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| Necrosis zone depth after bipolar plasma vaporization and resection in the human prostate |
Clara Breitlinga,Hans Nenningb,Jörg Rasslera,*( )
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aDepartment of Urology, St. Elisabeth Hospital, Leipzig, Germany
bInstitute for Pathology “Am Elsapark”, Leipzig, Germany |
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Abstract Objectives: To compare the depth of thermal necrosis after use of bipolar resection and vaporization technique comparing intra-individually bipolar loop and bipolar button electrodes.
Methods: Transurethral resection and vaporization of the prostate was performed in 55 male patients (260 specimens in total). In a standardized procedure, a bipolar resection loop was used for resection, and a bipolar button electrode was used for vaporization. Both electrodes were applied in each patient, either in the left or in the right lateral lobe. The depth of necrotic zones in the resected or vaporized tissue of each patient was measured in a standardized way by light microscopy.
Results: The mean depth with standard deviation of thermal injury caused by the loop electrode was 0.0495±0.0274 mm. The vaporization electrode caused a mean thermal depth with standard deviation of 0.0477±0.0276 mm. The mean difference of necrosis zone depths between the two types of electrodes (PlasmaButton-resection loop) was −0.0018 mm (p=0.691).
Conclusion: For the first time, we present directly measured values of the absolute necrosis zone depth after application of plasma in the transurethral treatment of benign prostatic hyperplasia. The measured values were lower than in all other transurethral procedures. Standardized procedures of measurement and evaluation allow a statistically significant statement that the low necrosis depth in bipolar procedures is independent of the applied electrodes.
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Received: 21 December 2020
Available online: 20 April 2023
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Corresponding Authors:
Jörg Rassler
E-mail: Joerg_Rassler@t-online.de
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| Parameter | Value | | Agea, year | 71.7±7.1 | | Group 1b,c | 29 (52.7) | | Group 2b,c | 26 (47.3) | | BMIa, kg/m2 | 26.47±3.99 | | PSAa, ng/mL | 4.69±3.62 | | Prostate volumea, cm3 | 70.42±33.76 | | Intake of 5alpha-reductase inhibitor (dutasteride or finasteride)b | 11 (20.0) | | Intake of alpha1-inhibitor (tamsulosin)b | 13 (23.6) | | Intake of combined 5alpha-reductase-inhibitor and alpha1-inhibitorb | 5 (9.1) | | No prostate-specific medicationb | 26 (47.3) | | Blood clotting inhibitor (acetylsalicylic acid)b | 16 (29.1) | | Positive family history for PCab | 1 (1.8) |
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Patients' data (n=55).
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Schematic explanation of the two procedures. Resection (top; A-D): a mucosa-free layer of one lateral lobe was resected with the loop (A) forming a standardized resection area (side Ⅰ; B); those specimens were not used for the study and were rinsed out; from the standardized resection area (side Ⅰ) the study specimens were taken with the resection loop (C). Vaporization (bottom; E-H): the other lateral lobe was vaporized with the PlasmaButton on the mucosa-free area (side Ⅰ; F); from this vaporization area study specimens were taken using the resection loop (G); the specimen surface (side Ⅰ) represents the area, which would remain inside the patient. The specimens were collected for histopathological examination and measurement of necrosis depth on sides Ⅰ and Ⅱ. The numbers in the red and blue boxes represent the mean necrosis zone depths (D and H).
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Necrotic zone depths at the concave side (side Ⅰ). (A) Absolute depth values in both methods (Button and Loop, respectively; in millimeter). (B) Difference (Delta) of the necrotic zone depths at side Ⅰ between PlasmaButton and resection loop (in millimeter). Boxes represent the interquartile range with the bold lines representing the medians and the whiskers the 10th/90th percentiles. The white squares and error bars in the boxes show the mean values ± 95% confidence intervals. The mean difference (PlasmaButton-resection loop; in millimeter) was with ?0.0018 mm not significant (paired t-test: p=0.691).
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Necrotic zone depths at the convex side (side Ⅱ). (A) Absolute depth values in both methods (Button and Loop, respectively; in millimeter). (B) Difference (Delta) of the necrotic zone depths at side Ⅱ between PlasmaButton and resection loop (in millimeter). Boxes represent the interquartile range with the bold lines representing the medians and the whiskers the 10th/90th percentiles. The white squares and error bars in the boxes show the mean values ± 95% confidence intervals. The mean difference (PlasmaButton-resection loop; in millimeter) was with ?0.003 mm not significant (paired t-test: p=0.798).
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