Download A RANDOMIZED COMPARATIVE EFFECTIVENESS TRIAL ON

A RANDOMIZED COMPARATIVE EFFECTIVENESS TRIAL ON TRANSURETHRAL
ENUCLEATION WITH OLYMPUS BUTTON ELECTRODE (B-TUEP)VERSUS
“TRADITIONAL LOOP” GYRUS PK FOR THE TREATMENT OF CLINICAL
OBSTRUCTING BENIGN PROSTATE HYPERPLASIA. RUA’S 2-YEARS EXPERIENCE
Roberto Giulianelli, Luca Albanesi, Francesco Attisani, Barbara Cristina Gentile, Davide Granata, Luca
Mavilla, Gabriella Mirabile, Francesco Pisanti, Manlio Schettini,, Giorgio Vincenti
Division of Urology – Nuova Villa Claudia Clinic- Rome- Italy
INTRODUCTION:
Transurethral resection of the prostate (TURP) has been, for many decades, the reference
standard in the surgical management of lower urinary tract syndrome (LUTS) due to bladder
outlet obstruction. Transurethral resection of the prostate (TURP) is the current optimal
therapy for the relief of bladder outflow obstruction, with subjective and objective success rate
of 85 to 90% . Besides these excellent success rate, bleeding, urinary tract infection , retrograde
ejaculation and incontinence are the complications associated with the procedure. Aim of the
study was to compare the outcome of “traditional” bipolar TURP with Gyrus PK vs the new
technique called B-TUEP (Trans-urethral in saline enucleation with Olimpus Button electrode).
MATERIALS AND METHODS:
From February 2011 to February 2013 , 120 consecutive patients, with a mean age of 63,34 ±
7,1 years, who had LUTS of BPE were enrolled in this study. A total of 60 patients with a mean
age of 62,5 ± 6,9 years were randomised to undergo bipolar “traditional loop” TURP
(Traditional Gyrus group) and 60 with a mean age of 64,18 ± 7,2 years to Transurethral in
saline enucleation ( B-TUEP group). All surgical procedures were performed by one surgeon
who were fully trained in bipolar Gyrus TURP and in B-TUEP resection. Preoperative work-up
was assessed by administering I.P.S.S., I.I.E.F.-5 and Qol. All patients were submitted to
uroflowmetry, TRUS, measurament of post-voidal residual urine and PSA determination. In
traditional TURP and B-TUEP groups, I.P.S.S., I.I.E.F.-5 and Qol , uroflowmetry, TRUS,
measurament post-voidal residual urine (PVR) , PSA determination and number of
reoperations were evaluated 3, 6, 9,12,15,18, 21 and months. Thus, in traditional TURP and BTUEP groups were analized operative time, resected tissue weight and perioperative
complications. Total postoperative catheter time, total post-operative hospital stay,
haemoglobin loss were recorded in the 2 groups.
RESULTS:
Comparative data on IPSS symptom score, I.E.F.F.-5 and Qol, PSA, peak urinary flow rates and
post-void residual urine volume in the 2 groups are similar but showed a significative
improvements regarding baselines value .The postoperative haemoglobin levels (13,6 ± 0,6
versus 11,4 ± 0,5, respectively), postoperative catheterization, hospital stay and 2-yrs overall
surgical re-treatment-free rate (5% vs 11,65%, respectively) were better in the Bipolar TURP
group.
DISCUSSION:
B-TUEP has a comparable outcome to Bipolar “traditional” TURP at short and medium term to
subjective and objective outcome measures. Its impact on bladder outlet function is also similar
to that of Bipolar “traditional” TURP.
CONCLUSIONS:
Improvement in I.-P.S.S. , Qol index, I.E.E.F.-5, Qmax and post-void residual urine volume were
comparable in both group denoting similar efficacy of the techniques.