Is transurethral vaporesection of the prostate better than standard transurethral resection?

Objective: The aim of this study was to undertake an evaluation of the comp arative efficacy and morbidity of transurethral vaporesection (TUVRP) and s tandard transurethral resection (TURP), two resection techniques using loop s of different thickness and power settings. Methods: In a prospective study, 185 patients with lower urinary tract symp toms suggestive of bladder outlet obstruction and benign prostatic enlargem ent were randomized to undergo either TUVRP or standard TURP. Inclusion cri teria were benign prostatic enlargement, moderate or severe lower urinary t ract symptoms and/or a significant urinary residual (> 60 ml), while patien ts with previous prostatic surgery, prostate cancer or neurogenic bladder d isorders were excluded. Prostate size, residual urine, urinary flow rate an d symptoms as well as associated bother (using the International Prostate S ymptom Score (IPSS) and the American Urological Association Bother Score (A UA-BS)) were assessed preoperatively. Intraoperative blood loss and fluid a bsorption were evaluated by measuring serum hemoglobin and respiratory alco hol concentration. Patients were followed for 1 year with the evaluation of flow rates, residual urine volumes, symptom scores and complications at 3, 6 and 12 months. Results: A significant difference was seen in the weight of the resected ti ssue (TURP 30.3 g vs. TUVRP 21.9 g, p <0.003). There were no significant di fferences in blood loss, intraoperative fluid absorption or procedure time between TUVRP and TURP, although more patients in the TURP group required b lood transfusions (13 vs. 7) and mean procedure time was longer for TUVRP ( 71.0 vs. 65.9 min). The postoperative improvements in IPSS, AUA-BS, residua l and Q(max) were significant in both groups (p <0.01 for each) but without difference between the two groups. The rate of complications (urinary trac t infections, urethral stricture, reintervention rate) during follow-up was the same in both groups. Conclusions: In this prospective randomized comparison of the clinical outc ome and morbidity of standard TURP versus TUVRP, there were no significant differences in any of the parameters evaluated except for the weight of the resected tissue. Copyright (C) 2001 S. Karger AG, Basel.