Advantages of transurethral rotoresection versus standard transurethral resection in the management of benign hyperplasia of the prostate

BACKGROUND AND PURPOSE: The endourologic community is in search of safer and efficient alternatives to conventional transurethral resection of the prostate (TURP). This research compared the efficacy of two transurethral resection techniques - conventional loop and rotoresection - in the surgical management of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: From January 2000 through December 2001, we randomized 128 BPH patients aged 55 to 74 years (average 61.4 +/- 2.7 years), all complaining of symptoms for prostatism for 1 to 14 years (average 4.5 +/- 1.5 years), to either transurethral rotoresection (TURotor; N = 58) or TURP (N = 70). The mean ages in the two groups were 67.53 +/- 7.21 years and 62.93 +/- 6.43 years, respectively. The diagnosis of BPH was made on the basis of patient history, International Prostate Symptom Score (IPSS), digital rectal examination, transrectal ultrasonography, uroflowmetry, and serum prostate specific antigen (PSA) concentration. Three months after surgery, we again measured the residual urine volume, uroflow, IPSS, and prostate size by ultrasonography. RESULTS: The TURotor took 30.1 +/- 10.2 minutes with an intraoperative blood loss of 130 +/- 25 mL. During the immediate postoperative period, an insignificant amount of blood was visible in the urine and irrigation fluid. We removed the catheter at 1.8 +/- 0.69 days. At 3 months' follow-up, the maximum uroflow rate (Q(max)) had increased to 19.87 +/- 6.77 mL/sec, and the residual urine volume had fallen to 38.75 +/- 18.84 mL. The average TURP lasted 42.1 +/- 13.2 minutes, or almost 30% longer than TURotor. The intraoperative blood loss averaged 21050 mL. The catheter was removed in 2.2 +/- 0.78 days. At 3 months, the Q(max) was 20.78 +/- 6.56 mL/sec, and the average amount of residual urine had fallen to 35.48 +/- 8.71 mL. CONCLUSION: Rotoresection is a promising alternative to conventional TURP because it affords almost bloodless, 30% faster removal of prostate tissue.