Transurethral electrovaporization and vapour-resection of the prostate: An appraisal of possible electrosurgical alternatives to regular loop resection

Electrovaporization is a modification of electrodesiccation and has the potential to allow the removal of prostatic tissue with reduced bleeding. This effect is improved by greater contact time from slow electrode excursion and the type of contact between electrode and tissue, both of which are operator-controlled variables. The tissue removal efficiency of TUEVAP depends on the delicate balance between simultaneous vaporization and coagulation, which governs the amount of tissue desiccation and the limitation of the vaporization effect with time. Factors critical to this balance include the configuration of the electrode, the efficiency of the generator across a range of impedance, and the technique of the operator. Early clinical data suggest that TUEVAP is associated with lower morbidity and shorter hospitalization than TURF. There is no dangerous or remote deep tissue heating provided the operator uses pure cutting current only and relies on low current density areas of the electrode to provide haemostasis. The use of coagulating current should be avoided at the prostatic apex. Long-term outcomes of TUEVAP are equivalent to TURF at 3 years. Pressure-flow studies and studies of the completeness of tissue removal also show equivalence to TURF. The electrode configuration, generator power curve characteristics, and use of a modified operative technique appear to be more critical when tackling medium to large prostates. Differences in electrode design between a regular loop and an electrovaporization electrode indicate that apical prostatic tissue should not be treated as in TURF, but requires the use of a modified operative technique, if sphincter damage from direct electrode contact is to be avoided. The place of vapour-resection loops is not yet established, but it is likely that they are associated with morbidity that lies between TUEVAP and TURF. Further fluid absorption studies and longer follow-up are required for each new electrosurgical modality, before their place in the endourological treatment of symptomatic prostatic enlargement is assured alongside the time-honoured standard set by TURF with a thin wire loop