710 © 2 0 0 3 B J U I N T E R N A T I O N A L | 9 2 , 7 1 0 – 7 1 2 | doi:10.1046/j.1464-410X.2003.04473.x Original Article ROTORESECTION FOR BPH B.S. WADIE et al. Short-term results of rotoresection for benign prostatic hyperplasia: a prospective study of safety and efficacy B.S. WADIE, A.B. SHEHAB EL-DEIN, A.M. MOHAMED, S.M. ELHALWAGY and M.A. GHONEIM Urology & Nephrology Centre, Mansoura, Egypt Accepted for publication 14 June 2003 of >1.8 mg/mL were excluded. The adenoma was resected using the Rotoresect® system (Karl Storz, Tuttlingen, Germany); the mean (SD) operative duration was 45.2 (9.9) min. The catheter was removed after 1.97 (0.3) days and patients assessed at 1, 3 and 6 months after surgery by an AUA score, Q max , blood haemoglobin level, urine analysis and transrectal ultrasonography; all patients but two completed the follow-up. RESULTS At 6 months the mean (SD) AUA score decreased from 20.5 (3.8) to 1.6 (1.3), the Q max increased from 8.7 (2) to 25.3 (12.6) mL/s, and the total prostate volume decreased from 36.5 (13) to 20.5 (7.8) mL. The mean initial haemoglobin level was 138 (10) g/L and at 1 month was 135 (12) g/L. No patient required a blood transfusion or had signs of transurethral resection syndrome. Early complications included UTI and mild stress incontinence in 10 and 11 patients, respectively. At 6 months these patients had sterile urine and were continent. Two patients had a urethral stricture and posterior urethral stone at 6 months and were treated successfully. CONCLUSION In the short-term, rotoresection is a safe and effective method for treating BPH; there was no significant blood loss or resection syndrome. The hospital stay was short, with excellent functional results. KEYWORDS rotoresection, BPH, short-term results, efficacy, safety, outcome OBJECTIVE To assess the safety and efficacy of rotoresection as a method for treating benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Thirty patients were prospectively enrolled between September 2000 and May 2001 (mean age 61 years, SD 6, range 52–78). All patients had a symptom score (AUA) of >12, a maximum urinary flow rate (Q max ) of <12 mL/s, a prostate of 20–80 mL and a prostate-specific antigen (PSA) level of 0– 4 ng/mL. Patients with prostate or bladder cancer, a PSA level of >10 ng/mL, previous prostate surgery, previous pelvic surgery, urethral stricture, active urinary tract infection (UTI), acute urine retention, neuropathic bladder and a serum creatinine INTRODUCTION BPH is a common disease generally affecting men aged >40 years. According to the definition of Garraway et al. [1] BPH manifests as a prostate of >20 g, a maximum urinary flow rate (Q max ) of < 15 mL/s and the presence of symptoms of urinary dysfunction. From this definition the prevalence of BPH was estimated to be 14% in men aged 40–50 years, 25% at 50–80 years and 43% at 60–70 years. TURP is accredited with a long-term success rate of 85–90% [2]. To date, no treatment method other than TURP has achieved the same success for both functional and anatomical outcome. Less invasive treatments are increasingly popular; transurethral electrovaporization is a method using high- frequency electric current to create an extended zone of tissue coagulation and vaporization [3]. It is associated with minimal blood loss but tissue ablation is not as immediate as with TURP. Recently, a rotating resection system (Rotoresect®, (Karl Storz, Tuttlingen, Germany) was introduced as a modification of the electrovaporization method, combining synchronous mechanical rotation of a specially designed electrode with the generation of high-frequency current. We prospectively evaluated the safety and efficacy of this new method. PATIENTS AND METHODS The prospective study included 30 patients, enrolled in conformity with USA Food and Drug Administration standards, using strict inclusion and exclusion criteria; patients were aged 50–80 years, with an AUA-7 symptom index of ≥ 12, a Q max of £ 12 mL/s with a voided volume of ≥ 125 mL, a prostatic length, determined on cystoscopy, of 3–5 cm and a prostate volume of 20–80 mL, and a PSA level of <4 ng/mL, or 4–10 ng/mL with a negative prostate biopsy. All patients gave informed written consent and had a life-expectancy of ≥ 1 year. Exclusion criteria, were: confirmed or suspected malignancy of the prostate or the bladder, a PSA of >10 ng/mL, previous prostate or rectal surgery (other than haemorrhoidectomy), previous pelvic surgery or irradiation, the presence of bladder stones or the occurrence of haematuria within 3 months of treatment, presence of a urethral stricture, acute urine retention, active prostatitis, neuropathic bladder, serum creatinine of > 1.8 mg/L, immunosuppressant drugs or drugs affecting voiding function, or a heart pacemaker. All patients were interviewed to obtain a detailed history, and the AUA-7 symptom index assessed by one interviewer for all patients. A physical examination, including a neuro-urological examination, was conducted. Urine analysis, urine culture, serum creatinine, serum electrolytes, complete blood count, blood sugar and serum total PSA were assessed. TRUS was carried out (7.5 MHz probe, Panther 2002,