Transurethral bipolar plasmakinetic resection combined with 2 μm continuous wave laser vaporization: a new method for the treatment of large volume benign prostatic hyperplasia.

Objective: The aim of this study was to evaluate the safety and efficiency of transurethral bipolar plasmakinetic resection of the prostate (PKRP) combined with 2 μm laser vaporization in the management of large prostates (>80 mL).

Background Data: The safety and efficiency of transurethral vaporesection of the prostate with benign prostatic hyperplasia (BPH), using a 2 μm laser system, have been verified. However, this method does still not manage large volume prostates efficiently.

Methods: From October 2009 to June 2010, 120 BPH patients with a median prostatic volume of 106.7 (±16.7) mL (range, 82.5-156.8 mL) were randomized for surgical treatment with PKRP combined with 2 μm laser vaporization (n=58) or PKRP only (n=62). All patients were preoperatively assessed with subjective symptoms score. Preoperative and perioperative parameters at 3-, 6-, and 9-month follow-up were also evaluated. All complications were recorded.

Results: PKRP combined with 2 μm laser vaporization was significantly superior to PKRP alone in terms of operative time, irrigation time, catheterization time, hospital stay, and hemoglobin decrease. The blood transfusion and urinary tract infection observed in the PKRP combined with 2 μm laser vaporization group was significantly less than that of the groups that received PKRP only. Both groups were similar with respect to resected tissue weight, transient incontinence, urethral stricture and retrograde ejaculation in the postoperative period. Both groups showed a significant improvement from baseline in terms of International Prostate Symptom Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and pulmonary vascular resistance unit (PVRU) values. However, no significant difference was found between them.

Conclusions: PKRP combined with 2 μm laser vaporization, which combines the advantages of both PKRP and 2 μm laser, is superior for its shorter operation time, less bleeding, and better efficiency. It may be a safer and more effective method for the treatment of BPH in large prostates.