TRANS URETHRAL ELECTRIC VAPORISATION OF PROSTATE AS AN ALTERNATE TO TRANS URETHRAL RESECTION IN BENIGN PROSTATIC HYPERPLASIA

Authors

  • Malik Masood Akhtar
  • Nasir Orakzai
  • Abdul Manan Qureshi

Abstract

Background: There is an impression that trans urethral electric vaporisation of prostate (TUEVP) is a relatively safe surgical procedure for obstructing benign prostates; however before considering it an alternative to Trans urethral resection (TURP) in our setting, we conducted this study to assess its safety, convenience and especially cost effectiveness in our practice. Methods: Fifty patients with signs of benign prostatic enlargement causing acute urinary retention were selected and divided into two equal groups A and B. Patients of group A underwent TURP while the group B patients had TUEVP. Postoperative follow up to assess the results of the surgeries, including noting the complication rate, began 24 hour after the catheter was removed, continuing during postoperative visits of the patient at 2 weeks, 3 months and finally 6 months. Results: For approximately same size prostate, the mean operation time was less for TUEVP as compared to the TURP. The mean volume of irrigating fluid used and the number of blood transfusions required was also less in the TUEVP patients. In addition, TURP patients were also noted to have slight postoperative hyponatraemia. Clot retention was more frequent in the TURP group than the TUEVP group. Urethral catheters were required for longer duration (mean duration 74.88 hrs vs 24hrs, p=0.0001) and so was the hospital stay (mean duration 6.25 days vs 4.4 days, p=0.0046) in the TURP group patients. Total mean cost of treatment was also higher in the patients undergoing TURP. Among the complications, only the peroperative blood transfusion rate was higher in the TURP patients as noted above. Conclusions: The TURP has slightly higher morbidity and is costlier than TUEVP but its results in terms of relieving outflow obstruction are significantly better than TUEVP. It is therefore concluded that TURP is a more effective procedure but TUEVP with lesser morbidity and cost, is more suitable for relatively lesser obstructions in our setting.   Key Words: Prostate, Prostatectomy, Diathermy

References

Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol 1984; 132: 474-9.

Glyn RJ, Campion, EW, Bouchard, GR, Silbert, JE. The development of benign prostatic hyperplasia among volunteers in the normative aging study. Am. J Epidemiol 1985; 121:78.

Costello AJ, Bowsher WG, Bolton DM, Braslis KG, Burt J. Laser ablation of the prostate in patients with benign prostatic hyperplasia. Br J Urol 1992; 69: 603-8.

Orandi A. Transurethral incision of prostate. J Urol 1973; 110: 229-31

Harewood LM, Cleeve LK, O'Connell HE, Pope AJ, Vaughan MG, Agarwal D. Transurethral needle ablation of the prostate (TUNA): Clinical results and ultrasound, endoscopic and histologic findings in pilot study of patients in urinary retention. J Endourol 1995; 9: 407-12.

Virdi JS, Pandit A, Sriram R. Transurethral needle ablation of the prostate: a prospective study with a 2-year follow-up. J Urol 1997; 79: 60-7.

Nowrocki JD, Bell TJ, Lawrence WT, Ward JP. A randomised controlled trial of transurethral microwave thermotherapy. Br J Urol 1997; 79: 389-93.

Kupeli S, Yilmaz E, Soygur T, Budak M. 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. J Endourol 2001; 15(3): 317-21.

Wang ZL, Wang XF, Li B, Ji JT, Hou SC, Shao SX et al. Comparative study of transurethral electrovaporization of prostate versus transurethral resection of prostate in benign prostatic hyperplasia. Zhonghua Nan Ke Xue 2002; 8(6): 428-30.

Miyata Y, Furukawa M. Transurethral electrovaporization of the prostate (TUV-P): comparative study with transurethral resection (TUR-P). Hinyokika Kiyo 1997; 43(7): 477-82.

Okada T, Terai A, Terachi T, Okada Y, Yoshida O. Transurethral electrovaporization of the prostate: preliminary clinical results with pressure-flow analysis. Int J Urol 1998; 5(1): 55-9.

Hammadeh MY, Fowlis G, Singh M, Philip T. One-year follow-up of a prospective randomised trial of electrovaporization vs resection of the benign prostate. Br J Urol 1997; 79: 1-4.

Narayan P, Tewar A, Garzotto M, Parramore HW, Schalow E, Starling J, Jones T. Transurethral vaportrode electrovaporization of the prostate: physical principles, technique and results. Urology 1996; 47: 505-10.

Narayan P, Tewar A, Groker B, Garzotto M, Mustafa S. Factors affecting size and configuration of electrovaporization lesions of the prostate. Urology 1996; 47: 679-88.

Kaplan SA, Alexis ETE. Transurethral electrovaporization of the prostate: A novel method for treating men with benign prostatic hyperplasia. Urology 1995; 45: 566-72.

Kaplan SA, Laor E, Fatal M, Te AE. Transurethral resection of the prostate versus transurethral electrovaporization of the prostate: a blinded, prospective comparative study with 1-year follow up. J Urol 1998; 159(2): 454-8.

Hammadeh MY, Madaan S, Hines J, Philip T. 5- year outcome of a prospective randomized trial to compare transurethral electrovaporization of the prostate and standard transurethral resection. Urology 2003; 61(6): 1166-71.

Desautel MG, Gurney TL, Diaz PA, Austria A, Badlani GH. Outcome of vaportrode transurethral vaporization of the prostate using pressure-flow urodymamic criteria. Urology 1998; 51(6): 1013-7.

Bruskewitz R, Issa MM, Roehrborn CG, Naslund MJ, Perez-Marrero R, Shumaker BP et al. A prospective randomised 1-year clinical trial comparing transurethral needle ablation to transurethral resection of prostate for the treatment of symptomatic benign prostatic hyperplasia. J Urol 1998; 159(5):1588-93.

Roehrborn CG, Issa MM, Bruskewitz RC, Naslund MJ, Oesterling JE, Perz-Marrero R et al. Transurethral needle ablation for benign prostatic hyperplasia: 12 month results of a prospective, multi center U.S. Study. Urology 1998; 5 (3):415-21.

Rosario DJ, Woo H, Potts KL, Cutinha PE, Hastie KJ, Chapple CR. Safety and efficacy of transurethral needle ablation of the prostate for symptomatic outlet obstruction. Br J Urol 1997; 80 (4):579-86.

Chow VD, Sullivan LD, Wright JE, Goldenberg SL, Fenster HN, Gleave ME et al. Transurethral electrovaporization of the prostate versus transurethral prostatic resection: a comparison of postoperative haemorrhage. Urology 1998;51(2):251-3.

Martov AG, Razumov SV, Gushchin BL, Sysoev PA. Vaporizing resection- a new treatment of benign prostatic hyperplasia. Urologiia 1999;5:3-6.

Helke C, Manseck A, Hakenberg OW, Wirth MP. Is transurethral vaporesection of the prostate better than standard transurethral resection? Eur Urol 2001;39(5):551-7.

Issue

Vol. 16 No. 4 (2004): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.