PURPOSE: To report the 5-year follow-up results of a randomized controlled trial comparing bipolar transurethral resection of the prostate (TURP) with standard monopolar TURP for the treatment of benign prostatic obstruction (BPO). MATERIALS AND METHODS: A total of 220 patients were randomized to bipolar plasmakinetic TURP (PK-TURP) or monopolar TURP (M-TURP). Catheterization time was the primary endpoint of this study. Secondary outcomes included operation time, hospital stay, as well as decline in postoperative serum sodium and hemoglobin levels. All patients were assessed preoperatively and followed-up at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Parameters assessed included quality of life, transrectal ultrasound, serum prostate-specific antigen level, postvoid residual urine volume, maximum urinary flow rates (Qmax), and International Prostate Symptom Score. Patient baseline characteristics, perioperative data including complications, and postoperative outcomes were compared. Complication occurrence was graded according to the modified Clavien classification system. RESULTS: PK-TURP was significantly superior to M-TURP in terms of operation time, intraoperative irrigation volume, resected tissue weight, decreases in hemoglobin and sodium, postoperative irrigation volume and time, catheterization time, and hospital stay. At 5 years postoperatively, efficacy was comparable between arms. No differences were detected in safety outcomes except that the clot retention rate was significantly greater after M-TURP. CONCLUSION: Our results indicate that PK-TURP is equally as effective in the treatment of BPO, but has a more favorable safety profile in comparison to M-TURP. The clinical efficacy of PK-TURP is long-lasting and comparable with M-TURP.
Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostate/*surgery ; Transurethral Resection of Prostate/adverse effects/*methods ; Treatment Outcome

BACKGROUNDTransurethral resection of prostate (TURP) has been considered as the standard treatment for benign prostatic hyperplasia (BPH). However, issues that have not yet been overcome for TURP include bleeding and absorption of irrigation fluid. Thus, novel improvement of the surgery is necessary. This study aimed to evaluate the efficacy and safety of bipolar plasma vaporization of the prostate (BPVP) with "button-type" electrode against standard TURP for BPH.

METHODSFrom January 2009 to January 2012, 30 patients who scheduled for surgical treatment of BPH surgical treatment were enrolled in the trial with provided consent for the study. Patients were prospectively randomized 1:1 to undergo either BPVP or TURP. Participants were blinded to the randomization scheme. All cases were assessed preoperatively and followed at 1, 3, and 6 months postoperatively by indwelling catheter time, blood loss, hospital stays, International Prostate Symptom Score (IPSS), quality of life (QOL), and Qmax.

RESULTSBPVP was significantly superior to TURP in terms of indwelling catheter time ((4.1 ± 4.1) days vs. (6.8 ± 6.8) days, P = 0.000), blood loss ((64.7 ± 103.8) ml vs. (254.7 ± 325.4) ml, P = 0.040), hospital stay ((8.7 ± 1.0) days vs. (11.7 ± 1.5) days, P = 0.000), IPSS ((4.2 ± 8.0) vs. (9.3 ± 3.7), P = 0.049), QOL ((1.5 ± 0.8) vs. (2.6 ± 1.4), P = 0.027), Qmax ((16.3 ± 5.7) ml/s vs. (12.5 ± 3.1) ml/s, P = 0.038), hemoglobin ((130.7 ± 9.4) g/L vs. ((122.1 ± 11.9) g/L, P = 0.047), Na(+) level ((138.6 ± 2.1) mmol/L vs. ((137.2 ± 2.0) mmol/L, P = 0.046) and operation time ((39.0 ± 15.5) minutes vs. ((69.3 ± 24.8) minutes, P = 0.004). And there were no statistical differences between BPVP group and TURP group in preoperatively assessment: patient's age ((70.9 ± 7.1) years vs. (71.9 ± 6.1) years, P = 0.736), IPSS ((24.6 ± 4.7) vs. (27.3 ± 5.9), P = 0.100), QOL ((5.1 ± 0.8) vs. (5.1 ± 1.0), P = 0.940), Qmax ((4.4 ± 2.7) ml/s vs. (5.3 ± 2.6) ml/s, P = 0.314), hemoglobin ((137.4 ± 8.7) g/L vs. (139.2 ± 10.4) g/L, P = 0.623), Na(+) level ((140.5 ± 1.8) mmol/L vs. (141.3 ± 1.4) mmol/L, P = 0.192) and prostate volume ((59.0 ± 17.4) ml vs. (70.1 ± 28.8) ml, P = 0.276).

CONCLUSIONSCompared with TURP, BPVP with "button-type" electrode shows superior efficacy and safety. Therefore, BPVP with "button-type" electrode represents a valuable endoscopic treatment alternative for BPH patients.

Aged ; Aged, 80 and over ; Electrodes ; Humans ; Laser Therapy ; adverse effects ; methods ; Male ; Middle Aged ; Prospective Studies ; Prostate ; surgery ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; adverse effects ; methods

OBJECTIVETo compare the impacts of transurethral resection of the prostate (TURP), transurethral electrovaporization of the prostate (TUEVP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) on male sexual function.

METHODSWe identified randomized controlled trials on the influence of TURP, TUEVP and HoLEP on the sexual function of BPH patients, and performed meta-analysis on the included data using Revman 5.0.25.

RESULTSNine randomized controlled trials involving 1 050 BPH patients were included in the meta-analysis. The baseline of the study was comparable. TURP affected erectile function less than TUEVP (P = 0.04), but the two had no significant difference in their influence on ejaculatory function. Nor was any significant difference found between HoLEP and TURP in their influence on either erectile or ejaculatory function at 12 and 24 months after surgery.

CONCLUSIONTUEVP induces a higher incidence of erectile dysfunction than TURP, but its influence on ejaculatory function is not significantly different from the latter. HoLEP and TURP have no significant difference in their influence on erectile function and ejaculatory function.

Erectile Dysfunction ; etiology ; Humans ; Male ; Prostatic Hyperplasia ; surgery ; Randomized Controlled Trials as Topic ; Transurethral Resection of Prostate ; adverse effects ; methods

OBJECTIVETo assess the influence of photoselective vaporization of the prostate (PVP) on the erectile function of the patient with benign prostatic hyperplasia (BPH).

METHODSUsing IIEF-5, we conducted a questionnaire investigation among 210 BPH patients before and after treated by PVP (n = 80) and transurethral resection of the prostate (TURP, n = 130). We also reviewed the clinical data and compared the pre- and post-operative penile erectile function between the two groups of patients.

RESULTSFollow-up was completed in 76 cases of PVP and 123 of TURP. The baseline data showed no statistically significant differences between the two groups in age, prostate volume, IPSS, QOL, Qmax, post void urine residual volume and IIEF-5 scores (P>0.05). Compared with the IEFF-5 score at the baseline (21.88 +/- 2.46), those at 3, 6 and 12 months after PVP were 16.72 +/- 3.17, 19.34 +/- 2.46 and 19.29 +/- 2. 18, respectively, significantly decreased at 3 months (P = 0.042), but with no remarkable difference at 6 and 12 months (P >0.05). Nor were there significant differences in the IIEF-5 score between the PVP and TURP groups at any time points (P>0.05). At 6 months after surgery, the incidence rates of erectile dysfunction were 11.7% and 13.7% in the TURP and PVP groups, respectively (P>0.05).

CONCLUSIONPVP may reduce erectile function in some cases in the early stage after surgery, but this adverse effect does not last long and is basically similar to that of TURP.

Humans ; Laser Therapy ; adverse effects ; methods ; Male ; Penile Erection ; Prostatic Hyperplasia ; physiopathology ; surgery ; Surveys and Questionnaires ; Transurethral Resection of Prostate ; adverse effects ; Treatment Outcome

OBJECTIVETo analyze the causes of non-improvement after different procedures of prostatectomy.

METHODSUsing the urodynamics and other techniques, we examined 84 non-improved patients who had undergone different procedures of prostatectomy.

RESULTSIn the TURP group, the main causes of non-improvement included bladder outlet obstruction (84.9%), weak contractility of the detrusor (30.4%), and detrusor instability (DI) (18.2%). In the open group, however, the main causes of non-improvement included detrusor weak contractility (52.9%), DI (35.2%), and bladder outlet obstruction (33.3%). There was significant difference between the two groups according to the Pearson Chi-square test (P = 0.000). The re-obstruction rate in the TURP group was much higher than that in the open group, suggesting that the level of the TURP should be improved.

CONCLUSIONSDifferent operative procedures yield different non-improvement after prostatectomy gradually. When BPH patients are diagnosed with detrusor weak contractility and DI, prostatectomy should be carefully considered.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostatectomy ; adverse effects ; methods ; Prostatic Hyperplasia ; physiopathology ; surgery ; Retrospective Studies ; Transurethral Resection of Prostate ; adverse effects ; Urodynamics

The purpose of the present study was to evaluate the efficacy and safety of bipolar transurethral prostatectomy (TURP) using the GyrusTM PlasmaKinetic System compared with conventional monopolar TURP. This study included 102 patients with benign prostatic hyperplasia (BPH) who underwent TURP from January 2003 to March 2005. In all, 49 consecutive patients had bipolar and 53 had monopolar TURP. All patients were assessed by preoperative and postoperative International Prostate Symptom Score (IPSS), uroflowmetry, transrectal ultrasonography, operative time, weight of resected tissue, change in serum sodium and hemoglobin, duration of catheter use, length of hospital stay, and complication rates. Significant improvement was seen postoperatively in both groups, and no difference was observed in the resection time, weight of resected tissue, change in serum sodium and hemoglobin, improvement of IPSS and peak flow rate (Qmax), or complication rates over the 12-month follow-up in both groups. There was, however, a significant difference in duration of catheter use and hospital stay. Duration of catheter use (2.28 days vs. 3.12 days) and hospital stay (3.52 days vs. 4.27 days) were shorter in the bipolar group (p = 0.012 vs. p = 0.034, respectively). Our results demonstrate that bipolar TURP using the Gyrus(TM) Plasma Kinetic System is as effective as conventional monopolar TURP with the additional advantage of reduced length of catheter use and hospital stay. Bipolar TURP is a promising new technique that may prove to be a good alternative to conventional TURP in the future.
Treatment Outcome ; Transurethral Resection of Prostate/adverse effects/*instrumentation/methods ; Prostatic Hyperplasia/*surgery ; Prostate/*surgery ; Middle Aged ; Male ; Humans ; Follow-Up Studies ; Equipment and Supplies/standards ; Aged

OBJECTIVETo study the causes, clinical manifestations, treatment and prevention of calculus that develops in the prostatic cavity after transurethral resection of the prostate.

METHODSWe reported 11 cases of calculus that developed in the prostatic cavity after transurethral resection or transurethral plasmakinetic resection of prostate. The patients complained of repeated symptoms of frequent micturition, urgent micturition and urodynia after operation, accompanied with urinary tract infection and some with urinary obstruction, which failed to respond to anti-infective therapies. Cystoscopy revealed calculi in the prostatic cavity, with eschar, sphacelus, uneven wound surface and small diverticula in some cases. After diagnosis, 1 case was treated by holmium laser lithotripsy and a second transurethral resection of the prostate, while the other 10 had the calculi removed under the cystoscope, followed by 1 -2 weeks of anti-infective therapy.

RESULTSAfter treatment, all the 11 cases showed normal results of routine urinalysis, and no more symptoms of frequent micturition, urgent micturition and urodynia. Three- to six-month follow-up found no bladder irritation symptoms and urinary tract infection.

CONCLUSIONRepeated symptoms of frequent micturition, urgent micturition, urodynia and urinary tract infection after transurethral resection of the prostate should be considered as the indicators of calculus in the prostatic cavity, which can be confirmed by cystoscopy. It can be treated by lithotripsy or removal of the calculus under the cystoscope, or even a second transurethral resection of the prostate. For its prevention, excessive electric coagulation and uneven wound surface should be avoided and anti-infection treatment is needed.

Aged ; Humans ; Male ; Middle Aged ; Prostatic Diseases ; etiology ; prevention & control ; therapy ; Transurethral Resection of Prostate ; adverse effects ; methods ; Urinary Calculi ; etiology ; prevention & control ; therapy

OBJECTIVETo compare the incidence rates of postoperative urinary incontinence between transurethral bipolar plasmakinetic enucleation and resection of the prostate (PKERP) and transurethral bipolar plasmakinetic resection of the prostate (PKRP), and provide evidence for the clinical application of PKERP.

METHODSTotally, 180 BPH patients were equally and randomly assigned to undergo PKERP and PKRP, respectively. We measured the urinary incontinence of the patients by pad test at 24 hours after extubation and every week after surgery for 4 weeks. Meanwhile, we recorded and compared the PSA level, prostate volume, Qmax, residual urine, IPSS, QOL, and the results of pad test between the two groups before and after surgery.

RESULTSThe incidence rates of urinary incontinence in the PKERP and PKRP groups were 35.56% and 18.89% (P < 0.01) at 24 hours after extubation, 20.00% and 7.78% at 1 week after surgery (P < 0.05), and 3.33% and 2.22% at 2 weeks. There was no significant difference in the severity of urinary incontinence between the two groups at any time point (P > 0.05). No permanent urinary incontinence was observed in either group.

CONCLUSIONCompared with PKRP, PKERP has a higher incidence rate of short-term urinary incontinence in the treatment of BPH, but not that of genuine incontinence, with similar severity and recovery time.

Aged ; Humans ; Incidence ; Male ; Postoperative Complications ; epidemiology ; Prostatic Hyperplasia ; surgery ; Single-Blind Method ; Transurethral Resection of Prostate ; adverse effects ; methods ; Urinary Incontinence ; epidemiology

Objective: To compare the safety and effectiveness of shovel-shaped electrode transurethral plasmakinetic enucleation of the prostate (PKEP) with those of plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostatic hyperplasia (BPH). METHODS: We retrospectively analyzed the clinical data about 78 BPH patients received in Shanghai Ninth People's Hospital from June 2016 to January 2017, 39 treated by shovel-shaped electrode PKEP and the other 39 by PKRP. We observed the patients for 6 months postoperatively and compared the effects and safety of the two surgical strategies. RESULTS: No statistically significant difference was observed between the PKEP and PKRP groups in the operation time (［69.3 ± 8.8］ vs ［72.2 ± 7.9］ min, P = 0.126), but the former, as compared with the latter, showed a markedly less postoperative loss of hemoglobin (［3.9 ± 2.8］ vs ［13.9 ± 5.2］ g/L, P <0.001) and shorter bladder irrigation time (［12.5 ± 1.2］ vs ［43.4 ± 2.8］ h, P <0.001), catheterization time (［64.0 ± 4.5］ vs ［84.8 ± 3.0］ h, P <0.001) and hospital stay (［3.1 ± 0.3］ vs ［5.5 ± 0.4］ d, P <0.001). There were no statistically significant differences between the PKEP and PKRP groups in the postoperative maximum urinary flow rate (Qmax) (［21.62 ± 1.07］ vs ［21.03 ± 0.96］ ml/s, P = 0.12), International Prostate Symptoms Score (IPSS) (5.85 ± 0.90 vs 6.03 ± 0.81, P = 0.279), quality of life score (QoL) (2.0 ± 0.73 vs 2.28 ± 0.72, P = 0.09), postvoid residual urine volume (PVR) (［19.59 ± 6.01］ vs ［20.21 ± 5.16］ ml, P = 0.629), or the incidence rates of urinary incontinence (2.56% ［1/39］ vs 7.69% ［3/39］, P >0.05) and other postoperative complications. CONCLUSIONS Both PKEP and PKRP are effective methods for the treatment of BPH, but PKEP is worthier of clinical recommendation for a better safety profile, more thorough removal of the prostate tissue, less blood loss, shorter hospital stay, and better improved quality of life of the patient.
China ; Electrodes ; adverse effects ; Equipment Design ; Humans ; Male ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Retrospective Studies ; Transurethral Resection of Prostate ; instrumentation ; methods ; Treatment Outcome

OBJECTIVE: To investigate the effect of transurethral resection of prostate (TURP) on the quality of life in aged patients with benign prostatic hyperplasia(BPH). METHODS: Altogether 358 BPH patients were evaluated by International Prostate Symptom Score (IPSS), the 5-Item Version of the International Index of Erectile Function (IIEF-5),Quality of Life Scale (QOLS) questionnaires, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS),residual urine volume (RUV), and maximum flow rate(Qmax) before and at 3 months after they underwent TURP. RESULTS: The mean scores of IPSS, QOLS, SAS, and SDS, and mean RUV decreased, and mean Qmax increased significantly at 3 months after receiving operation compared with those before the treatment in aged patients with BPH. But no significant difference was found in the scores of IIEF-5 between post-operation and pre-operation. CONCLUSION TURP may alleviate BPH clinical symptoms and improve quality of life, but may not be helpful to the recovery of sexual function in aged patients with BPH.
Aged ; Aged, 80 and over ; Erectile Dysfunction ; etiology ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Transurethral Resection of Prostate ; adverse effects ; methods