How does electrovaporization stack up to laser prostatectomy?
The newest intervention for BPH appears likely to give urologists more clinical wheat and chaff to sort in the search for an optimal treatment device. Transurethral electrovaporization of the prostate (TVP) leads to more consistent improvement in symptoms and flow and reduces catheterization and healing times compared with laser prostatectomy. TVP, however, involves a large instrument, requires spinal or general anesthesia, and does not spare the bladder neck, said Leonard Marks, MD, at AUA's annual meeting.
These observations came from a comparison of 26 BPH patients treated with electrovaporization and a control series of 29 patients treated in 1993 with laser prostatectomy. Primary outcomes were rate of healing, tissue ablation, and clinical efficacy.
The two patient groups were well matched in all respects, including AUA symptom score, which averaged 23 for the laser group and 21 for the TVP cohort, and urinary flow, which aver- aged 9 to 10 mL/s for both groups. Cystoscopy was used to evaluate extent of tissue ablation, healing, and prostate aperture. Previous clinical evaluation has shown that a larger aperture tends to correlate with better outcome, said Dr. Marks, a clinical assistant professor of urological surgery at the University of California Medical Center, Los Angeles.
Symptom score improved by more than 60% in both groups, and urinary output more than doubled with each type of treatment. Both techniques resulted in substantial tissue ablation, as determined after completion of tissue slough, he reported. Healing time, however, was much shorter with TVP--11 weeks on average versus 23 weeks for laser prostatectomy. Patients treated who had TVP had a much shorter catheterization requirement, 1.5 days versus 4.5 for laser prostatectomy, said Dr. Marks. Almost half the TVP patients left the hospital within 24 hours without a catheter.
The majority of the TVP cohort had class 3 (greater than or equal to 50% ablation) or 4 (total ablation of both lobes) prostate apertures. In contrast, laser treatment had a more variable effect on prostate aperture.
Dr. Marks said complication rates in the study will be addressed in a separate report. In response to a question from the audience, he characterized TVP as a "more morbid procedure, at least in the short term. I think it's probably more like TURP in terms of immediate complications, as opposed to laser prostatectomy."
- Urology Times, June 1996; Vol. 24, No. 6