Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition in male geriatric populations. The prostate goes through two main growth cycles during a man’s life. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth starts around age 25 and goes on for most of the rest of a man’s life. BPH most often occurs during this second growth phase.

As the prostate enlarges, it presses against the urethra. The bladder wall becomes thicker. One day, the bladder may weaken and lose the ability to empty fully, leaving some urine in the bladder. Narrowing of the urethra and urinary retention – being unable to empty the bladder fully – cause many of the problems of BPH.

There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies and surgery.

Safe

The safe solution – improved peri-operative safety profile

Our plasma technology system provides a smart solution for a safe, cost- and time-effective, proven therapy for patients with BPH. The combination of procedure-oriented plasma probes and the lowest frequency RF generator on the market offers a unique and innovative update to the gold standard of B-TURP.

M-TURP vs PLASMA

The golden standard, improved

Our plasma technology system has a more favorable perioperative safety profile compared to monopolar electrosurgery, especially regarding TUR syndrome occurrence, frequency of blood transfusions, and the clot retention rate.

-100% TUR Syndrome

  • Monopolar
  • Plasma

-65% Blood Transfusion

  • Monopolar
  • Plasma

-58% Clot Retention

  • Monopolar
  • Plasma

-64% Readmissions

  • Monopolar
  • Plasma

See reference

Treharne C., Crowe L., Booth D., Ihara Z.
Economic Value of the Transurethral Resection in Saline System for Treatment of Benign Prostatic Hyperplasia in England and Wales: Systematic Review, Meta-analysis, and Cost–Consequence Model, EU Focus, March 2016

Reduced Complications

Late complications (6–24 months)
Urethral stricture 2 (4) 3 (6) 1.0
Bladder‐neck contracture 1 (2) 2 (4) 1.0
Stress incontinence 0 2 (4) 0.49
Retrograde ejaculation, n/N (%) 8/22 (36) 9/18(50) 0.52

In a study, first published in BJU International (see reference), erectile dysfunction after M-TURP and a plasma treatment was accessed and although there was no significant effect on sexual activity in either group; the plasma group had a lower rate of retrograde ejaculation than M-TURP group. It was concluded, that this might occur, because there is no  electric current passing  through the body and did no harm to the surrounding nerves; secondly, the precise resection due to the clear visual field made it possible to preserve the tissue around the verumontanum.

See reference

Q. Chen, L. Zhang, Q.L. Fan, J. Zhou, Y.B. Peng, Z. WangBipolar transurethral resection in saline vs traditional monopolar resection of the prostate: results of a randomized trial with a 2-year follow-up
BJU Int, 106 (2010), pp. 1339-1343


Precise

The precise solution – reduces the risk of damaging surrounding tissue

M-TURP

Plasma

The thin plasma layer empowers surgeons to cut precisely and reduces the risk of damaging surrounding tissue and removes only the target tissue.

  • 50-100μn thin plasma layer
  • Preserves the prostatic capsule
  • Reduced thermal impact
  • Precise resection and coagulation

Reduced Thermal Impact

Reduced risk of damaging surrounding tissue.

The low working temperature (40-70C) protects the surrounding tissues, reduces injury and ensures reduced pain after surgery.

Efficient

The efficient solution – the cost- and time-effective for all prostate sizes

PLASMA Enuncleation vs Laser

The EAU Guidelines (2016) point to Plasma (bipolar resection) as one of the first-choice treatments for all prostate sizes.For larger prostates, Plasma enucleation is equally reccomended as HoLEP and open prostatectomy.

Minimally invasive laser prostatectomy is commonly used and has several advantages, such as speedy relief from symptoms, quick recovery, as well as reduced postoperative complications. Nevertheless, the cost issue, as well as the steep learning curve of laser prostatectomy restrict its widespread use, and indeed this technique is used in few centres [6].

In contrast, recently introduced bipolar electrosurgical technology has gained attention worldwide due to its low morbidity and affordability. In addition, bipolar electrosurgical technology achieves similar results to TURP in improving patient’s symptoms [7].

 

HoLEP and bipolar TURP are effective in treating patients with lower urinary tract symptoms due to BPH, however; the long operative time, the steep learning curve, as well as the higher expenses of HoLEP are in favor of bipolar TURP.

PKEP was noninferior to OP regarding Qmax at 1 yr postoperatively. Compared with OP, PKEP was associated with less perioperative hemoglobin decrease, shorter catheterization time, and shorter postoperative hospital stay (1.0 vs 3.2 g/dl, 40 vs 148 h, and 3 vs 8 d, respectively; p < 0.001 for all), as well as fewer short-term complications (22.5% vs 42.5%, p = 0.031). On intention-to-treat analysis, both the PKEP and OP groups had equivalent Qmax (25.2 ± 7.0 ml/s vs 25.7 ± 7.6 ml/s, respectively; p = 0.688), International Prostate Symptom Score (3.5 [2–5] vs 3 [2–5], respectively p = 0.755), quality of life (2 [1–3] vs 2 [1–3], respectively; p = 0.950), and postvoid residual urine (20 [9–33.5] vs 16.5 [7–31] ml, respectively; p = 0.469) at 72 mo postoperatively. No patients required reoperation because of recurrence of BPH. The relatively small sample size is the limitation.

See references

Chen, S., Zhu, L., Cai, J., Zheng, Z., Ge, R., Wu, M., … Tan, J. (2014). Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: A randomized noninferiority controlled trial with long-term results at 6 years. European Urology66(2), 284–291.

Fayad, A. S., El Sheikh, M. G., Zakaria, T., Elfottoh, H. A., & Alsergany, R. (2011). Holmium laser enucleation versus bipolar resection of the prostate: A prospective randomized study. which to choose? Journal of Endourology25(8), 1347–1352.

EAU Guidelines

Recommendations LE GR
B-TURP achieves short- and mid-term results comparable with M-TURP 1a A
B-TURP has a more favourable peri-operative safety profile compared with M-TURP 1a A
OP or EEP such as holmium laser or bipolar enucleation are the first choice of surgical
treatment in men with a substantially enlarged prostate (e.g. > 80 mL) and moderate-to-severe
LUTS.
1a A

See reference

EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). http://uroweb.org/wp-content/uploads/EAU-Guidelines-Management-of-non-neurogenic-male-LUTS-2016.pdf

Bladder Tumor

Our plasma technology system has a more favorable perioperative safety profile compared to monopolar electrosurgery, especially regarding TUR syndrome occurrence, frequency of blood transfusions, and the clot retention rate.

See references

Xishuang, S., Deyong, Y., Xiangyu, C., Tao, J., Quanlin, L., Hongwei, G., … Lin, Y. (2010). Comparing the safety and efficiency of conventional monopolar, plasmakinetic, and holmium laser transurethral resection of primary non-muscle invasive bladder cancer. Journal of Endourology24(1), 69–73.


		
Fayad, A. S., El Sheikh, M. G., Zakaria, T., Elfottoh, H. A., & Alsergany, R. (2011). Holmium laser enucleation versus bipolar resection of the prostate: A prospective randomized study. which to choose? Journal of Endourology25(8), 1347–1352.

PLASMA Enuncleation vs Open Prostatectomy

Our plasma technology system has a more favorable perioperative safety profile compared to monopolar electrosurgery, especially regarding TUR syndrome occurrence, frequency of blood transfusions, and the clot retention rate.

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