Augmented Electocutting energy (Electrovaporization)
TUVRP = TURP + TUVP
Technique of operation!
The “Wedge” resection device for electrosurgical transurethral prostatectomy Perlmutter AP & Schulsinger DA
J Endourol 12: 75-79, 1998
Transurethral electrovaporization-resection of the prostate using the “Wing” cutting electrode: Preliminary results of safety and efficacy in the treatment of men with prostatic outflow obstruction
Riyadh F. Talic
Urology 53: 106-110, 1999
Conclusions of the Feasibility Studies on TUVRP
TUVRP is a promising new modification of the standard TURP.
TUVRP combines the excellent resection capabilities of TURP and the benefits of electrovaporization.
No complications related to the augmented electrosurgical energy.
Safety & Efficacy of TUVRP
Randomized study versus standard TURP.
Effects of High electrocutting energy on:
Serum Prostate Specific Antigen (PSA).
Evaluate the role of the thick loop design.
Prospective Randomized Study of Transurethral Vaporization Resection of the Prostate Using the Thick Loop and Standard Transurethral Prostatectomy R. F. Talic, A. E. El Tiraifi, S.H. Hassan, S. R. El Faqih, R. A. Attassi, R. E. Abdel Halim
Transurethral Vaporization-Resection of the Prostate Versus Standard Transurethral Prostatectomy: Comparative Changes in Histopathological Features of the Resected Specimens R. F. Talic & A. C. Al Rikabi
Eur Urol 37: 301-305, 2000
Histopathology post TUVRP
Fifty patients that underwent TUVRP & TURP
One blinded Pathologist
Devised scoring system for severity of cautery artifacts
Histopathology post TUVRP
Electrocautery Artifacts (1 Point scoring):
Abnormal cellular orientation & spindling
Abnormal cellular detachment from underlying basement membrane
Patients that are fully potent pre TUVRP can expect to remain so post prostatectomy.
The heat that is generated by the increased level of cutting energy is dissipated by the irrigation fluids used during resection and does not seem to adversely affect potency.
The “Wing” Versus the “Vapor cut” electrodes in transurethral vaporization resection of the prostate: Comparative changes in Safety Parameters R. F. Talic, W. Al Kudair, A. E. El Tiraifi, N. M. Al Bogami, M. k. Mansi, S. Altaf & T. B. Hargreave
Urology Internationalis; 65: 95-99, 2000
“Wing” versus “Vapor cut”
Ninety patients at KKUH, WGH & KFNGH
KKUH & WGH: The “Wing” & Eschman Unit
KFNGH: The “Vapor cut” & Valley lab unit.
Baseline variables were balanced.
Safety features: The “Wing” versus the “Vapor cut”
Differences may be related to changes in the loop design!!
Safety features that are related to the vaporization effect are influenced by the speed of resection
TUVRP improves safety of transurethral prostatectomy and has the potential to reduce the main 2 morbidities that are associated with standard TURP namely; bleeding and electrolyte disturbances.
The shorter post operative catheterization time that is noted following TUVRP is clinically significant considering the demand for lower morbidity profiles and hospitalization time by the patients and health care providers
TUVRP maintains the efficacy of standard prostate debulking procedures
The higher energy level that is used in TUVRP does not seem to have an adverse effects, particularly in relation to erectile function, serum PSA levels and quality of histopathological specimens
The change to using TUVRP is simple and does not require capital investment in new technology.
Future work will need to further focus on the role of the thick loop design