Endoscopic rollerball electrovaporization of the prostate--the sandwich technique: evaluation of the initial efficacy and morbidity in the treatment of benign prostatic obstruction

Abstract

Objectives: To evaluate the safety, initial efficacy and morbidity of a new treatment for benign prostatic hyperplasia (BPH), endoscopic rollerball electrovaporization (EREV) of the prostate.

Patients and methods: Endoscopic rollerball electrovaporization with or without a modified transurethral prostatectomy (TURP) was performed in 51 patients (mean age 69 years). Before treatment, patients were evaluated by measuring maximum flow rate, post-void residual volume (PVR) and a symptom score. After undergoing EREV and modified TURP the operative and hospital records were reviewed and the duration of the procedure, hospital stay and the incidence of complications and/or morbidity were recorded. The urodynamic variables were re-evaluated after 3-8 months.

Results: Five patients were operated on for retention: of the remaining patients, the pre-operative mean symptom score was 18 (maximum 30), the mean maximum flow rate was 11.5 mL/s, the mean PVR was 159 mL and the mean duration of the procedure was 28 min. Of the 51 patients, 30 were discharged catheter-free on the first day after surgery. No patient required transfusion for associated blood loss, none had evidence of symptomatic bacteraemia and the transurethral resection syndrome did not occur. One patient who had a bladder carcinoma resected at the same operation was readmitted 2 weeks later with haematuria and clots. Three patients presented as emergencies within 8 weeks because of retention; one was admitted and required further EREV. On re-evaluation, the symptom scores decreased by a mean of 11 points, the maximum flow rate increased by a mean of 6.2 mL/s and the mean PVR decreased by 102 mL.

Conclusions: EREV of the prostate is a safe, effective and economic alternative to a standard TURP.