ELECTROVAPORIZATION OF THE PROSTATE - ELECTROSURGICAL MODIFICATION OFSTANDARD TRANSURETHRAL RESECTION IN 93 PATIENTS WITH BENIGN HYPERPLASIA

To determine the safety and efficacy of transurethral vaporization of the prostate (TVP) in the management of men with lower urinary tract s ymptoms, we reviewed the records of 93 consecutive patients (mean age 65.2 +/- 5.7 years) with mild to moderate lower urinary tract symptoms who underwent TVP since August 1994. The patients were assessed at ba seline for both safety and efficacy and in follow-up at 1 week (N = 93 ) and 1 (N = 87), 3 (N = 71), 6 (N = 59), 9 (N = 44), and 12 (N = 33) months. The mean American Urological Association Symptom Score decreas ed from 18.6 preoperatively to 8.9, 7.9, 8.1, and 6.3 at 1, 3, 6, and 12 months, respectively (P < 0.01). The peak uroflow rate (Q(max)) inc reased from 7.9 mL/sec to 16.4, 14.1, 14.7, and 17.3 mL/sec at 1, 3, 6 , and 12 months, respectively (P < 0.02). The mean operating time was 47.3 minutes; 96% of patients had the catheter removed within 24 hours and were discharged home the first postoperative day. There was a mea n 1.1 mL/dL decrease in hematocrit and a 1.4 mEq/L decline in serum so dium. Complications included mild hematuria (46%), clot retention (5%) (all necessitating transient recatheterization), and distal bulbar ur ethral stricture (N = 1). There was an 8% incidence of significant pos tprocedure irritative symptoms. No previously potent patient reported erectile dysfunction, but there was a 92% rate of retrograde ejaculati on. Transurethral vaporization is a potentially useful modification of transurethral resection. There has been significant clinical improvem ent maintained with minimal morbidity. This early clinical experience highlights several potential advantages of TVP, including significantl y lower cost and minimal postoperative irritative symptoms. Currently, a multicenter clinical trial is under way to determine the long-term efficacy and safety of TVP.