Bipolar techniques show advantages in treating benign prostatic hyperplasia

Atlanta-Results from a prospective, randomized controlled clinical trial suggest that bipolar plasma vaporization of the prostate (BPVP) is a promising advance in the surgical treatment of BPH in men with average-size prostates.

Bogdan Geavlete, MD, PhD, the study's first author, reported that BPVP offered an improved surgical efficiency when compared with bipolar transurethral resection in saline (TURis) and monopolar transurethral resection of the prostate (TURP) and was associated with a faster postoperative recovery and better long-term outcomes. He attributed the superiority of BPVP to the large vaporization surface and excellent coagulation properties of the "button" vapo-resection electrode (PlasmaButton, Olympus, Center Valley, PA). In a separate study, he reported that those attributes provided a premise for using the device during bipolar enucleation of the prostate (BPEP), which showed promise as a safe, efficient BPH endoscopic treatment modality for large prostates.

Both studies were presented at the AUA annual meeting in Atlanta.

The perioperative safety data showed the BPVP study group benefited from significantly lower mean hemoglobin level decrease compared with TURis and TURP (0.5 g/dL vs. 1.2 g/dL and 1.6 g/dL), as well as lower rates of intraoperative bleeding (1.8% vs. 8.2% and 13.5%) and capsular perforation (1.2% vs. 7.1% and 9.4%). Rates of postoperative hematuria and blood transfusion were also reduced in the BPVP group (2.9% and 1.2%) and significantly lower than after TURP (15.3% and 6.5%). Mean duration of catheterization was 23.5 hours for BPVP and twofold and threefold longer after TURis and TURP, respectively. Mean hospital stay for the three groups was 1.9, 3.1, and 4.2 days.

"Some of these differences between groups may be explained by the excellent cauterization properties of the bipolar technique, which reduced bleeding and subsequently improved visualization," said Dr. Geavlete, assistant professor of urology at the St. John Emergency Clinical Hospital, Bucharest, Romania.

There were no significant differences among the BPVP, TURis, and TURP groups concerning rates of irritative symptoms after surgery (12.4%, 11.2%, and 10.6%). IPSS scores were significantly reduced in all groups and rose slightly over time. However, at all follow-ups, IPSS scores in the BPVP series were significantly lower than in the comparator arms, and Qmax values were also consistently superior after BPVP.