Transurethral electrovaporization of the prostate: is it any better than standard transurethral prostatectomy? 5-year follow-up.
BACKGROUND AND PURPOSE: At present, transurethral resection of the prostate (TURP) is regarded as the most effective treatment for benign prostate hyperplasia (BPH). In the present randomized study, we compared TURP with transurethral electrovaporization of the prostate (TUVP). PATIENTS AND METHODS: A series of 77 BPH patients who underwent operation between 1996 and 2001 were included in the study, 40 who had TURP with a standard resection loop and 32 who had TUVP with a Spike loop. All available patients were evaluated preoperatively, at 1 month and 3 months after the operation (N=73), and 5 years after the operation (N=44). The International Prostate Symptom Score (IPSS), sexual function questionnaire, uroflowmetry (Qmax), postvoiding residual urine volume (PVR), and transrectal ultrasonography were used. In addition, postoperative serum sodium concentration, serum hematocrit, duration of catheterization, and operation time were compared. RESULTS: In the TUVP group, the mean IPSS decreased from 17.3 to 6.5, the PVR from 88 to 35 mL, and the prostate volume from 39 to 24 cc, while the Qmax increased from 6.3 to 12.9 mL/sec and the average flow from 2.6 to 7.9 mL/sec. In the TURP group, the mean IPSS decreased from 17.6 to 6.1, the PVR from 95 to 38 mL, and the prostate volume from 38 to 23 cc, while the Qmax increased from 5.9 to 13.2 mL/sec and the average flow from 2.4 to 8.3 mL/sec. Thus, significant improvements were observed in both groups, and the differences between them 5 years later were not significant P>0.05). Postoperative serum hemoglobin and hematocrit were significantly lower in the TURP group (P>0.05). However, no difference was seen in serum sodium concentrations. Also, there was no difference in the duration of the operations. The catheterization period was 22+/-5.7 hours in the TUVP group, while it was 75.7+/-10.5 hours in the TURP group (P<0.001). When morbidities observed during follow-up were evaluated, no significant difference was seen. CONCLUSIONS: The TUVP procedure is as effective as TURP with similar morbidity. The advantages of TUVP are that the urethral catheter is withdrawn earlier, hospitalization is shorter, and bleeding is less. Its disadvantage is that tissue cannot be sampled for histologic diagnosis. In our opinion, in order to exploit the advantages of this technique, TUVP should be preferred in elderly patients without any suspicion of prostate cancer for whom bleeding during operation is a source of risk.