Evaluating prostate surgery techniques for patients with benign prostatic hyperplasia

This study compared the outcomes of two different types of prostate surgery for the treatment of benign prostatic hyperplasia. The authors concluded that vaporization was associated with more side effects after surgery compared to loop resection.

Benign prostatic hyperplasia (BPH) is a condition where the prostate enlarges and presses against the bladder. This can lead to sudden urges to urinate, incontinence (urine leakage), and waking up in the middle of the night to use the bathroom.

Transurethral resection of the prostate (TURP) surgery involves removing the excess prostate tissue to treat BPH symptoms. This is done using a tube that goes through the penis. Loop resection uses a wire loop to remove prostate tissue. Vaporization uses an electric current to vaporize prostate tissue, with the help of a tube-like instrument containing an electrode. Which of these procedures is safer and more effective for patients with BPH is unclear.

This study included 89 patients with BPH. 44 patients underwent bipolar loop TURP, and 45 patients had bipolar vaporization. Patients were followed up at 1, 3, and 9 months after surgery.

Patients who had vaporization had a significantly longer operation time than patients who had loop resection (81 minutes vs. 55 minutes). Vaporization led to urinating more frequently after surgery compared to loop resection (80% vs. 50%). Narrowing of the urethra (the opening in the penis that passes urine) was significantly higher with vaporization (11% vs. 0%).

Blood clots for up to 4 weeks after surgery were also significantly more frequent after vaporization compared to loop resection (20% vs. 2%). However, blood loss was much less with vaporization (0.8% vs. 2.0%).

1 month after surgery, 80% of patients who had vaporization reported urinary symptoms. This decreased to 47% at 3 months and dropped lower to 29% at 9 months after surgery.

Both techniques improved urine flow. Q-max measures how much urine is produced in a given amount of time. Vaporization improved urine flow by 17 mL per second compared to 18 mL per second with loop resection.

This study found that vaporization was associated with more side effects after surgery compared to loop resection for patients with BPH.

This study had a small number of patients and a short follow-up. Larger studies with a longer follow-up are needed to evaluate long-term outcomes of TURP surgery.