Prospective randomized comparison of transurethral resection of prostate using vapor resection (WedgeTM) loop and standard loop in prostates larger than 40 CC

Purpose: Transurethral resection of the prostate (TURP) is the gold standard for treatment of benign pro static hyperplasia (BPH). However; the morbidity of this procedure necessitates constant attempts at modifications to the standard equipment and technique. We report on the safety and efficacy of TURP with the thick vapor resection WEDGE′" loop (Microvasive0, Boston Scientific Corporation, USA) compared with the standard wire loop in comparable groups of patients with prostates larger than 40 cc. Material and Methods: We prospectively randomized 60 patients with bladder outflow obstruction due to BPH into 2 groups of 30 each. The inclusion criteria included an indication for prostatectomy and prostate size larger than 40 cc. The exclusion criteria included carcinoma prostate and neurovesical dysfunction. Pre-operative evaluation included assessment of International prostate symptom score (IPSS), prostate volume (in cc), maximum fow rate (Qmax) and residual urine (in ml). Patients in group 1 underwent transurethral vapor resection of the prostate (TUVRP) using the WEDGE" loop while patients in group 2 underwent TURP using a standard wire loop. Operating time, resected tissue weight, duration of catheterization, nursing contact time, hospital stay, haemoglobin change, serum sodium levels, and any complications were noted and compared in the 2 groups. The IPSS maximum f ow rate and residual urine were re-evaluated at 6 months after the procedure and compared in the 2 groups. Results: Both groups were comparable in terms of age, IPSS, prostate volumes, Qmax and residual urine. The mean prostate volume in group I and 2 was 63.6 cc and 58.48 cc respectively. The mean resected weight in group 1 and 2 was 20.30 gin and 17.52 gin respectively. Irrigant (1.5% ghvcine) volume used was 14.65L and 19.12L and the operating time was 47 min and 68.6 min in the 2 groups respectively. Estimated mean intra-operative blood loss was 50 (30-50 ml) and 250 (100-300 ml) respectively. Duration of post-operative catheterization was 1.56 days and 2.28 days and haemoglobin change was +/- 1.32 g and +/- 1.96 g respectively. The differences in duration of hospital stay and the change in serum sodium were not significant. Post operative catheterization duration, post operative irrigant requirement was significantly different in both the groups. The incidence of complications was similar and the efficacy assessed with IPSS, Qmax and residual urine was comparable at 6 months. Conclusion: The use of a thick vapor resection loop for TURP significantly reduces operating time, blood loss, irrigant requirement, nursing contact time, and duration of catheterization, besides providing a clew vision during surgery without affecting the efficacy and complications