The 'Wing' versus the 'Vapor Cut' electrodes in transurethral electrovaporization-resection of the prostate: comparative changes in safety parameters

Change in intraoperative rectal temperature influencing erectile dysfunction following transurethral resection of the prostate

BACKGROUND/PURPOSE

In this study, we assessed the relationship between changes in intraoperative rectal temperature and erectile function in patients who have undergone transurethral resection of the prostate.

METHODS

Eighty-six potential patients with benign prostatic hyperplasia-induced lower urinary tract symptoms were studied. Patients were divided into two groups: group 1-small prostates (<40 ml) and group 2-large prostates (≥ 40 ml), as determined by transrectal ultrasound measurement. The intraoperative rectal temperature was evaluated using a transrectal thermosensor and the differences between the highest intra- and preoperative temperatures were recorded. The erectile function at baseline, at three months and at one-year postoperatively was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire.

RESULTS

Intraoperative rectal temperature differences were 0.54 ± 0.24°C for group 1 (n=45) and 0.44 ± 0.20°C for group 2 (n=41), (p=0.04). The IIEF-5 scores for group1 and group 2 were, respectively, 20.9 ± 1.6 and 20.6 ± 1.6 at baseline (p=0.32), 17.3 ± 2.9 and 18.7 ± 3.2 (p=0.037) at 3 months, 17.9 ± 2.7 and 18.7 ± 3.0 (p=0.17) at 1 year postoperatively. The deterioration of erectile function at 3 months post-operatively was observed for both groups. The percentage of retrograde ejaculation between two groups was not significantly different (p=0.33) at 1 year postoperatively.

CONCLUSION

Our study revealed that a higher intraoperative rectal temperature difference caused by transurethral resection of the prostate might affect the postoperative erectile function, particularly in patients with a small prostate.

Transurethral RollerLoop vapor resection of prostate for treatment of symptomatic benign prostatic hyperplasia: a 2-year follow-up study

OBJECTIVE

We compared the 2-year safety and efficacy of two transurethral resection techniques-transurethral vapor resection of the prostate (TUVRP) and conventional loop transurethral resection of the prostate (TURP)-in the surgical management of benign prostatic hyperplasia.

MATERIAL AND METHODS

Between August 1997 and September 2002, 441 patients underwent transurethral prostatectomy, either TUVRP (n = 221) or TURP (n = 220). TUVRP was performed using a "RollerLoop" resection loop. All patients were assessed preoperatively by means of International Prostate Symptom Score (IPSS), quality of life (QOL) score, prostate volume, peak urinary flow (Qmax) and post-void residual volume (PVR) measurements and a sexual function questionnaire. Patients were followed up for 3, 6, 12 and 24 months after surgery, and this was followed by a comparison of the incidences of sexual dysfunction, complications and re-treatment.

RESULTS

After 2 years of follow-up, no differences were noted between the TUVRP and TURP groups with respect to average IPSS (p = 0.9), QOL scores (p = 0.56), Qmax (p = 0.89) or PVR (p = 0.55), as well as the incidences of bladder neck contracture or urethral stricture (p = 0.34), re-treatment (p = 0.49) or sexual dysfunction (p = 0.57). However, significant reductions in operative time (p = 0.005), decrease in serum hemoglobin levels (p < 0.001), catheterization time (p < 0.001), postoperative hospital stay (p < 0.001) and hospitalization costs (p < 0.001) were observed in the TUVRP group compared to the TURP group.

CONCLUSION

Our results suggest that TUVRP provides equivalent safety and efficacy to TURP during a 2-year follow-up period, in which short-term advantages in perioperative morbidity and cost savings were also demonstrated.

Vapor resection: a good alternative to standard loop resection in the management of prostates >40 cc

BACKGROUND AND PURPOSES

The morbidity of transurethral vesection of the prostate (TURP) necessitates constant attempts at modifications to the standard equipment and technique. Patients with larger prostates (>40 cc) need a longer time for the procedure, and the blood loss, requirement for irrigation fluid, and incidence of postoperative complications tend to be greater. We report on the safety and efficacy of TURP with the thick vapor resection loop compared with the standard wire loop in comparable groups of patients with prostates >40 cc.

PATIENTS AND METHODS

We randomized 100 patients with benign prostatic hyperplasia (BPH) into two groups of 50 each which were similar in age. The inclusion criteria included an indication for prostatectomy and prostate size >40 cc. Patients who were on finasteride preoperatively (six) and those who had histopathologic adenocarcinoma of the prostate (three) were excluded. Preoperative evaluation included assessment of International Prostate Symptom Score (IPSS), prostate volume by abdominal ultrasonography, maximum flow rate (Q(max)), and residual urine volume. The two groups were similar in the signs and symptoms of BPH. Patients in Group 1 underwent transurethral vapor resection of the prostate (TUVRP) using the vapor resection loop (Wing trade mark; Richard Wolf, Germany), while patients in Group 2 underwent TURP using a standard wire loop. All procedures were performed by consultant urologists with equivalent experience. We used a Martin ME 401 (Gebruder Martin, Tuttlingen, Germany) electrosurgical generator with settings of 120 to 150 Watts and 50 to 70 W for cutting and coagulating, respectively, for the thick loop and 70 to 80 W and 40 to 50 W for the standard loop. Operating time, resected tissue weight, duration of catheterization, nursing contact time, hospital stay, hemoglobin change, serum sodium concentrations, and any complications were noted and analyzed using the Kruskal-Wallis paired variables test, and P values were calculated. P value <0.04 was considered significant. The IPSS, Q(max), and residual urine volume were reevaluated at 6 months and 1 year after the procedure and compared for the two groups.

RESULTS

The median prostate volume was 63 cc and 54 cc in Groups 1 and 2, respectively, and the median resected weight was 20 and 19 g, respectively (P = NS). The differences in operating time (median 45 v 60 minutes; P < 0.0001), intraoperative irrigant use (15 v 21 L; P < 0.0001), and intraoperative blood loss (median 52.5 v 150 mL; P < 0.0001) in the two groups were statistically significant. Peroperative blood loss was estimated by the indicator dilution method of Freedman et al in three 5-mL samples of the irrigant fluid and arriving at the average of the three values and adjusted for the volume of irrigant fluid used. The differences in postoperative irrigant (P < 0.01) and catheter duration (P = 0.04) were also significant. Two patients received blood transfusion in Group 2 and none in Group 1. The difference in the change in hemoglobin and serum sodium postoperatively in the two groups was not statistically significant. The complications were dysuria in six patients lasting for a month and one capsular perforation in Group and incontinence lasting for 6 months in two patients and stricture in one patient in Group 2. The efficacy, assessed with IPSS, Q(max), and residual urine volume, was comparable at 6 months and at 1 year.

CONCLUSION

The use of a thick vapor resection loop for TURP coupled with higher generator settings as recommended for them, especially for prostates >40 cc, is beneficial, as it significantly reduces operating time, blood loss, irrigant requirement, nursing contact time, and duration of catheterization, besides providing clear vision during surgery and ease of resection. There was no reduction in efficacy or increase in complications.

Impact of interventional therapy for benign prostatic hyperplasia on quality of life and sexual function

Considering the epidemiologic impact of benign prostatic hyperplasia (BPH), the use of minimally invasive surgery in the treatment of this condition is one of the main ambitions of contemporary urology. Compared with the prevalence of BPH and LUTS in elderly men, only a small percentage of patients requires surgery for indications such as renal insufficiency, chronic retention, and infection. The majority of patients seek treatment because of the bothersome nature of their symptoms and expect improvement in their quality of life. The goal of interventional therapy is to restore the comfort and well being of the patients, including preserving their sexuality. Therefore, there is increased focus on the quality of life and sexual function in the evaluation of the outcome of interventional therapy for BPH.