Randomized study of transurethral resection of the prostate and combined transurethral resection and vaporization of the prostate as a therapeutic alternative in men with benign prostatic hyperplasia

Background and Purpose: In recent gears, various minimally invasive alterna tives to transurethral resection have become available for treatment of ben ign prostatic hyperplasia (BPH). Transurethral electrovaporization has beco me popular, with reported improvements in subjective and objectives measure s, but a high rate of postoperative irritative symptoms and lack of tissue for histologic examination are the two most commonly reported disadvantages of this procedure. To decrease the postoperative irritative symptoms while minimizing intraoperative and postoperative bleeding and also to obtain ti ssue samples, we have combined the techniques of vaporization, which was te rmed "vapor-cut." The aim of this randomized study was to compare the effic acy and safety of vapor-cut with those of the gold standard, transurethral resection. Patients and Methods: A series of 100 consecutive men (mean age 63.5 +/- 3. 4 years) with moderate to severe symptoms of prostatism were randomized to receive transurethral resection of the prostate (TURP) or vapor-cut since N ovember 1997, Adverse events during the procedure, including serial changes in both serum hematocrit and sodium and postoperative irritative symptoms, were recorded after removal of the urethral catheter. Preoperative and pos toperative symptom scores and maximum flow rates (Q(max)) were obtained fro m all patients. The volume of the prostate was measured preoperatively and postoperatively using transrectal ultrasonography. The mean follow-up of th e patients was 6.7 months (range 6-10 months), Results: The mean operative times for the vapor-rut group and the TURF grou p were 48.2 minutes and 42.7 minutes, respectively (P > 0.05). In the TURF group and the vapor-cut group, the International Prostate Symptom Score (I- PSS) decreased from 21.6 to 5.0 (P < 0.01) and from 19.4 to 4.0 (P < 0.01), respectively, at 6 months. The Q(max) increased from 9.2 +/- 2.6 mL/sec to 24.6 +/- 3.4 mL/sec (P < 0.01) in the TURP group and from 7.9 <plus/minus> 2.1 mL/sec to 26.7 +/- 3.7 mL/sec (P < 0.01) in the vapor-cut group, The m ean reductions in the weight of the prostate were 49.8% in the TURF group ( P < 0.05) and 53.6% in the vapor-cut group (P ( 0.05), Both catheterization time and hospital stay were significantly shorter for the vapor-cut group (P < 0.05), The decreases in the mean serum sodium concentration were stati stically insignificant in both groups. However, the decrease in the mean he matocrit was statistically significant in the TURF group but not in the vap or-cut group. No patient in either group had the transurethral resection sy ndrome or required blood transfusion, After removal of the urethral cathete r, irritative voiding symptoms, usually associated with frequency, were gre ater in those patients treated with TURF than in those having vapor-cut. No ne of the patients demonstrated sphincteric incontinence, bladder neck cont racture, or urethral stricture. Conclusion: From our preliminary experience, vapor-cut seems to give result s comparable to those of TURF. Because there is almost no bleeding during v apor-cut, the procedure is performed under excellent visibility, which perm its more rapid and effective resection.