Plasmakinetic Enucleation versus Bipolar Transurethral Resection of the Prostate for Prostates Larger than 70ml: a Prospective, Randomised Trial with 5-Year Follow-up.

Abstract OBJECTIVE: To compare the perioperative and postoperative characters of plasmakinetic enucleation (PkEP) with bipolar transurethral resection of the prostate (B-TURP) for large-volume benign prostatic hyperplasia (BPH). METHODS: In this prospective, randomized controlled trial, 80 BPH patients with prostate larger than 70ml were randomly assigned to undergo either B-TURP or PkEP. Operation time, resected adenoma weight, changes in haemoglobin concentrations, duration of catheterization, and time of postoperative hospital stay were recorded and compared. Patients were followed up at 1, 6, 12, 24, 36, 48, and 60 months after surgery. RESULTS: Greater resected prostate weight, less blood loss, shorter duration of catheterization and postoperative hospital stay were recorded in the PkEP group than the B-TURP group (64.2±19.0 g vs 50.6±20.0 g, p=0.03; 0.87±0.42 g vs 1.74±0.63 g, P<0.01; 35.5±5.8 h vs 60.1±5.8 h, p<0.01; 3.2±0.9d vs 4.4±1.1, p <0.01; respectively). The postoperative improvement in International Prostate Symptom Score (IPSS), Quality of Live (QOL), maximal flow rate (Q(max)) and post-void residual urine volume (PVR) was similar between the two groups at 1, 6, 12 and 24 months but was significantly better in the PkEP group at 36, 48 and 60 months. During the 5-year follow-up, none in the PkEP group but 2 patients in the B-TURP group experienced a recurrence. CONCLUSIONS: For large-volume BPH, PkEP is associated with less blood loss, shorter hospital stay and catheterization time than B-TURP. Moreover, PkEP seems to be superior at long-term follow-up, with fewer re-operations necessary.