Bipolar plasma vaporization versus monopolar TUR and “cold-knife" TUI in secondary bladder neck sclerosis – An evidence based, retrospective critical comparison in a single center clinical setting
Identifieur interne : 000350 ( Main/Exploration ); précédent : 000349; suivant : 000351Bipolar plasma vaporization versus monopolar TUR and “cold-knife" TUI in secondary bladder neck sclerosis – An evidence based, retrospective critical comparison in a single center clinical setting
Auteurs : C. Moldoveanu ; B. Geavlete ; M. Jecu ; F. Stanescu ; L. Adou ; C. Bulai ; C. Ene ; P. GeavleteSource :
- Journal of Medicine and Life [ 1844-122X ] ; 2014.
Abstract
Introduction: A long term, retrospective study was performed aiming to outline a critical comparison concerning the efficacy, safety and durability of the bipolar plasma vaporization (BPV), standard monopolar transurethral resection (TUR) and “cold-knife" “star" transurethral incision (TUI) in secondary bladder neck sclerosis (BNS) cases.
Materials & Methods: Of the 126 patients included in the trial based on maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19, classical resection was performed in 46 cases, “cold-knife" TUI in 37 cases and bipolar vaporization in 43 patients. The evaluation protocol comprised IPSS, QoL (quality of life) score, Qmax and PVR (post-voiding residual urinary volume) assessment performed at 1, 3, 6, 12, 18 and 24 months after the initial intervention.
Results: Significant intraoperative complications (capsular perforation – 8.7%; bleeding – 4.3%) occurred secondary to monopolar resection. “Star" TUI was the fastest technique, followed by plasma-button vaporization (7.2 and 11.4 versus 16.5 minutes). BPV and TUI patients benefitted from the shortest catheterization periods (0.75 and 1 versus 2.0 days) and hospital stays (1.0 and 1.25 versus 2.0 days). Immediate postoperative adverse events consisted of hematuria (6.5% of the TUR cases) and acute urinary retention (8.1% of the TUI group). Significantly higher long term BNS recurrence rates requiring re-treatment were established in the TUI (18.7%) and TUR (12.8%) series by comparison to BPV (5.4%). Among patients that completed the follow-up protocol, equivalent IPSS, QoL, Qmax and PVR features were determined in the 3 study arms.
Conclusions: The plasma vaporization approach was confirmed as a successful match to conventional TUR and “cold-knife" TUI in terms of surgical safety profile, postoperative recovery, therapeutic durability and urodynamic and symptom score parameters.
Url:
PubMed: 24653766
PubMed Central: 3956105
Affiliations:
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Geavlete</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Jecu, M" sort="Jecu, M" uniqKey="Jecu M" first="M" last="Jecu">M. Jecu</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Stanescu, F" sort="Stanescu, F" uniqKey="Stanescu F" first="F" last="Stanescu">F. Stanescu</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Adou, L" sort="Adou, L" uniqKey="Adou L" first="L" last="Adou">L. Adou</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Bulai, C" sort="Bulai, C" uniqKey="Bulai C" first="C" last="Bulai">C. Bulai</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Ene, C" sort="Ene, C" uniqKey="Ene C" first="C" last="Ene">C. Ene</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Geavlete, P" sort="Geavlete, P" uniqKey="Geavlete P" first="P" last="Geavlete">P. 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Moldoveanu</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Geavlete, B" sort="Geavlete, B" uniqKey="Geavlete B" first="B" last="Geavlete">B. Geavlete</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Jecu, M" sort="Jecu, M" uniqKey="Jecu M" first="M" last="Jecu">M. Jecu</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Stanescu, F" sort="Stanescu, F" uniqKey="Stanescu F" first="F" last="Stanescu">F. Stanescu</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Adou, L" sort="Adou, L" uniqKey="Adou L" first="L" last="Adou">L. Adou</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Bulai, C" sort="Bulai, C" uniqKey="Bulai C" first="C" last="Bulai">C. Bulai</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Ene, C" sort="Ene, C" uniqKey="Ene C" first="C" last="Ene">C. Ene</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author><author><name sortKey="Geavlete, P" sort="Geavlete, P" uniqKey="Geavlete P" first="P" last="Geavlete">P. Geavlete</name><affiliation><nlm:aff id="A1">"Saint John" Emergency Clinical Hospital, Department of Urology</nlm:aff><wicri:noCountry code="subfield">Department of Urology</wicri:noCountry></affiliation></author></analytic><series><title level="j">Journal of Medicine and Life</title><idno type="ISSN">1844-122X</idno><idno type="eISSN">1844-3117</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Introduction: A long term, retrospective study was performed aiming to outline a critical comparison concerning the efficacy, safety and durability of the bipolar plasma vaporization (BPV), standard monopolar transurethral resection (TUR) and “cold-knife" “star" transurethral incision (TUI) in secondary bladder neck sclerosis (BNS) cases. </p><p> Materials & Methods: Of the 126 patients included in the trial based on maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19, classical resection was performed in 46 cases, “cold-knife" TUI in 37 cases and bipolar vaporization in 43 patients. The evaluation protocol comprised IPSS, QoL (quality of life) score, Qmax and PVR (post-voiding residual urinary volume) assessment performed at 1, 3, 6, 12, 18 and 24 months after the initial intervention. </p><p> Results: Significant intraoperative complications (capsular perforation – 8.7%; bleeding – 4.3%) occurred secondary to monopolar resection. “Star" TUI was the fastest technique, followed by plasma-button vaporization (7.2 and 11.4 versus 16.5 minutes). BPV and TUI patients benefitted from the shortest catheterization periods (0.75 and 1 versus 2.0 days) and hospital stays (1.0 and 1.25 versus 2.0 days). Immediate postoperative adverse events consisted of hematuria (6.5% of the TUR cases) and acute urinary retention (8.1% of the TUI group). Significantly higher long term BNS recurrence rates requiring re-treatment were established in the TUI (18.7%) and TUR (12.8%) series by comparison to BPV (5.4%). Among patients that completed the follow-up protocol, equivalent IPSS, QoL, Qmax and PVR features were determined in the 3 study arms. </p><p> Conclusions: The plasma vaporization approach was confirmed as a successful match to conventional TUR and “cold-knife" TUI in terms of surgical safety profile, postoperative recovery, therapeutic durability and urodynamic and symptom score parameters.
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</name></author><author><name sortKey="Arya, M" uniqKey="Arya M">M Arya </name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Herrando, C" uniqKey="Herrando C">C Herrando </name></author><author><name sortKey="Batista, Je" uniqKey="Batista J">JE Batista </name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bader, Mj" uniqKey="Bader M">MJ Bader </name></author><author><name sortKey="Tilki, D" uniqKey="Tilki D">D Tilki </name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lagerveld, Bw" uniqKey="Lagerveld B">BW Lagerveld </name></author><author><name sortKey="Laguna, Mp" uniqKey="Laguna M">MP Laguna </name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Basok, Ek" uniqKey="Basok E">EK Basok </name></author><author><name sortKey="Basaran, A" uniqKey="Basaran A">A Basaran </name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bach, T" uniqKey="Bach T">T Bach </name></author><author><name sortKey="Herrmann, Tr" uniqKey="Herrmann T">TR Herrmann </name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list></list><tree><noCountry><name sortKey="Adou, L" sort="Adou, L" uniqKey="Adou L" first="L" last="Adou">L. Adou</name><name sortKey="Bulai, C" sort="Bulai, C" uniqKey="Bulai C" first="C" last="Bulai">C. Bulai</name><name sortKey="Ene, C" sort="Ene, C" uniqKey="Ene C" first="C" last="Ene">C. Ene</name><name sortKey="Geavlete, B" sort="Geavlete, B" uniqKey="Geavlete B" first="B" last="Geavlete">B. Geavlete</name><name sortKey="Geavlete, P" sort="Geavlete, P" uniqKey="Geavlete P" first="P" last="Geavlete">P. Geavlete</name><name sortKey="Jecu, M" sort="Jecu, M" uniqKey="Jecu M" first="M" last="Jecu">M. Jecu</name><name sortKey="Moldoveanu, C" sort="Moldoveanu, C" uniqKey="Moldoveanu C" first="C" last="Moldoveanu">C. Moldoveanu</name><name sortKey="Stanescu, F" sort="Stanescu, F" uniqKey="Stanescu F" first="F" last="Stanescu">F. Stanescu</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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