To perform a prospective, randomized, long-term comparison between bipolar plasma vaporization of the prostate (BPVP), bipolar transurethral resection in saline (TURis), and monopolar transurethral resection of the prostate (TURP) concerning the perioperative and follow-up parameters.

A total of 510 patients with benign prostatic hyperplasia (BPH), Q_max <10 mL/s, International Prostate Symptom Score (IPSS) >19, and prostate volume between 30 and 80 mL were enrolled in the trial. All cases were evaluated preoperatively and at 1, 3, 6, 12, and 18 months after surgery by IPSS, quality of life, Q_max, and ultrasonography.

Each study arm including 170 cases emphasized similar preoperative parameters. The capsular perforation and intraoperative bleeding rates as well as the mean hemoglobin drop were significantly decreased for BPVP by comparison with TURis and TURP. The postoperative hematuria, blood transfusion, and clot retention rates were significantly higher in the TURP group. The operation time was significantly shorter only for BPVP patients, whereas the catheterization period and hospital stay were significantly reduced for BPVP, followed by TURis. The rates of irritative symptoms and urethral strictures were similar in the 3 series. The recatheterization, bladder neck sclerosis, and retreatment rates were significantly lower in the BPVP group. During the 1, 3, 6, 12, and 18 months' follow-up, the BPVP series emphasized significantly superior parameters in terms of IPSS and Q_max.

BPVP represents a valuable endoscopic treatment alternative for BPH patients, with superior efficacy and satisfactory complication rate. The long-term follow-up emphasized durable improvements of the postoperative parameters for BPVP.