TRANSURETHRAL RESECTION OF THE PROSTATE VERSUS TRANSURETHRAL ELECTROVAPORIZATION OF THE PROSTATE: A FOLLOWUP BLINDED, PROSPECTIVE COMPARATIVE STUDY WITH 1-YEAR (1998)

Purpose: Transurethral electrovaporization of the prostate has been increasingly used as a surgical adjunct in the management of men with lower urinary tract symptoms. In this prospective study we compare the safety and efficacy of transurethral resection of the prostate and electrovaporization. Materials and Methods: We compared 32 consecutive men (mean age 68.9 years) with lower urinary tract symptoms treated by transurethral electrovaporization of the prostate to a cohort of 32 men (mean age 72.8 years) treated by transurethral resection of the prostate. Parameters of evaluation included American Urological Association symptom score, peak urinary flow rate, adverse events, including serial changes in serum hematocrit and sodium, operative time, postoperative catheterization time, hospitalization time and days lost from work. The data were analyzed by an investigator who was blinded to which procedure was performed. Results: A total of 61 patients were evaluable for followup at 1 year. None required retreatment. At 1 year symptom score decreased 12.8 (66% of patients) and 12.2 (67%) and peak urinary flow increased 9.7 ml. per second (135%) and 11.3 ml. per second (136%) for electrovaporization and resection, respectively, (p <0.001). Operative time was significantly longer with electrovaporization than with resection (47.6 2 17.6 versus 34.6 ? 11.2 minutes, p <0.003). Catheterization time (67.4 2 13.6 versus 12.9 2 4.6 hours), hospitalization time (2.6 % 0.9 versus 1.3 2 0.5 days) and days lost from work (18.4 2 7.6 versus 6.7 2 2.1) were significantly greater for resection than electrovaporization, respectively. There were no major complications in the electrovaporization group while in the resection group 1 patient required transfusion (5 units) and in 1 a clinical transurethral resection syndrome developed. Potency and retrograde ejaculation were normal in 18 of 18 patients (100%) and 13 of 17 (76%) after resection and 19 of 20 (95%) and 17 of 20 (85%) after electrovaporization. Conclusions: The results indicate that transurethral resection and transurethral electrovaporization of the prostate are effective in reducing lower urinary tract symptoms with similar preservation of sexual function. Both significantly improve peak urinary flow, although resection to a greater degree. Postoperative morbidity, catheterization time, hospitalization time and days lost from work were significantly less, and operative time was significantly longer with electrovaporization. Further studies are underway to determine the long-term durability of response of transurethral electrovaporization of the prostate relative to transurethral resection. Transurethral prostatectomy remains the most effective method of treating symptomatic benign prostatic hyperplasia with subjective and objective success rates of 85 to go%.' A number of minimally invasive and surgical modifications have been touted as either potential adjuncts or replacements for transurethral resection,sJ in part because of the perceived morbidity associated resection, including bleeding, the transurethral resection syndrome, infection, retrograde ejaculation, impotence and incontinence.. 12