BERKELEY, CA (UroToday.com) - Despite increasing popularity among numerous centers worldwide, the plasma vaporization technique has occasionally been questioned from the perspective of actually obtaining an efficient removal of the prostate in benign prostatic hyperplasia (BPH). Basically, several groups of authors underlined the potential drawback of achieving rather reduced prostatic tissue ablation by simple bipolar vaporization when compared to the standard single loop resection.[1, 2] In any case, the technically imposed pauses in the vaporization process, aimed at avoiding the system overheating, clearly affected the overall efficacy and surgical fluency of this procedure and imposed the search for a better alternative. Based on these premises, a second-generation energy source was introduced as a promising technical setting able to provide a continuous plasma vaporization phenomenon unimpaired by time limitations, as well as a truly instantaneous plasma ignition occurrence.[3]
Following the natural path of clinical research designed to establish the viability of a newly introduced technological advancement, a single centre, prospective, randomized, short-term trial was performed comparing the continuous plasma vaporization of the prostate (C-BPVP) to standard bipolar vaporization (S-BPVP) and conventional monopolar transurethral resection of the prostate (TURP). During the course of the study in question, a total of 180 BPH patients with prostate volumes between 30 and 80 mL and severe lower urinary tract symptoms were enrolled in an equally randomized fashion. The inclusion criteria were represented by maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19, while pathologically confirmed prostate cancer patients as well as those who failed to complete the 6-month evaluation protocol were excluded from the continuation of the trial.
Most importantly, the mean surgical duration was significantly reduced for the C-BPVP technique by comparison to S-BPVP and TURP (31.5 versus 40.6 and 49.8 minutes), thus emphasizing a quite substantial 22.4% and, respectively, 39.1% decrease in operation time. Moreover, the continuous mode managed to preserve the BPVP advantages over classical resection in terms of safety profile, as underlined by the significantly lower capsular perforation rates (1.7% and 3.3% versus 10%). The superior haemostatic abilities of the plasma vaporization approach were once again confirmed in light of the significantly lower mean hemoglobin level drops (0.4 and 0.6 versus 1.4 g/dL) and postoperative hematuria rates (1.7% and 1.7% versus 13.3%).
From a different point of view, the faster convalescence period, enjoyed by the plasma vaporization patients, remained an advantage in both C-BPVP and S-BPVP study arms when drawing a parallel to monopolar TURP, due to the significantly shorter mean catheterization periods (24.1 and 23.9 versus 73.6 hours) and hospital stays (2.1 and 2.2 versus 4.5 days). Regarding the early irritative symptoms profile, otherwise a main point of concern when discussing bipolar electrosurgery, a similar frequency of such adverse events was determined in the 3 series (10% and 11.7% versus 8.3%).
A quite optimistic perspective for the plasma vaporization approach was outlined by the similar, and occasionally superior, functional outcomes obtained during the 6-months evaluation period when facing a comparison to conventional resection. So, during all the periodic check-ups, significantly improved IPSS and Qmax parameters characterized C-BPVP and S-BPVP cases, while no real difference was found concerning the mean QoL and PVR values. Last, but not least, equivalent prostatic tissue ablative properties were described for the 3 types of techniques when summarizing the statistically similar mean prostate volumes and PSA levels. Of a certain importance in this regard could also be considered the similar postoperative prostate volume decreases and PSA value reductions defined in the 3 groups.
Based on all of the above, we could conclude that the recent technological advancement represented by the continuous plasma activation mode brought considerable improvements to bipolar vaporization, in general, from the point of view of surgical effectiveness, speed, and fluency. Safety was preserved under the superior terms to which the BPVP technique was accustomed. Moreover, patients’ comfort turned out to be a real gain, supported by the significant decrease in the number of catheter and hospital days. The previously outlined advantages over classical TURP concerning the superior symptom scores and voiding parameters secondary to the plasma vaporization approach continued to remain present in the C-BPVP technical variation, while the BPH bulk ablation abilities displayed similar features among the 3 treatment alternatives.
References:
- Reich O, Schlenker B, Gratzke C, et al. Plasma vaporisation of the prostate: initial clinical results. Eur Urol. 2010;57(4):693-7.
- Robert G, Descazeaud A, Delongchamps NB, et al. Transurethral plasma vaporization of the prostate: 3-month functional outcome and complications. BJU Int. 2012 Aug;110(4):555-60.
- Geavlete B, Jecu M, Geavlete P. Continuous plasma vaporization - A new step forward in BPH endoscopic treatment. European Urology Today. 2012;24(3):31.
Written by:
Bogdan Geavlete, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
"Saint John" Emergency Clinical Hospital
Department of Urology
13 Vitan Barzesti Street
Sector 4, 042122
Bucharest, Romania
E-mail:
More Information about Beyond the Abstract