Bipolar plasma enucleation of the prostate (B-TUEP) in Benign Prostate Hypertrophy Treatment. Medium-term Results
Numerous endoscopic techniques have been described since Iglesias published the results of his modified resectoscope for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE),. Classic transurethral resection of the prostate (cTURP) has long been the accepted gold standard to treat symptomatic disease of prostates weighing 30-80g. A variety of therapeutic solutions and technical innovations have been developed to bring improvements to BOO endoscopic treatment. The plasma-button enucleation of the prostate (B-TUEP) is considered a successful treatment option mainly because the large surface creats the conditions for a fast enucleation process, continuous vaporization and concomitant haemostasis [Geavlete B, Stanescu F, Iacoboaie C, Geavlete P. Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases – a medium term, prospective, randomized comparison. BJU Int. 2013 May;111(5):793-803.]. Aim of this study was to assess safety, efficacy, and medium term durability of B-TUEP for the treatment of BOO due BPE.
Materials and Methods
Between July 2011 and March 2012, 50 consecutive patients underwent B-TUEP at our institution, by a single surgeon (R.G.). All patients were pre-operatively assessed with maximum urinary flow rate (Qmax), the single-question quality of life (QoL), International Prostate Symptoms Score (I.P.S.S.) and the International Index of Erectile Function (IIEF-5) questionnaires, Transrectal Ultrasound gland volume evaluation (TrUS), prostate-specific antigen (PSA)and post-voided residual of urine (PVR). Postoperativeparameters were evaluated and the patients were reassessed at 1-, 3-, 6-,12-, 18-, 24-, and 36-mo follow-up with the same examinations.
We observed a significant improvement occurred at 12, 24 and 36 months in terms of Qmax (22.3 ± 4.74 mL/s, 23.2 ± 0.30 mL/sec and 23.6 ± 1.26 mL/sec, respectively, p<0.01), and QoL (5.28±0.97, 5.69±0.90 and 5.73±0.87).IPSS and IEEF scores improved significantly (p<0.05). Gland volume evaluation and postvoid residual decreased (p<0.001). Prostate-specific postoperative antigen level was0.76±0.61 ng/mL, 0.7±0.51 ng/mL and 0.62±0.18 ng/mL, at 12, 24 and 36 months respectively Two patients (4 %) had persistent BOO and requiring reoperation. During the 36-month follow up five patients (10%), developed neoplasms and turned so lost.
After 3-yr follow-up, B-TUEP represents an effective, durable and safe surgical intervention. Voiding parameters such as Qmax, QoL score, IPSS, PVR improved significantly (p < 0.05) from baseline, starting from 3-mo after B-TUEP and continuing during the follow-up, until they reached a plateau that was stable up to the 36-mo visit.
The present report adds to the evidence that B-TUEP could be the alternative ‘‘size-independent’’ surgical treatment for symptomatic BPE-related BOO.