TRANSURETHRAL ELECTROVAPORIZATION OF THE PROSTATE VS. TRANSURETHRAL RESECTION - RESULTS OF A MULTICENTRIC, RANDOMIZED CLINICAL-STUDY ON 150PATIENTS

Aim of the Study: To evaluate clinical, urodynamic efficacy and safety of TURF and TVP in patients with symptoms due to obstructive benign p rostatic hypertrophy with a prospective multicentric randomized study. Materials and Methods: 150 patients with BPH, urodynamically obstruct ed, were randomized to receive TURF or TVP. At the end of the recruitm ent phase, 80 patients underwent TURF and 70 patients underwent TVP. P atients were clinically evaluated by the I-PSS score at months 0, 1, 3 , 6 and 12. Preoperative evaluation included complete blood routine ex amination, PSA, transrectal ultrasound and pressure/flow studies. Pres sure/flow studies were also performed after 3 months. Results: There w as no statistical difference between groups in any of the preoperative parameters. All patients were considered urodynamically obstructed at preoperative pressure studies. As for catheter days and hospitalizati on days, statistical differences between TVP and TURF were found; cath eter days were 2.71 days (SE 0.12) in the TURF group vs. 1.9 (SE 0.24) in the TVP group (p < 0.000). Hospitalization was 4.7 days (SE 0.22) after TURF and 3.9 days (SE 0.24) after TVP (p < 0.000). Mean preopera tive I-PSS score was 18.84 and 18.19 in the TVP and TURF groups, respe ctively. At 3, 6 and 12 months, IPSS was 5.52 and 5.50, 3.77 and 4.94, 3.52 and 4.04 for TURF and TVP, respectively. Mean preoperative peak flow rate (PFR) was 8.78 and 7.26 ml/s for TURF and TVP, respectively; after 3, 6 and 12 months, PFR was 19.21 and 18.8, 20.77 and 20.13, 20 .30 and 20.31 ml/s, respectively. After 3 months, 6 patients in the TU RF group (7.5%) and 7 patients in the TVP group (10%) were borderline obstructed. 1 patient in the TVP group (1.4%) was still obstructed and underwent TURF. As for complications, 4 patients (5.7%) in the TVP gr oup had stress urinary incontinence after 12 months vs. 1 (1.25%) in t he TURF group. Discussion: The present study clearly demonstrates that TVP is as effective as TURF in relieving urinary obstruction due to B PH, it offers some advantages in terms of catheterization and hospital stay, but at the price of a higher incidence of postoperative urine i ncontinence. Technical improvements might solve this problem in the fu ture, perhaps combining TVP with TURF of the apical tissue.