TURP with the new superpulsed radiofrequency energy: More than a gold standard.
OBJECTIVE: Superpulsed radiofrequency, a new energy, has been developed and applied in transurethral resection of the prostate (TURP) using a regular cutting loop. The aim of the study was to evaluate the clinical application of superpulsed radiofrequency to reduce bleeding morbidity and to improve patient outcome. The original results of the experimental and clinical study are presented. METHODS: From November 1997 to June 1998, 37 patients were submitted to a clinical, nonrandomized study. The age range was 45-81 years. All patients completed the International Prostate Symptom Score (IPSS) and were examined using digital rectal examination, prostate-specific antigen level, transrectal ultrasound, free uroflow, and urodynamic pressure flow study. Hemoglobin was tested before and after surgery. Follow-up was at 3 and 6 months. All operations were performed with a short-acting spinal anesthesia and the resected prostate weight was 18-66 g. RESULTS: 36 patients were treated as 1-day surgery; 1 patient was hospitalized for 1 day. Intraoperative bleeding was very low (hemoglobin tested before and after surgery): the postoperative Hb was <1 g/dl in 34 patients, and Hb = 2 g/dl in 3 patients. Postoperative bleeding was minimal; late bleedings were not observed. Stress incontinence or incontinence were not observed. At 6 months, the patients were asked about any changes in their sexual lives, and no symptoms of impotence were reported. The peak flow rate (PFR) ranged from 4 to 7 ml/s at baseline, with a medium PFR of 5.5 ml/s. At 3 and 6 months the average increase in PFR was 11 and 10 ml/s, respectively, in all patients. CONCLUSIONS: As shown by this study, superpulsed radiofrequency is a safe and effective technology. It is superior to high-frequency surgical units and high-frequency coagulating intermittent cutting in terms of whole intraoperative bleeding (hemoglobin tested before and after surgery) and for the impressive impact on minimizing postoperative bleeding. In terms of improvement in urinary flow, the results of TURP with superpulsed radiofrequency at 3 and 6 months are comparable with the average PFR generally reported for TURP performed with high-frequency surgical units. Moreover, superpulsed radiofrequency TURP enhances the gold standard and makes TURP competitive with the other alternative treatments available for benign prostatic hyperplasia. Further studies could better define and extend the application of this new form of energy either in urologic or general surgery.