Clinical comparison of two new minimally invasive techniques in the treatment of benign prostatic hyperplasia: Twister™ Diode Laser System vs. BiVap (Richard Wolf®) saline vaporization of the prostate.

Aim: The aim of this study was to evaluate complications and postoperative follow-up outcomes of the recently developing endoscopic techniques of BiVap (Richard Wolf®) and Twister™ system in patients with benign prostatic obstruction (BPO).

Methods: Eighty patients treated with BiVap (Richard Wolf®) (N.=46) and Twister™ system (N.=34) were included in the study. Operation, hospitalization and catheter removal time were noted. Postoperative complications including urinary tract infection, transient hematuria, severe dysuria, and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. Statistical analyses were performed with SPSS version 18. A P-value<0.05 was considered significant.

Results: Mean age of the patients was 64.1 ± 7.1 years. Significant improvement was observed for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. In group 1 maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 3, 3, 12, 3 and 12th months, respectively. In group 2 maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 6, 6 and 3rd months, respectively. There was no significant difference between the two groups in terms of IPSS, Qmax, Qave, QoL, PSA, PVR, IIEF (Total), IIEF-EF, IIEF-IS, IIEF-OF, IIEF-SD and IIEF-OS during the 1 year follow-up period. Total IIEF and subgroup scores improved to their preoperative levels by the postoperative 3rd month in both groups.

Conclusion: Both BiVap (Richard Wolf®) and Twister™ systems are safe and highly effective minimal invasive techniques, which can be used in the surgical treatment of BPO.