Category: Basic Science: BPH/LUTS

MP3-4 - The 7 years’ evidence-based outcome of transurethral bipolar plasma enucleation of the prostate versus open prostatectomy – A long-term, prospective, randomized-controlled clinical comparison in large BPO cases

Thu, Sep 20
4:00 PM - 6:00 PM

Introduction & Objective :

A long-term, prospective, randomized-controlled trial assessed the viability of the transurethral bipolar plasma enucleation of the prostate (BPEP) by comparison to open transvesical prostatectomy (OP) in cases of benign prostatic obstruction (BPO) due to large size benign prostatic hyperplasia.

Methods :

140 BPO patients with prostate volume >80 mL, maximum flow rate (Qmax) 19 were equally randomized for BPEP and OP. The BPEP technique was based on the retrograde stepwise prostatic bulk enucleation using bipolar energy followed by the adenoma lobes’ morcellation. All patients were evaluated preoperatively and every 6 months after surgery for a period of 7 years by IPSS, Qmax, quality of life score (QoL), abdominal ultrasound measuring the post-voiding residual urinary volume (PVR) and postoperative prostate volume as well as PSA level evolution.

Results :

The 2 series displayed similar preoperative prostate volume (132.6 vs. 129.7 mL). The BPEP and OP techniques emphasized equivalent mean operating times (91.4 vs. 87.5 minutes) and resected adenoma tissue weights (108.3 vs. 115.4 grams). The postoperative hematuria rate (2.9% vs. 12.9%), mean hemoglobin level drop (1.7 vs. 3.1 g/dL), catheterization period (1.5 vs. 5.8 days) and hospital stay (2.1 vs. 6.9 days) were significantly reduced in the BPEP group. Re-catheterization for acute urinary retention was more frequent after OP (8.6% vs. 1.4%), while the early irritative symptoms’ rates were similar subsequent to BPEP and OP (11.4% vs. 7.1%). The calculated prostate volume decreases (82.7-84.7% vs. 81.0-83.9%, respectively) and PSA level reductions (90.2-92.5% vs. 89.8-92.6%) were statistically equivalent in the BPEP and OP study arms. During the 8 years’ follow-up, no statistically significant differences were determined in terms of IPSS, Qmax, QoL, PVR and PSA levels between the 2 series at all the periodical check-ups<./p>

Conclusions :

The bipolar plasma enucleation was confirmed as a feasible therapeutic approach in large BPO cases based on the improved surgical safety related to the diminished hemorrhagic risks. BPEP patients benefited from a significantly shorter postoperative recovery and fewer complications. BPEP and OP emphasized statistically similar adenoma tissue removal capabilities and long-term functional outcomes as well as symptom scores.

Bogdan Geavlete

Associate Professor of Urology
"Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
Bucharest, Bucuresti, Romania

Dr. Bogdan Geavlete, MD, PhD, is Associate Professor at the "Saint John" Emergency Clinical Hospital, Department of Urology in Bucharest, Romania. As a research scholar, his training included fellowships in endourology in general at Asklepios Klinik Barmbek in Hamburg, Germany, as well as in flexible ureteroscopy in particular, at Tenon Hospital in Paris, France. Dr. Geavlete also completed a European Urological Scholarship Programme (EUSP) clinical fellowship at Radboud University, in Nijmegen, The Netherlands.
During the past 10 years, he was involved as faculty (speaker and moderator) in the most prestigious urological international events such as the EAU, AUA, WCE, SIU, CEM, EULIS and Challenges in Endourology annual meetings, while also co-authoring over 300 posters and videos.
His main areas of expertise and research focuses have been centered on non-muscle invasive bladder cancer (PhD in photodynamic diagnostic, international premiere and randomized clinical research in plasma-button large tumors’ vaporization), benign prostatic obstruction (prospective, randomized-controlled studies in BPH bipolar plasma enucleation published in famous ISI journals) and urolithiasis (international speaker, moderator and trainer in flexible ureteroscopy).
Dr. Geavlete gained 10 international awards for best posters, videos or oral presentations in the most important congresses of the urological international scientific agenda such as the EAU, CEM, EMUC, Experts in stone disease, Engineering and Urology Society and Challenges in Endourology & Functional Urology meetings. Also, he is an investigator in multicenter international clinical trials as well as in national research grants, while also completing a post-PhD research fellowship in narrow band imaging. He is a member in the organizing committees of national congresses and earned 5 national awards.
Over the past decade, Dr. Geavlete has been selected as a reviewer for 31 international journals, published 3 books in international publishing houses and 26 articles in international ISI journals and co-authored 68 PubMed indexed articles.

Cristian Moldoveanu

Bucharest, Bucuresti, Romania

Cosmin Ene

Bucharest, Bucuresti, Romania

Catalin Bulai

Bucharest, Bucuresti, Romania

Georgiana Balan

Bucharest, Bucuresti, Romania

Petrisor Geavlete

Saint John Emergency clinical Hospital
Bucharest, Bucuresti, Romania

Professor of Urology, Chairman of the "Saint John" Emergency Clinical Hospital, Department of Urology, Vice-president of the Romanian Association of Urology