Influence of General and Local Anesthesia on Postoperative Pain After a Loop Electrosurgical Excision Procedure.

OBJECTIVE: To compare patient satisfaction, histopathologic results, and short-term morbidity in patients undergoing loop electrosurgical excision procedure (LEEP) under local anesthesia (LA) versus general anesthesia (GA). METHODS: Participants who met the inclusion criteria were randomly allocated in a 1:1 ratio to the LA group or GA group. Pain was determined by both objective (faces pain scale-revised) and subjective (visual analog scale score) methods. RESULTS: Data from 244 patients (123 in the LA group and 121 in the GA group) were analyzed. The median cone volume was 2.0 (0.4-4.7) cm 3 in the LA group and 2.4 (0.3-4.8) cm 3 in the GA group. There was no difference in margin involvement or repeat conization between the groups. The procedure time, time to complete hemostasis, intraoperative blood loss, and early postoperative blood loss were similar between the groups. The visual analog scale scores were higher in the LA group at 1, 2, and 4 hours postoperatively, but the differences between the groups were not significant. In addition, the median faces pain scale-revised scores at 1, 2, and 4 hours postoperatively were not significantly different between the LA and GA groups. CONCLUSIONS: The present study showed no difference in pain during the postoperative period, need for additional analgesia, volume of the extracted cone specimens, rate of positive surgical margin, bleeding volume, or operation time in women undergoing loop electrosurgical excision procedure under LA versus GA.

Electrosurgery or laser for benign prostatic enlargement: trumpcard or pitfalls.

PURPOSE OF REVIEW: To summarize and comment on publications of the last 2 years in the field of endoscopic surgery for benign prostatic enlargement, focusing on similarities and differences of laser and electrosurgery. RECENT FINDINGS: Because of good hemostasis and safety, invasive endoscopic surgery has evolved to a choice of treatment for vulnerable patients with ongoing antithrombotic medication and in same-day surgery. Recent publications show a good perioperative course and no deterioration in the postoperative outcome. Furthermore, alterations to the original surgical techniques of resection, enucleation, and vaporization have increased the preservation rate for antegrade ejaculation, advancing them to an appealing choice of treatment for sexually active men. Favorable outcomes can be achieved in both laser and electrosurgery. Only the choice of the surgical technique determines the outcome. SUMMARY: Various invasive endoscopic surgical techniques are available, offering different advantages and disadvantages for the patient. All of them can be performed with laser and electrosurgery. Therefore, focusing on the proper choice of surgical technique instead of the energy source will guarantee the patient to benefit most.

A Systematic Review on the Treatment of Dermatosis Papulosa Nigra.

Dermatosis papulosa nigra (DPN) is a benign skin condition that is primarily reported in skin of color patients. While prevalent, treatment options are limited and the benign course of DPNs may cause them to be overlooked by clinicians. However, large and multiple lesions in cosmetically sensitive areas may be emotionally and socially distressful to patients. There are few literature reviews examining treatment options for this condition. A literature search was performed using PubMed, Medline, Embase, and Web of Science databases. 67 articles were identified and 15 studies met the inclusion criteria. Our findings demonstrate that laser therapy is becoming increasingly utilized as a safe and efficacious treatment for DPNs in skin of color patients. J Drugs Dermatol. 20(4):467-472. doi:10.36849/JDD.2021.5555.

Treatment Modalities for Cherry Angiomas: A Systematic Review.

BACKGROUND: Cherry angiomas are benign vascular proliferations of endothelial cells associated with aging. Currently, no mainstay of treatment for these vascular anomalies exists. OBJECTIVE: To review existing evidence-based therapies for the treatment of cherry angiomas. METHODS: A literature search in May 2019 was performed with PubMed Database and Cochrane Library using the following terms: "cherry angioma," "senile hemangioma," "senile angioma," "cherry hemangioma," and "Campbell de Morgan spots." RESULTS: Ten studies included in this systematic review reported laser therapy and nonlaser therapy as efficacious treatments for cherry angiomas. Among the laser therapies, pulsed dye laser (PDL) was preferred over potassium-titanyl-phosphate (KTP) and electrodessication (ED), based on decreased procedure-related pain. The neodymium-doped yttrium aluminum garnet (Nd:YAG) laser 1064 nm produced less pigmentary complications, whereas KTP and PDL risked pigmentary changes in darker-skinned individuals. Nonlaser therapies included cryotherapy, sclerotherapy, electrosurgery (i.e., ED, electrocoagulation), and radiofrequency ablation. No therapy proved to be superior. CONCLUSION: A variety of therapeutic modalities exist for the treatment of cherry angiomas. However, a limited number of high-quality studies explored the efficacy of treatments and compared treatment modalities. Light-based methods such as argon, KTP, Nd:YAG, intense pulsed light, and PDL, along with non-light-based interventions such as cryotherapy, electrosurgery, and sclerotherapy effectively treated cherry angiomas.

Population-based assessment of re-treatment and healthcare utilisation after photoselective vaporisation of the prostate or electrosurgical transurethral resection of the prostate.

OBJECTIVE: To compare the healthcare utilisation and repeat surgical treatment rate amongst older men undergoing an electrosurgical-transurethral resection of the prostate (TURP) vs photoselective vaporisation of the prostate (PVP), as the real-world implementation and outcomes of laser-based treatment have not been well studied. PATIENTS AND METHODS: We used administrative data from the province of Ontario, Canada, to identify all men aged >66 years who underwent their first electrosurgical-TURP/PVP between 2003 and 2016. Our primary exposure was type of procedure (PVP or electrosurgical-TURP). Our primary outcome was need for repeat surgical treatment. The primary analysis was an adjusted marginal Cox model approach, which accounted for clustering of patients within surgeons; adjusted hazard ratios (aHRs) or odds ratios (aORs) and 95% confidence intervals (CIs) are reported. RESULTS: We identified 52 748 men: 6838 (13%) underwent PVP, and 45 910 (87%) underwent electrosurgical-TURP. The median age was similar, and PVP became more common with time. Compared to the PVP group, more patients in the electrosurgical-TURP group had prior gross haematuria or urinary retention, and fewer had used anticoagulants, α-blockers, or 5α-reductase inhibitors. The need for repeat surgical treatment was significantly higher amongst men who had PVP (aHR 1.57, 95% CI 1.38-1.78; absolute risk difference +2.3%). PVP was also associated with a slightly higher risk of return to the emergency room within 30 days (aOR 1.11, 95% CI 1.01-1.22) and a significantly lower risk of blood transfusion (aOR 0.24, CI 0.16-0.37); the majority of PVP cases were done with a <24 h stay (73%) vs electrosurgical-TURP (7%). CONCLUSIONS: While some of the expected benefits of PVP (such as reduced transfusion risk and shorter length of stay) were observed, the significantly higher rate of repeat surgical treatment compared to electrosurgical-TURP may represent an important difference in implementation of this technology outside of clinical trials.

Bipolar Plasmakinetic Enucleoresection of the Prostate: Our Experience with 245 Patients for 3 Years of Follow-Up.

OBJECTIVE: The aim of this study was to evaluate the safety, feasibility, and effectiveness of bipolar transurethral plasmakinetic enucleation of the prostate (PKEP). PATIENTS AND METHODS: Between January 2010 and October 2013, 245 patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent transurethral enucleation of prostate using bipolar plasma vaporization energy. Patients were evaluated preoperatively by full detailed history, routine preoperative investigation digital rectal examination, serum prostate-specific antigen, abdominal and transrectal ultrasonography, and maximum flow rates (Qmax). RESULTS: Patients' ages ranged from 50 to 81 (65.5 ± 6) years with transrectal ultrasound-measured prostate volume of 97.1 ± 36.7 mL resulting in an operating time of 76.9 ± 27.9 minutes, and postoperative irrigation and catheterization times were 3.5 ± 3.2 and 12.7 ± 6.1 hours, respectively. No significant complication occurred intra- or postoperatively. Qmax increased from 7.1 ± 3.2 mL/second preoperative to 18.4 ± 4.2 mL/second (p < 0.001). The International Prostate Symptom Score decreased from 25 ± 6 to 7.9 ± 2.4 (p < 0.01). CONCLUSION: This study confirmed that PKEP is a safe, easy to learn, and durable technique suitable for any prostate sizes.

The Effectiveness and Safety of Transurethral (Bipolar) Plasmakinetic Resection of Prostate Combined with Thulium Laser for Large Benign Prostatic Hyperplasia (>80ml).

PURPOSE: To evaluate the clinical curative effect and safety of transurethral (bipolar) plasmakinetic resection of theprostate (PKRP) combined with thulium laser in the treatment of large prostates (> 80mL). MATERIALS AND METHODS: From January 2014 to December 2015, 61 patients with benign prostate hyperplasia(BPH) were treated with PKRP combined with thulium laser (n = 25) or PKRP only (n = 36). We retrospectivelyanalyzed the perioperative status of patients status during 3-month follow-up. RESULTS: There was no significant difference between the two groups before treatment (P > .05). PKRP combinedwith thulium laser was significantly superior to PKRP in terms of surgical duration, intraoperative blood loss,postoperative bladder washing time, postoperative complications and time of hospital stay (P < .05). There were nosignificant improvements at international prostatic symptom score (IPSS), quality of life (QOL), maximum flowrate (Qmax), and post-void residual (PVR) urine between two groups after 3 months (P > .05). CONCLUSION: PKRP combined with thulium laser is superior than PKRP only for better surgical duration, lessbleeding, higher efficiency and much quicker recovery. It may be a better choice for the treatment of BPH withlarge prostate (> 80mL).

Limited Impact of Music Therapy on Patient Anxiety with the Large Loop Excision of Transformation Zone Procedure - a Randomized Controlled Trial.

BACKGROUND: Many studies have pointed to strategies to cope with patient anxiety in colposcopy. Evidence shows that patients experienced considerable distress with the large loop excision of transformation zone (LLETZ) procedure and suitable interventions should be introduced to reduce anxiety. This study aimed to investigate the effects of music therapy in patients undergoing LLETZ. MATERIALS AND METHODS: A randomized controlled trial was conducted with patients undergoing LLETZ performed under local anesthesia in an out patient setting at Ramathibodi Hospital, Bangkok, Thailand, from February 2015 to January 2016. After informed consent and demographic data were obtained, we assessed the anxiety level using State Anxiety Inventory pre and post procedures. Music group patients listened to classical songs through headphones, while the control group received the standard care. Pain score was evaluated with a visual analog scale (VAS). Statistical analysis was conducted using Pearson Chi-square, Fisher's Exact test and T-Test and p-values less than 0.05 were considered statistically significant. RESULTS: A total of 73 patients were enrolled and randomized, resulting in 36 women in the music group and 37 women in the non-music control group. The preoperative mean anxiety score was higher in the music group (46.8 VS 45.8 points). The postoperative mean anxiety scores in the music and the non-music groups were 38.7 and 41.3 points, respectively. VAS was lower in music group (2.55 VS 3.33). The percent change of anxiety was greater in the music group, although there was no significant difference between two groups. CONCLUSIONS: Music therapy did not significantly reduce anxiety in patients undergoing the LLETZ procedure. However, different interventions should be developed to ease the patients' apprehension during this procedure.

Electrosurgical transurethral resection of the prostate and transurethral incision of the prostate (monopolar techniques).

INTRODUCTION: We summarize the current guidelines, techniques, efficacy and complications associated with monopolar transurethral resection of the prostate (TURP) and transurethral incision of the prostate (TUIP) for benign prostatic hyperplasia (BPH). Patients who elect to have endoscopic surgical bladder outlet reduction are faced with an abundance of evolving treatment options. As new technology comes and goes, TURP and TUIP remain the gold standard for which new treatments are compared. MATERIALS AND METHODS: A review of past and contemporary data including American and European guidelines was performed. Techniques, efficacy, durability, short term and long term complications of TURP and TUIP are summarized. RESULTS: Small prostate sizes < 30 mL without a median lobe can be effectively treated with TUIP with decreased perioperative complications and sexual side effects compared to TURP. Monopolar TURP demonstrates significant improvements in IPSS, peak flow rate (Qmax), and quality of life (QoL) with durable (8 year-22 year) outcomes. Secondary intervention increases by 1%-2% annually. Thirty-day mortality rate is low (0.1%) as well as incidence of TUR syndrome (< 1.1%). Short term and long term complications include bleeding requiring transfusion, clot retention, acute urinary retention (AUR), and urinary tract infections as well as incontinence, bladder neck contracture, urethral stricture, and sexual dysfunction. CONCLUSIONS: Monopolar TURP and TUIP are effective endoscopic treatments for BPH with durable long term results. While the short term and long term complication rates are acceptable, new technologies aim to increase tolerability of bladder outlet reduction by decreasing treatment related morbidity.

Efficacy and Safety of Plasmakinetic Resection of the Prostate in Patients with a Prostate Gland Larger than 80 cc: 30-Month Follow-Up Results.

PURPOSE: This study aimed to evaluate the efficacy and safety of transurethral plasmakinetic resection of the prostate (PKRP) for the treatment of patients with benign prostatic hyperplasia (BPH) in men with prostate volume >80 cc. PATIENTS AND METHODS: From January 2010 to December 2011, 120 patients were included in our study; among these patients, 66 had prostate sizes of 80 cc to 100 cc and 54 had prostate sizes >100 cc. Pre-, peri- and postoperative evaluations were performed. RESULTS: The mean operative duration of PKRP was 112 minutes, and the mean resected tissue weight was 60.01 g. Hemoglobin level decreased by 0.65±0.52 g/dL, and serum sodium content decreased by 0.06±2.62 mmol/L. The mean catheterization time was 83.05 hours, and the mean hospital stay was 12.47 days. The short follow-up time (30 months) demonstrated significant improvement in International Prostate Symptom Score, quality of life, and postvoid residual volume compared with preoperative characteristics. One patient underwent reoperation because of a blood clot in the bladder. Twelve patients complained of retrograde ejaculation. No patient experienced urinary incontinence. CONCLUSIONS: PKRP is safe and efficacious for men with BPH who have a large prostate (volume >80 cc).

Bipolar versus monopolar transurethral resection of the prostate: a prospective randomized trial focusing on bleeding complications.

PURPOSE: We compare monopolar vs bipolar transurethral resection of the prostate in patients with benign prostatic hyperplasia, focusing on functional outcomes as well as rates of bleeding complications and the transurethral resection syndrome. MATERIALS AND METHODS: A total of 137 patients with benign prostatic hyperplasia (mean age 67 years, range 47 to 91) were prospectively randomly assigned to undergo monopolar (67) or bipolar (70) transurethral resection of the prostate. Patient characteristics of the 2 groups were similar. Hemoglobin (as a marker of blood loss) was measured preoperatively and perioperatively. I-PSS, I-PSS-QoL score, maximal flow rate and post-void residual urine volume were assessed preoperatively and 3 and 12 months postoperatively. Duration of surgery, indwelling catheter use and hospitalization were also documented, as were postoperative clot retention requiring removal by catheterization or surgery, and rates of bladder neck and/or urethral strictures. RESULTS: No significant perioperative differences were found in duration of surgery, catheterization or hospitalization, or in blood loss or rates of blood transfusion and transurethral resection syndrome. Postoperatively there were no significant differences in I-PSS or I-PSS-QoL scores, or rates of rehospitalization, clot retention, blood transfusions, reoperation or urethral strictures. However, bladder neck stricture occurred significantly more often in the bipolar group (8.5% vs 0%, p = 0.02). The 3 and 12-month followup showed significant and equal improvement in micturition in the 2 groups. CONCLUSIONS: Bipolar and monopolar transurethral resection of the prostate are effective and safe techniques for the surgical treatment of benign prostatic hyperplasia. The only significant difference between them was a significantly higher rate of bladder neck strictures with bipolar resection of the prostate.

Thulium laser enucleation versus plasmakinetic resection of the prostate: a randomized prospective trial with 18-month follow-up.

OBJECTIVE: To compare the clinical outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) and plasmakinetic bipolar resection of the prostate (PKRP) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial with 18 months of follow-up. METHODS: The study randomized 158 consecutive patients with BPH to ThuLEP (n = 79) or PKRP (n = 79). All patients were evaluated preoperatively and at 1, 3, 6, 12, and 18 months after surgery by International Prostate Symptom Score (IPSS), quality of life score (QOLS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). RESULTS: The 79 patients in each study arm each showed no significant difference in preoperative parameters. Compared with PKRP, ThuLEP required a longer operation time (65.4 vs 47.4 minutes, P = .022) but resulted in less hemoglobin decrease (0.15 vs 0.30 g/dL, P = .045). ThuLEP also needed less catheterization time (2.1 vs 3.5 days, P = .031), irrigation volume (12.4 vs 27.2 L, P = .022), and hospital stay (2.5 vs 4.6 days, P = .026). During the 1, 3, 6, 12, and 18 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS. CONCLUSION: ThuLEP and PKRP both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to PKRP in blood loss, catheterization time, irrigation volume, and hospital stay but inferior to PKRP in operation time. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through the 18 months of follow-up.

Midterm results from an international multicentre randomised controlled trial comparing bipolar with monopolar transurethral resection of the prostate.

BACKGROUND: Pooled data from randomised controlled trials (RCTs) with short-term follow-up have shown a safety advantage for bipolar transurethral resection of the prostate (B-TURP) compared with monopolar TURP (M-TURP). However, RCTs with follow-up >12 mo are scarce. OBJECTIVE: To compare the midterm safety/efficacy of B-TURP versus M-TURP. DESIGN, SETTING, AND PARTICIPANTS: From July 2006 to June 2009, TURP candidates with benign prostatic obstruction were consecutively recruited in four centres, randomised 1:1 into the M-TURP or the B-TURP arm and regularly followed up to 36 mo postoperatively. A total of 295 patients were enrolled. INTERVENTION: M-TURP or B-TURP using the AUTOCON II 400 electrosurgical unit. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Safety was estimated by complication rates with a special emphasis on urethral strictures (US) and bladder neck contractures (BNCs) recorded during the short-term (up to 12 mo) and midterm (up to 36 mo) follow-up. Efficacy quantified by changes in maximum urine flow rate, postvoid residual urine volume, and International Prostate Symptom Score was compared with baseline, and reintervention rates in each arm were also evaluated. RESULTS AND LIMITATIONS: A total of 279 patients received treatment after allocation. Mean follow-up was 28.8 mo. A total of 186 of 279 patients (66.7%) completed the 36-mo follow-up. Posttreatment withdrawal rates did not differ significantly between arms. Safety was assessed in 230 patients (82.4%) at a mean follow-up of 33.4 mo. Ten US cases were seen in each arm (M-TURP vs B-TURP: 9.3% vs 8.2%; p=0.959); two versus eight BNC cases (M-TURP vs B-TURP: 1.9% vs 6.6%; p=0.108) were collectively detected at the midterm follow-up. Resection type was not a significant predictor of the risk of US/BNC formation. Efficacy was similar between arms and durable. A total of 10 of 230 patients (4.3%) experienced failure to cure and needed reintervention without significant differences between arms. High overall reintervention rates, withdrawal rates, and sample size determination not based on US/BNC rates represent potential limitations. CONCLUSIONS: The midterm safety and efficacy of B-TURP and M-TURP are comparable. TRIAL REGISTRATION: Netherlands Trial Register, NTR703 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=703).

Flammability of topical preparations and surgical dressings in cutaneous and laser surgery: a controlled simulation study.

BACKGROUND: Surgical fires are a rare, but serious complication of dermatologic procedures involving electrosurgical and laser devices. Given the lack of data regarding basic fire safety principles, many dermatologists remain unaware of this potential risk. OBJECTIVE: We evaluated the flammability of topical preparations and surgical drapes commonly encountered in the immediate operative field during cutaneous and laser surgery. METHODS: Surgical dressings, drapes, and pork belly skin were examined for fire risk upon exposure to isopropyl alcohol, chlorhexidine gluconate, and aluminum chloride under dry, saturated, and damp conditions. Both electrosurgery and a carbon-dioxide laser were used as ignition sources. RESULTS: At least some char was observed in 86 of 126 simulated conditions (68%). Flames occurred in 2 test conditions: dry underpad drapes and cotton balls exposed to the carbon-dioxide laser. In general, drapes and dressings dampened or saturated with isopropyl alcohol failed to ignite with electrofulguration or electrodessication, although sparks and moderate char developed on pork belly skin and the underpad drape. Materials dampened or saturated with chlorhexidine gluconate, which contains isopropyl alcohol, generated less smoke and char compared with materials exposed to aluminum chloride, which does not contain alcohol. LIMITATIONS: Future studies may assess the flammability of materials in the setting of oxygen supplementation. CONCLUSION: In common cutaneous surgical environments, electrosurgery or ablative laser may lead to char and rarely to fire. Char may be seen in up to two thirds of simulated conditions, and in a minute proportion of conditions, fire is observed.

Plasma vaporisation of the prostate: initial clinical results.

BACKGROUND: Laser vaporisation of the prostate has had a considerable impact in recent years. In an attempt to achieve tissue vaporisation with bipolar high-frequency generators, plasma vaporisation was recently introduced. OBJECTIVE: To provide the first clinical information on bipolar plasma vaporisation of the prostate for patients with lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO). DESIGN, SETTING, AND PARTICIPANTS: Thirty patients were included in this prospective bicentre study. INTERVENTION: All patients underwent bipolar plasma vaporisation with a novel electrode (Olympus Winter & Ibe GmbH, Hamburg, Germany). MEASUREMENTS: International Prostate Symptom Score (IPSS), bother score, maximum flow rate (Q(max)), and postvoid residual were evaluated at baseline and at the time of discharge as well as at 1, 3, and 6 mo after the intervention. RESULTS AND LIMITATIONS: Mean preoperative prostate volume was 59±32 ml (range: 30-170), and mean operating time was 61±26 min (range: 20-140). Besides one reoperation (conventional transurethral prostatectomy) due to persistent obstruction, no major complication occurred intra- or postoperatively and no blood transfusion was required. Catheterisation time averaged 41±35 h (range: 18-192). Transient mild to moderate dysuria was noted in four patients (13%). At 1, 3, and 6 mo, Q(max) increased from 6.6±2.7 ml/s preoperative to 17.3±4.7 ml/s (p<0.01), 18.5±4.6 ml/s (p<0.01), and 18.1±5.0 ml/s (p<0.01), respectively. The IPSS decreased from 20.8±3.6 to 10.4±3.5 (p<0.01), 8.2±2.9 (p<0.01), and 8.1±3.1 (p<0.01), respectively. These data represent a small nonrandomised study cohort with limited follow-up. CONCLUSIONS: Our initial experience indicates that bipolar plasma vaporisation might be a safe and effective treatment option for patients with LUTS due to BOO. To define the potential role of this novel technique, randomised trials with longer follow-up are mandatory.

Bipolar transurethral resection in saline system versus traditional monopolar resection system in treating large-volume benign prostatic hyperplasia.

OBJECTIVES: We report our prospective clinical result of transurethral resection in saline (TURIS) versus monopolar transurethral resection of the prostate (TURP) system in treating large-volume benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Patients with BPH (volume >50 ml) were enrolled in the study. An intravenous device was used for serum sodium and hemoglobin tests to monitor the alteration. All acute complications were noted. Patients were followed up for at least 6 months. RESULTS: Forty patients were randomized into two groups. Follow-up data were compared with baseline. The decline in serum sodium postoperatively was smaller in the TURIS group (6.9 +/- 0.7 vs. 14.8 +/- 1.8 mM, p = 0.001). Hemoglobin only dropped by 1.4 g/dl in the TURIS group, whereas it dropped by 2.5 g/dl in the TURP group (p = 0.001). The TURIS system showed a better resection rate (0.64 vs. 0.52 g/min, p = 0.001). Total acute complication rate was 8 of 19 (42%) in the TURP arm and 4 of 21 (19%) in the TURIS arm. The catheter was removed sooner (2.5 vs. 3.4 days) and hospitalization time was less (3.0 vs. 4.2 days) in the TURIS group. The mean improvement in the International Prostate Symptom Score and maximum urinary flow rate at 6 months was comparable in the two groups. CONCLUSION: The TURIS system demonstrated superior safety in treating large-volume BPH and had a similar efficacy to TURP in short term.