Electrovaporization of the prostate in patients with benign prostatic enlargement

To determine the effectiveness and safety of transurethral electrovaporization in the treatment of benign prostatic enlargement (BPE).

The study comprised 91 patients (median age 65 years) with BPE (median prostate volume 61 mL). Patients were assessed with a general and urological history, the International prostate symptom score (IPSS), urinary tract and prostatic ultrasonography, uroflowmetry and biopsy of the prostate. An electrosurgical generator (cutting at 200 W and coagulating at 70 W) with grooved electrodes was used to vaporize the prostate. The variables assessed before and after treatment were the IPSS, quality-of-life score, uroflowmetry, complications, and the duration of hospitalization.

The mean operative duration was 45 min, blood loss was negligible and the mean duration of catheterization was 24 h. Recatheterization was necessary in 5.5% of patients. The median values before and after treatment were: IPSS, 19 and 5; QOL score, 4 and 2; and maximum urinary flow rate 8.3 and 22.1 mL/s (all P < 0.001). In nearly all cases, the Siroky nomogram showed that patients became unobstructed.

Electrovaporization of the prostate has many advantages over other techniques used in the treatment of BPE, including transurethral resection (TURP). It is cheaper than laser-assisted prostatectomy in particular and is also simpler to perform. Higher-risk patients can be treated, it uses existing electrosurgical equipment with minor modifications and only the electrodes, which are inexpensive, differ from TUR loops; the TURP resectoscope can be used and there is almost no need for blood transfusion. Intra- and post-operative morbidity is very low, recatheterization rare, the hospital stay brief and the results equal to or better than those obtained with TURP. Convalescence is generally uneventful and rapid because haematuria is rare and, when present, mild. Patients can return to work earlier than after TURP. Although a promising technique, only a longer follow-up will allow firm conclusions about its suitability.