Needlescopic Enucleation Versus Vapoenucleation of BPH
Needlescopic Enucleation Versus Vapoenucleation of BPH
Transurethral resection of the prostate (TURP) is the current standard procedure for men with
 prostate volume 30-80 gm. In case with large prostate adenoma (>80 g), the resection time
 required by TURP is associated with increased risk of TUR syndrome, blood loss and other
 complications.

 Many types of minimally invasive surgery exist along with new equipment and techniques. Many
 types of laser devices such as greenlight laser, thulium laser and holmium laser, are used to
 enucleate the prostate. Increasing evidence has proven their safety and efficacy However, the
 use of laser devices is difficult and associated with steep learning curve and high medical
 expenses.

 PKEP is a safe and effective procedure for the treatment of bladder obstruction secondary to
 BPH. This procedure not only improves maximum flow rate at 3 and 12 months after surgery, but
 it also improves all other recorded parameters (IPSS, QOL, IEFF-5, PVR, PSA).

 A button electrode can be effectively used to enucleate the prostate because of its powerful
 vaporisation and strong coagulation (B-TUEP technique) ,such as that with a holmium laser,
 thulium laser and greenlight laser. However its associated with short term complication as
 early irritative symptoms, Bulai reported that 16.7% of the patients suffering from early
 irritative symptoms while Geavlete reported that 11.4% of patient suffering from early
 irritative symptoms.
Aim: compare safety and efficacy and adverse events of endoscopic enucleation of large
 prostate using hot knife electrode (needloscopic enucleation) versus the standard
 vaporization electrode ( vapoenucleation) patients & methods: Patients will randomly be
 divided into two equal groups: Group A: Patient will be subjected to bipolar endoscopic
 enucleation of the prostate by vaporization electrode (vapoenucleation).

 Group B: Patient will be subjected to endoscopic enucleation of the prostate by bipolar hot
 kife electrode (needloscopic enucleation) Inclusion criteria: patients with Qmax of less than
 15 mL/second due to BPH, severe LUTS/BPH requiring surgical treatment, and International
 Prostate Symptom Score (IPSS)>7 due to BPH.

 exclusion criteria: prostate and/or bladder cancer, bladder diverticula, urethral stricture,
 active urinary tract infection (UTI), unless treated, and men with neurogenic voiding
 dysfunction.

 Operative Technique: Endoscopic enucleation of the prostate in saline utilizing either
 bipolar vaporization electrode or bipolar hot knife (collin's) electrode.

 follow up: operative time, resected tissue weight, cath time, hospital stay and change of;
 IPSS,QOL, Qmax, PVR, PSA, IIEF-5 & MSHQ-EjD besides; perioperative adverse events are
 recorded & followed-up.
Inclusion Criteria:

 -  patients with Qmax of less than 15 mL/second due to BPH, severe LUTS/BPH requiring
 surgical treatment, and International Prostate Symptom Score (IPSS)>7 due to BPH.

 Exclusion Criteria:

 -  prostate and/or bladder cancer, bladder diverticula, urethral stricture, active
 urinary tract infection (UTI), unless treated, and men with neurogenic voiding
 dysfunction.