.82 (0.55–3.7)
55.8 (31–78)
24.4 (20–32)
4.2 (3–5)
6.3 (4.3–9.5)
85.3 (0–176)
14.2 (11.9–15.1)
1.85 (0.42–3.54)
0.47
0.595
0.507
0.878
0.712
0.106
0.501
1/75 (1.33)
2/75 (2.66)
7/80 (8.75)
11/80 (13.75)
0.037
0.013
0.6 (0.1–1.3)
35.1 (18–56)
23.8 (18–36)
47.6 (24–72)
1.5 (0.3–2.2)
50.4 (24–78)
71.2 (48–96)
93.1 (72–120)
0.002
0.002
0.002
0.018
13/80 (16.25)
5/80 (6.25)
4/80 (5)
9/80 (11.25)
0.012
0.028
0.049
0.561
2/80 (2.5)
2/80 (2.5)
5/80 (6.25)
4/80 (5)
4/80 (5)
0.167
0.600
0.416
0.052
0.278
3/75 (4)
0
0
6/75 (8)
0
1/75 (1.33)
7/75 (9.33)
4/75 (5.33)
5/75 (6.66)
FIG. 4. Left (left) and right (right) prostatic lobes vaporization by the plasma corona produced by the
‘mushroom’ type electrode.
significantly shorter for TURis-PVP than for
standard TURP and monopolar TURP caused a
higher decrease of the haemoglobin level (P =
0.002; Table 1).
The rate of complications represented by
haematuria, UTIs and re-hospitalization for
©
acute urinary retention was higher for the
TURP than for TURis-PVP (Table 1). Blood
transfusion necessity, clot retention and rehospitalization for secondary haemorrhage
only occurred in the TURP group, with a rate
of 6.25% (P = 0.028), 5% (P = 0.049) and 2.5%
(P = 0.167), respectively (Table 1). The early
severe irritative complications were slightly
more frequent in the TURis-PVP group
(Table 1). The pathological analysis confirmed
the BPH diagnosis in all cases, with no
associated malignancy.
At the 1 month follow-up improvements in all
the measured variables were better in the
TURis-PVP group than the TURP group
(Table 2). The differences remained stable and
significant in all regards at the 3- and 6month follow-ups At the 6-month evaluation
of prostate volume by TRUS there were similar
improvements for patients from both series,
consisting of a decrease in prostate volume of
70.1% for TURis-PVP and 66.8% for TURP
(Table 2). The PSA level measured at 1, 3 and 6
months also displayed a similar response in
the two groups (Table 2).
DISCUSSION
Despite conventional monopolar TURP
remaining the first-line treatment option for
prostates of 30–80 mL, plasma energy in a
saline environment is mentioned in the EAU
Guidelines 2009 as a viable alternative [3].
The basis of TURis-PVP is represented by the
ability of the UES-40 bipolar electrosurgical
generator to produce a plasma corona on the
surface of the spherical shape ‘mushroom’
type electrode. Plasma vaporization occurs by
direct gentle contact with the tissue surface
and performs concomitant haemostasis
(Fig. 4).
Subjectively, this type of vaporization does
not alter the visual characteristics of the
tissues, enabling the surgeon to differentiate
the adenomatous tissue, the muscular fibres
of the prostatic capsula and the anatomical
boundaries of the operating area with
increased accuracy. Due to the lack of
bleeding, visibility remains excellent
throughout the procedure. The vaporization
area emphasizes a remarkably smooth surface
and sharp margins, with no irregularities
or debris and no supplementary thermal
lesions of the subjacent tissue (Fig. 5). The
postoperative aspects of the prostatic fossa
revealed a large passage, without obstruction,
in every case (Fig. 6).
Some of the stages of conventional TURP
were significantly reduced (concomitant
vaporization and haemostasis, quick
evacuation of the few resected tissue
fragments), with the actual vaporization
2010 THE AUTHORS
JOURNAL COMPILATION
©
2010 BJU INTERNATIONAL
1697
G E AV L E T E ET AL.
FIG. 5. Smooth surface of the prostatic capsula after
plasma vaporization.
TABLE 2 Results at the 1-, 3- and 6-months follow-ups
Results, mean (range)
IPSS
1 month
3 months
6 months
HRQL
1 month
3 months
6 months
Qmax, mL/s
1 month
3 months
6 months
PVR, mL
1 month
3 months
6 months
Prostate volume, mL
6 months
PSA level, ng/mL
1 month
3 months
6 months
TURis-PVP
TURP
P
4.4 (1–8)
4.8 (1–9)
5 (1–9)
8.3 (2–14)
8.6 (3–16)
9.1 (3–17)