TRANSURETHRAL ADENOMA ENUCLEATION’S IN SALINE BUTTON ELECTRODE (B -TUEP) WITH GYRUS PK SYSTEM FOR THE TREATMENT OF BENIGN PROSTATE HYPERPLASIA. RUA’S PRELIMINARY EXPERIENCE

Roberto Giulianelli1, Luca Albanesi1, Barbara Cristina Gentile1, Luca Mavilla1, Gabriella Mirabile1, Francesco Pisanti1, Francesco Attisani1, Giorgio Vincenti1, Manlio Schettini1
  • 1 Nuova Villa Claudia (Roma)

Objective

Conventional transurethral resection of the prostate (TURP) still remains the gold standard treatment of LUTS due to bladder outlet obstruction (BOO) for benign prostatic hyperplasia (BPH). Since 2003 in our department, using OLYMPUS BIPOLAR SISTEM, we performed over 3000 bipolar prostate resection. The morbidity of transurethral resection of the prostate requires new equipment and technique.
We evaluated our results with Transurethral in saline Enucleation with Button electrode (TUEP-B) for the treatment of bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH).Between July 2011 to March 2012, one urologist, performed 50 Transurethral in saline Enucleation with Button electrode (TUEP-B) with Gyrus PK system for the treatment of BOO due to BPH.

Methods and results

Between July 2011 to March 2012, one urologist, performed 50 Transurethral in saline Enucleation with Button electrode (TUEP-B) with Gyrus PK system for the treatment of BOO due to BPH. The average age of the patients was 71 years (range 58-84 yrs) . The preoperative investigation protocol included digital rectal examination, Prostatic Specific Antigen (PSA), International Prostate symptom Score (IPSS), IEFF-5, Quality of Life (QOL), Uroflowmetry with post-voiding residual urinary volume (PVR) and transrectal ultrasonography assessing prostate volume. The aim of this study was to evaluate Qmax’s improvement, and, in second time, to evaluate the change in IPSS, IEFF-5, QOL, PSA, PVR, Prostate weight e HB. Intraoperatively, we evaluated total B-TUEP time, including total enucleation’s and resection’s time and prostate’s and adenoma’s weight.
Following surgery, we evaluated bladder irrigation’s time , catheterization’s time, RUA post B-TUEP, hospital’s stay and any emergency after the surgery within 30 days.
The follow up was performed after one month from the surgical procedure and then every 3 months, with PSA and HB dosage, IPSS, IEFF-5, QOL, Uroflowmetry with PVR . Postoperatively, TRUS was performed 6 months .

Discussion

All patients have a period of 12 months of follow-up.
After three mpnths the patients (82%) had an improvement of Qmax > 15 ml/sec < 25 ml/sec , ( p<0,001). After six months they had an improvement in 80% ( p<0,001) and after twelve months in 77,2% ( p<0,001), respectively
All end point have an improvement compared to the baseline (p< 0,001). The Hb no change pre and after the operation surgery (p<0,1).
The resection time was minor than 40 minutes in 34 pts (68%), less than 75 minutes in 14 pts (28%) and more than75 min in 2 pts (4%).
The bladder irrigation time was between 24h and 36h in about 80% (40 pts) . In14% of pts we had haematuria and clot retension and only one pts (2%) was necessary a second look endoscopy. The hospitalization time was less than 48 hour in 74% and minor than 72 hours in 74% and 12% of patients respectively.
In 6% of pts we had a new readmission in hospital for haematuria with RUA.
We had no urinary incontinence
After six months we had 2 pts with urinary obstruction and in secon time we permed a TUIP.

References

Transurethral in saline Enucleation with Button electrode (B-TUEP) with Gyrus PK system for Bladder Outlet Obstruction (BOO) caused by Benign Prostate Hypertrophy (BPH) is a rapid and safety technique, showing optimal outcomes.

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