Long-term outcomes of bipolar transurethral enucleation and resection of the prostate on patients with benign prostatic obstruction: a 10-year follow-up

Peijie Chen, Peng Xu, Chunxiao Liu, Peijie Chen, Peng Xu, Chunxiao Liu

Abstract

Objective: We aimed to explore the long-term outcomes of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in patients with benign prostatic hyperplasia (BPH).

Methods: A total of 1195 patients with BPH who underwent B-TUERP from July 2006 to June 2010 were enrolled in this retrospective study. Preoperative data, particularly urodynamic study (UDS) parameters, were collected by questionnaire and examination. Postoperative follow-up was performed at 3, 6, 12, 36, 60 and 120 months, respectively. Demographic, perioperative and functional data were analysed. International Prostate Symptom Score, quality of life and overactive bladder syndrome score (OABSS) were used to assess the functional scores. Predictors of postoperative urgency incontinence were identified by univariate analysis.

Results: Long-term outcomes of functional score were significantly better than the preoperative values. All UDS variables, including maximum urinary flow rate, postvoid residual urine volume, compliance, maximum cystometric capacity (MCC), bladder outlet obstruction index, prostatic urethral pressure and detrusor pressure at maximum urinary flow rate, were all significantly improved. No one required reoperation due to recurrent BPH. The postoperative rate of transient urinary incontinence was 31.7%, while the long-term incontinence rate was 0%. Retrograde ejaculation occurred in 44.3% patients who remained sexually active after operation. Patients who had transient urge incontinence were older with preoperative higher OABSS, prostate-specific antigen (PSA) and detrusor overactivity rate and lower MCC.

Conclusion: B-TUERP is a safe, successful and highly effective treatment for BPH at 10-year follow-up. Increased age, OABSS, PSA level and detrusor overactivity rate are potential predictors for urge incontinence after B-TUERP.

Keywords: benign prostatic hyperplasia; bipolar; enucleation; outcome; resection.

Conflict of interest statement

The authors report no conflicts of interest in this work.

References

    1. Langan RC. Benign Prostatic Hyperplasia. Prim Care 2019;46(2):223-32.
    1. Roehrborn CG. Pathology of benign prostatic hyperplasia. Int J Impot Res 2008;20(3):S11-S18.
    1. Kim EH, Larson JA, Andriole GL. Management of Benign Prostatic Hyperplasia. Annu Rev Med 2016;67:137-51.
    1. Mobley D, Feibus A, Baum N. Benign prostatic hyperplasia and urinary symptoms: Evaluation and treatment. Postgrad Med 2015;127(3):301-17.
    1. Paolone DR. Benign prostatic hyperplasia. Clin Geriatr Med 2010;26(2):223-39.
    1. Yucel M, Aras B, Yalcinkaya S, Hatipoglu NK, Aras E. Conventional monopolar transurethral resection of prostate in patients with large prostate (80 grams). Cent European J Urol 2013;66(3):303-8.
    1. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol 2006;50(5):969-79.
    1. Fayad AS, Elsheikh MG, Zakaria T, Elfottoh HA, Alsergany R, Elshenoufy A, Elghamarawy H. Holmium Laser Enucleation of the Prostate Versus Bipolar Resection of the Prostate: A Prospective Randomized Study. "Pros and Cons". Urology 2015;86(5):1037-41.
    1. Liu C, Zheng S, Li H, Xu K. Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics. J Urol 2010;184(6):2440-5.
    1. Sun F, Han B, Cui D, Zhao F, Sun X, Zhuo J, Jing Y, Liu H, Xia S, Yang Y, Luo G, Guo F. Long-term results of thulium laser resection of the prostate: a prospective study at multiple centers. World J Urol 2015;33(4):503-8.
    1. Zheng SB, Liu CX, Xu YW. Application of intracavitary retrograde dissection in transurethral vaporization resection of the prostate. Di Yi Jun Yi Da Xue Xue Bao 2005;25(6):734-5,738. (In Chinese)
    1. Li BK, Chen BS, Xin YH, Liu CX, Zheng SB, Xu YW, Li HL, Zou Y, Li LP. Can the lower urinary tract storage symptoms be completely resolved after plasmakinetic enucleation of the prostate? Asian J Androl 2017;19(6):655-8.
    1. Xu P, Xu A, Chen B, Zheng S, Xu Y, Li H, Shen H, Liu C. Bipolar transurethral enucleation and resection of the prostate: Whether it is ready to supersede TURP? Asian J Urol 2018;5(1):48-54.
    1. Schäfer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, Sterling AM, Zinner NR, van Kerrebroeck P; International Continence Society. Good urodynamic practices: uroflowmetry, filling cystometry and pressure-flow studies. Neurourol Urodyn 2002;21:261-74.
    1. Matsukawa Y, Gotoh M, Kato M, Funahashi Y, Narita M, Mitsui K. Effects of dutasteride on storage and voiding symptoms in male patients with lower urinary tract symptoms as a result of benign prostatic obstruction: the 1-year outcomes from a prospective urodynamic study. Int J Urol 2014;21:826-30.
    1. Lee MH, Yang HJ, Kim DS, Lee CH, Jeon YS. Holmium laser enucleation of the prostate is effective in the treatment of symptomatic benign prostatic hyperplasia of any size including a small prostate. Korean J Urol 2014;55(11):737-41.
    1. Xu A, Zou Y, Li B, Liu C, Zheng S, Li H, Xu Y, Chen B, Xu K, Shen H. A randomized trial comparing diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia. J Endourol 2013;27(10):1254-60.
    1. Shah AA, Gahan JC, Sorokin I. Comparison of robot-assisted Versus open simple prostatectomy for benign prostatic hyperplasia. Curr Urol Rep 2018;12;19(9):71.
    1. ShimizuY, HiraokaY, IwamotoK, Takahashi H, AbeH, OgawaH. Is complete resection of hypertrophic adenoma of the prostate possible with TURP? J Nippon Med Sch 2005;72:146-8.
    1. Palaniappan S, Kuo TL, Cheng CW, Foo KT. Early outcome of transurethral enucleation and resection of the prostate versus transurethral resection of the prostate Singapore Med J 2016;57(12):676-80.
    1. Arcaniolo D, Manfredi C, Veccia A, Herrmann TRW, Lima E, Mirone V, Fusco F, Fiori C, Antonelli A, Rassweiler J, Liatsikos E, Porpiglia F, De Sio M, Autorino R; EAU Section of Uro-Technology (ESUT) Research Group. Bipolar endoscopic enucleation versus bipolar transurethral resection of the prostate: an ESUT systematic review and cumulative analysis. World J Urol 2020;38(5):1177-86.
    1. Zou Z, Xu A, Zheng S, Chen B, Xu Y, Li H, Duan C, Zheng J, Chen J, Li C, Wang Y, Gao Y, Liang C, Liu C. Dual‑centre randomized‑controlled trial comparing transurethral endoscopic enucleation of the prostate using diode laser vs. bipolar plasmakinetic for the treatment of LUTS secondary of benign prostate obstruction: 1‑year follow‑up results. World J Urol 2018;36:1117-26.
    1. Xu A, Zou Y, Li B, Liu C, Zheng S, Li H, Xu Y, Chen B, Xu K, Shen H. A randomized trial comparing diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia. J Endourol 2013;27:1254-60.
    1. Zhao Z, Zeng G, Zhong W, Mai Z, Zeng S, Tao X. A prospective, randomised trial comparing plasmakinetic enucleation to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia:three-year follow-up results. Eur Urol 2010;58:752-8.
    1. Chen S, Zhu L, Cai J, Zheng Z, Ge R, Wu M, Deng Z, Zhou H, Yang S, Wu W, Liao L, Tan J. Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: a randomized noninferiority controlled trial with long-term results at 6 years. Eur Urol 2014;66:284-91.
    1. Homma Y, Kawabe K, Tsukamoto T, Yamaguchi O, Okada K, Aso Y, Watanabe H, Okajima E, Kumazawa J, Yamaguchi T, Ohashi Y. Estimate criteria for efficacy of treatment in benign prostatic hyperplasia. Int J Urol 1996;3:267-73.
    1. Chung DE, Te AE, Staskin DR, Kaplan SA. Efficacy and safety of tolterodine extended release and dutasteride in male overactive bladder patients with prostates >30 grams. Urology 2010;75:1144-148.
    1. Griffiths DJ. Pressure-flow studies of micturition. Urol Clin North Am 1996;23:279-97.
    1. Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 2011;109:408-11.
    1. Neill MG, Gilling PJ, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR, Wilson LC. Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology 2006;68:1020-4.
    1. Cho SY, Park J, Yoo S, Cho MC, Jeong H, Son H. One-year surgical outcomes of complete or incomplete enucleation of prostate by monopolar electrocoagulation, photoselective vapoenucleation of 120W GreenLight Laser, and Holmium Laser. Urology 2017;108:142-8.
    1. Xia SJ, Zhuo J, Sun XW, Han BM, Shao Y, Zhang YN. Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol 2008;53:382-9.
    1. Placer J, Salvador C, Planas J, Trilla E, Lorente D, Celma A, López MÁ, Morote J. Effects of holmium laser enucleation of the prostate on sexual function. J Endourol 2015;29:332-9.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe