Comparative results of transurethral resection [TURP], transurethral vaporization [TVP] and vaporesection in benign prostatic hyperplasia. A prospective randomized study

To compare the efficacy and safety of TURP, TVP and combined TURP and TVP method termed Vaporesection using new storz-designed electrode in complete tissue removal in cases of Benign Prostatic Hyperplasia.From January 1998 to July 1999, in a prospective triple blind study, 120 patients with moderate to severe lower urinary tract symptoms and diagnostic evidence of obstruction [Clinical, urodynamic and TRUS] were randomized to undergo either TURP [using standard cutting wire loop], TVP [using roller bar electrode, vapotrode] or Vaporesection using roller cutting electrode. The prostate volume was measured before and after procedure using transrectal ultrasound to evaluate the completeness of tissue resection by either method. The parameters evaluated included the operative time, postoperative catheterization, American Urological Association [AUA] symptom score, Peak urine flow and post-void residual urine.A total of 111 patients were evaluable for follow up at 1 year. None required retreatment. Patients of the 3 groups were balanced for the different baseline variables. The mean operative duration of the TVP was 46.7 +/- 17.6 min., significantly longer than that of TURP at 35.9 +/- l2.2 min and vaporesection at 36.l +/- 11.2 min [p<0.01]. One hour after TURP, patients had significantly lower levels of serum sodium and hematocrite than TVP and vaporesection. The mean duration of catheterization after TURP was 67.4 +/- 13.6 hours, significantly more than after TVP 30.2 +/- 4.6 hours and vaporesection 28.6 +/- 5.3 hours. Compared with baseline values, the IPSS, Qmax and PVR improved significantly in the 3 groups at all intervals of follow up and there were no significant differences between the groups during the follow up. None of the patients of the 3 groups complained of impotence during the follow up.TURF and TVP have equal efficacy in completeness of tissue removal with less blood loss in TVP than TURF but TURP consumes less time than TVP. Vaporesection of the prostate is a safe, effective alternative to standard TURF and TVP. It has the advantages of minimal blood loss, excellent operative visibility, less postoperative irritative symptoms and good tissue removal for histopathology