Bipolar plasma vaporization versus monopolar TUR and "cold-knife" TUI in secondary bladder neck sclerosis - an evidence based, retrospective critical comparison in a single center clinical setting.

Abstract

INTRODUCTION:

A long term, retrospective study was performed aiming to outline a critical comparison concerning the efficacy, safety and durability of the bipolar plasma vaporization (BPV), standard monopolar transurethral resection (TUR) and "cold-knife" "star" transurethral incision (TUI) in secondary bladder neck sclerosis (BNS) cases.

MATERIALS & METHODS:

Of the 126 patients included in the trial based on maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19, classical resection was performed in 46 cases, "cold-knife" TUI in 37 cases and bipolar vaporization in 43 patients. The evaluation protocol comprised IPSS, QoL (quality of life) score, Qmax and PVR (post-voiding residual urinary volume) assessment performed at 1, 3, 6, 12, 18 and 24 months after the initial intervention.

RESULTS:

Significant intraoperative complications (capsular perforation - 8.7%; bleeding - 4.3%) occurred secondary to monopolar resection. "Star" TUI was the fastest technique, followed by plasma-button vaporization (7.2 and 11.4 versus 16.5 minutes). BPV and TUI patients benefitted from the shortest catheterization periods (0.75 and 1 versus 2.0 days) and hospital stays (1.0 and 1.25 versus 2.0 days). Immediate postoperative adverse events consisted of hematuria (6.5% of the TUR cases) and acute urinary retention (8.1% of the TUI group). Significantly higher long term BNS recurrence rates requiring re-treatment were established in the TUI (18.7%) and TUR (12.8%) series by comparison to BPV (5.4%). Among patients that completed the follow-up protocol, equivalent IPSS, QoL, Qmax and PVR features were determined in the 3 study arms.

CONCLUSIONS:

The plasma vaporization approach was confirmed as a successful match to conventional TUR and "cold-knife" TUI in terms of surgical safety profile, postoperative recovery, therapeutic durability and urodynamic and symptom score parameters.

• Authors: C Moldoveanu, B Geavlete, M Jecu, F Stanescu, L Adou, C Bulai, C Ene, P Geavlete
• Journal: Journal of medicine and life (J Med Life) Vol. 7 Issue 1 Pg. 94-9 (Mar 15 2014) ISSN: 1844-3117 [Electronic] Romania
• PMID: 24653766 (Publication Type: Comparative Study, Journal Article)

Topics

• Cystotomy (methods)
• Evidence-Based Medicine
• Humans
• Quality of Life
• Retrospective Studies
• Sclerosis (etiology, surgery)
• Transurethral Resection of Prostate (adverse effects)
• Ureteroscopy (methods)
• Urinary Bladder Diseases (etiology, surgery)
• Volatilization