Two surgical means of treating benign prostatic hyperplasia (BPH) — bipolar transurethral enucleation of the prostate (TUEP) and photoselective vaporization of the prostate (PVP, a new approach) — were compared in a recent study that followed patients for one year. Researchers reported that while both methods are safe and effective, bipolar TUEP appeared to have better results, although their study had limitations.
The research article, “Bipolar transurethral enucleation of prostate versus photoselective vaporization for symptomatic benign prostatic hyperplasia (>70 ml),” was published in the Asian Journal of Andrology.
Several methods are used to treat BPH, with the standard approach being TURP (transurethral resection of the prostate). But TURP surgery often results in complications, which alternative methods are trying to avoid.
Previous studies found PVP to be as effective as TURP in managing bladder outlet obstruction, with fewer side effects. Likewise, bipolar TUEP is known to be a safe and feasible treatment approach.
Researchers prospectively reviewed surgeries done on 81 BPH patients at two sites in China between February 2011 and December 2013; 39 patients underwent bipolar TUEP, and 42 were treated by PVP.
Results showed no complications related to bleeding in either group, and both methods required comparable operation times (83.59 for bipolar TUEP vs. 89.60 minutes for PVP). Compared to the bipolar TUEP group, catheterization time and postoperative hospital stays were shorter for the PVP patients (55 hours vs. 110 hours, and 3.60 days vs. 5.82 days, PVP versus bipolar TUEP, respectively). No major complications were observed in either group.
An assessment done 12 months after surgery found patients treated by bipolar TUEP had better outcomes than those who underwent PVP in terms of BPH treatment goals: International Prostate Symptom scores (3.51 TUEP vs. 5.12 PVP), quality of life (0.75 vs. 1.24), maximum urinary flow rate (26.04 vs. 22.49), post-void residual urine volume (10.59 vs17.26), and prostate-specific antigen level (1.26 vs. 2.20 ng ml−1).
“Both bipolar TUEP and PVP are safe and effective for treating benign prostatic hyperplasia,” the authors concluded. “Bipolar TUEP offers more complete removal of prostatic adenoma than PVP. Our results indicated that the clinical efficacy of bipolar TUEP was more durable and favorable than 160- PVP at the 12-month follow-up.”
The study has several limitations, however, including a small sample size and limited follow-up, and lacked any evaluation of post-surgical sexual function in the patients. For these reasons, the authors recommend further study.