Bipolar vaporization, resection, and enucleation versus open prostatectomy: optimal treatment alternatives in large prostate cases?

OBJECTIVES: The study compared the transurethral resection in saline (TURis), transurethral vaporization in saline (TUVis), bipolar plasma enucleation of the prostate (BPEP), and open prostatectomy (OP) in a single-center, prospective, randomized controlled clinical setting exclusively involving large prostate patients.

PATIENTS AND METHODS: During a 4½ year enrollment period, 320 cases of prostate volume over 80 mL, maximum flow rate (Qmax) below 10 mL/second, International Prostate Symptom Score (IPSS) over 19, or urinary retention were included in the trial and equally randomized in the four study arms. Patients were assessed preoperatively as well as at the 1-, 3-, 6-, and 12-month follow-up checkups using the IPSS, quality of life (QoL) score, Qmax, postvoiding residual urinary volume (PVR), and prostate-specific antigen (PSA).

RESULTS: Similar preoperative parameters were established in the four series. OP and BPEP were characterized by resembling operating times, while TURis and TUVis displayed prolonged surgical durations. TURis emphasized a substantially decreased mean resected tissue weight. TUVis showed the lowest mean hemoglobin level drop, followed by TURis and BPEP (equivalent results) and finally OP (highest bleeding). OP described the longest mean catheterization period and hospital stay, followed by TURis, and afterward by TUVis and BPEP (similar data). During the follow-up period, statistically equivalent IPSS, QoL, Qmax, and PVR outcomes were established for OP, BPEP, and TURis. TUVis displayed significantly smaller Qmax improvements, but similar other functional features. Significantly lower mean PSA levels were determined secondary to OP and BPEP when compared to bipolar resection and subsequently to vaporization.

CONCLUSIONS: OP and BPEP emphasized the highest surgical efficiency (prolonged postoperative recovery for OP), while TUVis displayed the lowest hemorrhagic risks. On the medium term, generally resembling functional outcomes were determined for the four techniques, with significantly decreased mean PSA values secondary to OP and BPEP.