'Button type' bipolar plasma vaporisation of the prostate compared with standard transurethral resection: a systematic review and meta-analysis of short-term outcome studies

Objective: To evaluate the surgical morbidity and effectiveness in improving symptoms of benign prostatic hyperplasia (BPH), comparing 'button-type' bipolar plasma vaporisation (BTPV) vs transurethral resection of the prostate (TURP).

Methods: We conducted a literature search of published articles until November 2014. Only prospective and randomised studies with comparative data between BTPV and conventional TURP (mono- or bipolar) were included in this review.

Results: Six articles were selected for the analyses. In the 871 patients evaluated, 522 underwent TURP and 349 BTPV. There was a tendency for a higher transfusion rate in the TURP group, with two BTPV cases (0.006%) and 16 TURP cases (0.032%) requiring transfusions (P = 0.06). The number of complications was similar between the groups (odds ratio 0.33, 95% confidence interval [CI] 0.8-1.31; P = 0.12; I(2) = 86%). When subdivided by severity, 10.7% (14/131) and 14.6% (52/355) of complications were classified as severe (Clavien 3 or 4) in patients who underwent BTPV and TURP, respectively (P = 0.02). The average duration of indwelling catheterisation was significantly less in patients who underwent BTPV (standardised mean difference [SMD] -0.84; 95% CI -1.54 to 0.14; P = 0.02; I(2) = 81%). Both treatments significantly improved symptoms and the postoperative International Prostate Symptom Score was similar in both groups (SMD 0.09, 95% CI -1.56 to 1.73; P = 0.92).

Conclusion: BTPV is an effective and safe treatment for BPH. The improvement of urinary symptoms and overall complications are comparable to conventional TURP. However, BTVP appears to be associated with a lower rate of major complications and duration of indwelling catheterisation.