TRANSURETHRAL RESECTION OF THE PROSTATE VERSUS TRANSURETHRAL ELECTROVAPORIZATION OF THE PROSTATE - A BLINDED, PROSPECTIVE COMPARATIVE-STUDYWITH 1-YEAR FOLLOW-UP

Purpose: Transurethral electrovaporization of the prostate has been in creasingly used as a surgical adjunct in the management of men with lo wer urinary tract symptoms. In this prospective study we compare the s afety and efficacy of transurethral resection of the prostate and elec trovaporization. Materials and Methods: We compared 32 consecutive men (mean age 68.9 years) with lower urinary tract symptoms treated by tr ansurethral electrovaporization of the prostate to a cohort of 32 men (mean age 72.8 years) treated by transurethral resection of the prosta te. Parameters of evaluation included American Urological Association symptom score, peak urinary flow rate, adverse events, including seria l changes in serum hematocrit and sodium, operative time, postoperativ e catheterization time, hospitalization time and days lost from work. The data were analyzed by an investigator who was blinded to which pro cedure was performed. Results: A total of 61 patients were evaluable f or followup at 1 year. None required retreatment. At 1 year symptom sc ore decreased 12.8 (66% of patients) and 12.2 (67%) and peak urinary n ow increased 9.7 ml. per second (135%) and 11.3 ml. per second (136%) for electrovaporization and resection, respectively, (p < 0.001). Oper ative time was significantly longer with electrovaporization than with resection (47.6 +/- 17.6 versus 34.6 +/- 11.2 minutes, p < 0.003). Ca theterization time (67.4 +/- 13.6 versus 12.9 +/- 4.6 hours), hospital ization time (2.6 +/- 0.9 versus 1.3 +/- 0.5 days) and days lost from work (18.4 +/- 7.6 versus 6.7 +/- 2.1) were significantly greater for resection than electrovaporization, respectively. There were no major complications in the electrovaporization group while in the resection group 1 patient required transfusion (5 units) and in 1 a clinical tra nsurethral resection syndrome developed. Potency and retrograde ejacul ation were normal in 18 of 18 patients (100%) and 13 of 17 (76%) after resection and 19 of 20 (95%) and 17 of 20 (85%) after electrovaporiza tion. Conclusions: The results indicate that transurethral resection a nd transurethral electrovaporization of the prostate are effective in reducing lower urinary tract symptoms with similar preservation of-sex ual function. Both significantly improve peak urinary flow, although r esection to a greater degree. Postoperative morbidity, catheterization time, hospitalization time and days lost from work were significantly less, and operative time was significantly longer with electrovaporiz ation. Further studies are underway to determine the long-term durabil ity of response of transurethral electrovaporization of the prostate r elative to transurethral resection.