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Benign prostatic hyperplasia is a common disease in older men and is accompanied by a blockage in the bladder neck. There are many treatment options that depend on the symptoms and complications of the lower urinary system and the blockage associated with benign prostatic hyperplasia. These options include watchful waiting, pharmacotherapy, minimally invasive therapy, TURP and open prostatectomy.
About 20 percent of patients with mild or severe symptoms are treated with different surgical procedures. Among these surgical procedures is the removal of the prostate via the urethra using a monopolar TURP technique which is the corner stone. Prostatectomy is accompanied by numerous side effects, including complications from blood loss, fluid disturbances of body salts and electrolytes. As part of our efforts to overcome these side effects, prostatectomy has been shown using the bipolar TURP.
The advantages of the bipolar TURP include the ability of the patient to tolerate the salt solution, thus reducing the possibility of TUR syndrome, another advantage is reduction of tissue denaturation due to the high frequency current as the resectoscope and electrode act as neutral electrode that complete the circuit without need to the patient’s plate. Recently, prostatectomy using plasma vaporization has become a new technique for treating benign prostatic hyperplasia, similar to prostatectomy surgically but conservatively. Many devices, such as holmium laser, tholium laser and diode laser are used to proactively remove the prostate via the urethra using enucleation. This depends on tissue vaporization and the ability to stop any bleeding that may occur during the procedure. However, the application of this technique is limited due to increasing the cost of the treatment and increasing the surgical time and high learning curve. The plasma device may be used in the presence of a stream of plasma excision through the urethra by plasma vaporization, which is effective as laser technology, but less than in the melting of tissue and safety, but not suitable for patients with large prostate.
Vapoenucleation of the prostate and Bipolar TURP using saline irrigation system are technologic innovation based on an idea that has been present for some years. This study showed very good result of vapoenucleation group as an alternative to bipolar TURP, efficacy, with shorter catheterization and hospitalization time.
Likewise, with improved vision during surgery, surgeons can achieve superior hemostasis and it’s suggested especially in a highly selected group of patients at high risk. Vapoenucleation provides a new option among minimally invasive surgical treatments for BPH. The short- term complication profile appears to be better than with bipolar TURP, but further studies are required to prove this because there is certain variability in the rate of occurrence of some of them.
Although our study has the drawback of sample size; enucleation of the prostate is a promising new technique that may prove to be a good alternative to conventional TURP in the future.