Plasmakinetic Enucleation of the Prostate Compared with Open Prostatectomy for Prostates Larger Than 100 Grams: A Randomized Noninferiority Controlled Trial with Long-term Results at 6 Years |
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Authors: | Shushang Chen Lingfeng Zhu Jinquan Cai Zhengrong Zheng Rong Ge Meijing Wu Zhen Deng Hao Zhou Shunliang Yang Weizhen Wu Lianming Liao Jianming Tan |
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Institution: | 1. Department of Urology, Fuzhou General Hospital, Xiamen University, Fujian Medical University, Fuzhou, Fujian, China;2. Department of Oncology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China;3. Department of Gynecology and Obstetrics, Fujian Provincial Hospital, Fuzhou, Fujian, China;4. Department of Health Statistics, Second Military Medical University, Shanghai, China;5. Department of Urology, People''s Hospital Affiliated to Fujian University of Traditional Chinese Medicine (The People''s Hospital of Fujian Province), Fuzhou, Fujian, China;6. Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China |
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Abstract: | BackgroundStudies have demonstrated that plasmakinetic enucleation of the prostate (PKEP) and open prostatectomy (OP) have equivalent short-term efficacy for large prostates, but no comparison concerning their long-term results was reported.ObjectiveTo demonstrate the noninferiority of PKEP to OP concerning maximum urinary flow rate (Qmax) at 1 yr postoperatively and to compare the long-term results of both procedures.Design, setting, and participantsFrom 2004 to 2007, 160 patients with prostates >100 g were randomized to receive PKEP or OP. A total of 153 patients (95.6%) completed the noninferiority study, and 123 patients (76.9%) finished a 6-yr follow-up assessment.InterventionThe PKEP procedures were performed with 27F Karl Storz continuous flow resectoscopy and the Gyrus PlasmaKinetic device. OP was performed by a suprapubic transvesical approach.Outcome measurements and statistical analysisThe primary end point was Qmax at 1 yr postoperatively. Secondary end points included other perioperative parameters and postoperative micturition variables. The student t test, Mann-Whitney U test, chi-square test, or Fisher exact probability test was used as appropriate.Results and limitationsPKEP was noninferior to OP regarding Qmax at 1 yr postoperatively. Compared with OP, PKEP was associated with less perioperative hemoglobin decrease, shorter catheterization time, and shorter postoperative hospital stay (1.0 vs 3.2 g/dl, 40 vs 148 h, and 3 vs 8 d, respectively; p < 0.001 for all), as well as fewer short-term complications (22.5% vs 42.5%, p = 0.031). On intention-to-treat analysis, both the PKEP and OP groups had equivalent Qmax (25.2 ± 7.0 ml/s vs 25.7 ± 7.6 ml/s, respectively; p = 0.688), International Prostate Symptom Score (3.5 2–5] vs 3 2–5], respectively p = 0.755), quality of life (2 1–3] vs 2 1–3], respectively; p = 0.950), and postvoid residual urine (20 9–33.5] vs 16.5 7–31] ml, respectively; p = 0.469) at 72 mo postoperatively. No patients required reoperation because of recurrence of BPH. The relatively small sample size is the limitation.ConclusionsPKEP is a durable procedure with short- to long-term micturition improvement equivalent to OP and significantly lower perioperative morbidity.Patient summaryWe compared PKEP with OP for large prostates and found that PKEP is less invasive, with short- to long-term micturition improvement equivalent to OP.Trial registrationPlasmakinetic Enucleation of the Prostate and Open Prostatectomy to Treat Large Prostates. ClinicalTrials.gov identifier NCT01952912. http://www.clinicaltrials.gov/ct2/show/NCT01952912?term=NCT016301952912&rank=1. |
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Keywords: | Benign prostatic hyperplasia Plasmakinetic enucleation of the prostate Open prostatectomy |
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