BERKELEY, CA (UroToday.com) - Until now, most studies have compared the outcomes of plasmakinetic resection of the prostate (PKR) or plasmakinetic vaporization of the prostate (PKVP) in BPH with monopolar transurethral resection of the prostate (TURP). In this study, we compared the efficacy and outcomes of PKVP with PKR in the treatment of BPH.
A total of 183 patients diagnosed with BPH underwent plasmakinetic prostatic surgey between 2008 and 2012 at the Kars State Hospital and Kafkas University Faculty of Medicine. After clinical and preoperative evaluation, patients were randomized to the PKR (Group 1) or Group 2 (PKVP) sequentially by using computer-generated numbers. Patients were included in the study, if they had moderate to severe LUTS, based on their IPSS, requiring surgery, recurrent urinary retention, failed medical therapy, and obstructive pressure flow study or Qmax less than 10 mL/s. Groups 1 and 2 included 96 and 87 patients, respectively. All patients in both groups were compared in terms of hemoglobin drop, operation time, catheter duration, reobstruction, incontinence, and recatheterization. Hemoglobin drop was calculated in blood samples on postoperative day 1. Success was evaluated with IPSS and Qmax value at postoperative month 12. Cases with an IPSS < 14 and Qmax > 15 mL/s were considered successful.
There were no statistically significant differences between either group in terms of age, prostatic volume, PVR, preoperative Qmax value, and IPSS (p > 0.05). The mean preoperative Qmax value of Group 1 and Group 2 was 7.30 ± 2.59 mL/s and 6.57 ± 2.731 mL/s (p = 0.06), respectively. The IPSS of Group 1 and Group 2 was 20.52 ± 5.71 and 21.46 ± 5.68 (p = 0.26). The mean PVR of Group 1 and Group 2 decreased to 34.38 ± 26.01 mL and 40.14 ± 27.54 mL, respectively, at postoperative month 1. The mean Qmax value of Group 1 on the first month increased to 16.7 ± 3.73 mL/s, and the IPSS decreased to 11.9 ± 3.82. Group 2 had a mean Qmax value of 17.01 ± 3.65 mL/s and an IPSS of 11.7 ± 3.71 at postoperative month 1. The difference between the groups was not statistically significant, but the improvements in baseline values for both groups were statistically significant (p < 0.05). When we compared the Qmax values at month 12, there was no statistical difference between both groups. Group 1 had a mean Qmax value of 17.92 ± 3.819 mL/s and Group 2 with 18.15 ± 3.832 mL/s (p = 0.69). We also did not find any significant differences in IPSS between PKR and PKVP groups at month 12. The mean IPSS in Group 1 and Group 2 were 12.29 ± 3.758 and 12.01 ± 3.677, respectively (p = 0.61). The overall IPSS and Qmax values significantly improved from the baseline values at the end of first year. There was a statistical difference between both groups in terms of hemoglobin drop, catheter duration and operation time. The mean catheter duration of Group 1 was 3.74 ± 1.04 days, and in Group 2 it was 2.64 ± 0.849 days (p < 0.001). The mean operation time of Group 1 and Group 2 was 52.07 ± 8.682 minutes and 61.08 ± 10.256 minutes, respectively (p < 0.001). Group 1 had a mean hemoglobin drop value of 1.28 ± 0.75 g/dL, on the other hand this value was only 0.55 ± 0.62 g/dL in Group 2 (p < 0.001). Only in 2 cases from Group 1, did we crossover to PKVP due to inadequate hemostatis control. We stopped all procedures and converted to PKVP for the final part of the operations. After conversion, we obtained successful hemostasis control. There were no significant differences between both groups in terms of infravesical obstruction, incontinence and recatheterization. Patients admitted to the emergency department needed recatheterization; most of these patients were the ones treated with PKVP.
The improvements in Qmax and IPSS of PKR and PKVP groups over baseline values at the end of month 12 were statistically significant. Moreover, there was no statistically significant success difference between both groups. This was due to the preferred same energy source. After introducing plasmakinetic technology in our department, most patients with BPH treated with this system had acceptable outcomes. Hemoglobin drop rate of PKVP group was significantly lower than in the PKR group and this may be attributed to coagulation advantage of vaporization mode. Also vaporization of the tissue and simultaneous coagulation mode provide a very clear vision in the operating field and eliminates the risk of TUR syndrome. The longer operating time of PKVP might be attributed to the hemostasis motivation of the surgeon at the end of the procedure. Coagulation mode was used for hemostasis after vaporization of adenomatous tissue.
We should mention one key point to explain the moderate IPSS value, which is discordant with high Qmax of the same patients who underwent either PKR or PKVP in our study. The main reason is the low education level of these patients. It was difficult for most patients to complete the IPSS questionnaire. This is also an explanation where there was discordance between IPSS and uroflowmetry results. IPSS is a subjective parameter which depends on patients’ answers, and the uroflowmetry is an objective parameter.
Eleven patients treated with PKVP required recatheterization after removal of the initial catheter. Only 6 patients in Group 1 were recatheterized in the early period. Of the 11 patients in the PKVP group, we performed diagnostic cystoscopy in 4 patients due to difficulty in applying urethral catheter. In all patients, we observed severe edema around the verumontonum and apex of the prostate that obstructed the urethra. We had recatheterized these patients for 1 week with anti-inflammatory therapy and the catheters were removed after 1 week. All of the patients voided satisfactorily after being free of catheters.
PKVP to manage BPH is safe and effective. When compared with PKR, it provides a significantly shorter catheter duration and less bleeding due to advantage of hemostasis control with similar IPSS and Qmax improvements after 1 year.
Written by:
Mert Ali Karadag, MD 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.
Kafkas University Faculty of Medicine, Department of Urology, Kars, Turkey
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