Bipolar plasma vaporization of secondary bladder neck sclerosis (SIU 2011)
- uploaded: Sep 16, 2011
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Institution:â€œSaint Johnâ€ Emergency Clinical Hospital, Bucharest, Romania
Introduction and Objectives: This trial aimed to assess the therapeutic efficiency, overall safety and short-term postoperative results of bipolar plasma vaporization (BPV) in cases of secondary bladder neck sclerosis (BNS). A prospective, randomized comparison to the standard monopolar transurethral resection TUR was also performed.
Materials and Methods: A total of 60 patients (mean age of 72) with BNS secondary to TURP (41 cases), to open surgery for BPH (open prostatectomy â€“ 14 cases) and to radical prostatectomy for prostate cancer (5 cases) were enrolled in the trial. The inclusion criteria consisted of Qmax < 10 ml/s and IPSS >19. All patients were evaluated preoperatively and at 1, 3 and 6 months after surgery by International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum flow rate (Qmax) and post-voiding residual urinary volume (RV).
Results: Similar preoperative parameters were determined for patients from both series. BPV and TUR were successfully performed in all cases (30 patients each). The mean operative time, catheterization period and hospital stay were significantly reduced in the BPV series (16.5 versus 27 minutes, 18 versus 46.5 hours and 34.5 versus 73 hours). Capsular perforation only occurred in 2 cases of the TUR study arm, while the rate of irritative symptoms was similar in the 2 series (13.3% versus 16.7%). The 1, 3 and 6 monthsâ€™ follow-up emphasized superior parameters for the BPV group by comparison to the TUR group in terms of IPSS (3.4 versus 6.3, 3.6 versus 6.5 and 3.7 versus 6.8, respectively) and Qmax (23.8 versus 21.1 ml/s, 23.7 versus 20.6 ml/s and 23.0 versus 20.7 ml/s, respectively). At the same time intervals, QoL was also significantly improved in the BPV arm (1.2 versus 1.4, 1.4 versus 1.6 and 1.4 versus 1.7), while no significant differences were established in terms of RV between the 2 series. Only 2 patients of the TUR group required re-treatment during the follow-up period.
Conclusions: BPV constitutes a valuable endoscopic treatment alternative for secondary BNS. In a randomized analysis, the method emphasized superior efficacy, a satisfactory safety profile and significantly improved short-term follow-up parameters by comparison to the standard TUR.
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