Transurethral electrovaporization-resection of the prostate using the "wing" cutting electrode: preliminary results of safety and efficacy in the treatment of men with prostatic outflow obstruction.

OBJECTIVES

Transurethral vaporization-resection of the prostate (TUVRP) is a modification of the standard transurethral prostatectomy (TURP). The technique uses the "Wing" resection loop with electrovaporization current to achieve simultaneous resection, vaporization, and coagulation of prostatic tissue. We evaluate the early safety and efficacy results of TUVRP in the treatment of patients with prostatic outflow obstruction.

METHODS

The first 31 patients treated with TUVRP since September 1997 are reported. The group included 19 patients with urinary retention and 12 patients with lower urinary tract symptoms (LUTS). Patients with symptoms were assessed at baseline with the International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax). The same parameters were evaluated at 3 months for the entire group. Safety parameters included changes in serum hematocrit and sodium concentration, incidence of side effects, and changes in sexual function.

RESULTS

All patients with retention were voiding spontaneously with an IPSS of 3.9+/-3.1 and Qmax of 21.3+/-10.2 mL/s. In the patients who presented with LUTS, the IPSS decreased from 24.3+/-8.3 to 4.1+/-4.9 at 3 months and Qmax increased from 5.2+/-4.5 mL/s to 16+/-7.5 mL/s at 3 months (P <0.001). Mean resection weight was 27.9+/-18.4 g. Mean postoperative catheter time was 24.1 hours. Mean change in hematocrit concentration was 2.5 mL/dL and the change in sodium concentration was 0.8 mEq/L. Complications included 1 patient with a bladder neck contracture, 1 with a urethral stricture, and 1 with clot retention; 1 patient developed transurethral syndrome. No change in sexual function was noted in this group.

CONCLUSIONS

TUVRP is a promising new modification of TURP. This procedure combines the excellent debulking capabilities of TURP (with preservation of the entire specimen for histopathologic examination) and adds the benefits of electrovaporization, resulting in minimal blood loss and electrolyte disturbance.