The PLASMA System

The PLASMA system is the smart choice for a safe, cost- and time-effective, proven therapy for patients with BPH and NMIBC. 15,18 It is highly customizable, with optimized interaction between the constantly extended assortment of procedure-oriented PLASMA electrodes and an intelligent high-frequency generator.

PLASMA sets an innovative standard for individual BPH treatment.

The Safe Choice

Comparable Clinical Outcome with Increased Safety Profile Compared to M-TURP
The PLASMA (TURis) system offers an equivalent efficacy to monopolar TURP 8,15 that includes maximum flow rate (Qmax), resection weight/radicality, PVR (Post-Void Residual), and IPSS (International Prostate Symptom Score)/IIEF-5 (International Index of Erectile Function).

However compared to monopolar technology, the PLASMA system has a more favorable perioperative safety profile, especially regarding TUR syndrome occurrence, frequency of blood transfusions, and the clot retention rate. 18

The Individual Choice

Variety of Treatment Options for Each Individual Patient
PLASMA provides solutions for different prostate sizes, anatomies, and different patient profiles to achieve the best clinical results for each patient. For example high-risk patients and patients who want the ability to maintain antegrade ejaculations. PLASMA, therefore, is the answer to the trend of more personalized treatments in surgery. Treatment options include:
  • Resection with resection loops in different sizes and angles
  • Vaporization with oval and round vaporization buttons
  • Enucleation with a special loop.

"With PLASMA each surgeon is able to offer the best fitting treatment option to his patient by being able able to perform either a resection, a vaporization or an enucleation, depending on the patients needs and profi le, and even change the technique during the procedure." (January 2017)


Prof. Dr. Jörg Raßler
Urology Department, St. Elisabeth-Krankenhaus, Leipzig

The Proven Choice

EAU Recommended and Clinically Investigated
PLASMA is recommended and clinically investigated. In its 2016 guidelines, the EAU recommends PLASMA (TURis/Bipolar Resection) as one of the first choice for all prostate sizes.

PLASMA is the most widespread and thoroughly researched alternative to monopolar TURP. Current scientific evidence includes 15 high-quality RCTs conducted specifically with Olympus PLASMA. 15,18

The guidelines also say that the PLASMA results in the short and medium term are comparable to the results for monopolar TURP. But PLASMA has an increased perioperative safety profile than monopolar TURP.

The Efficient Choice

Reduced Hospital Stay and Readmissions for Reduced Costs Compared to M-TURP
The improvement of clinical outcomes may also reduce overall hospitalization and readmission costs significantly. The graphic shows the potential costs saving with PLASMA compared to monopolar TURP for 100 annual patients.

The higher cost of consumables and capital equipment (lower bars) associated with PLASMA is offset by savings on complication, hospitalization, and readmission costs (upper bars) based on improved clinical outcomes.

An economic analysis published in a NICE guideline, followed by another publication shows the potential saving of up to 21% by switching from monopolar to PLASMA technology. 15

PLASMA PROCEDURES FOR BPH

PLASMA Resection

Transurethral resection remains the most common treatment for BPH and NMIBC. For PLASMA resections, bipolar HF current is used to create the PLASMA corona that vaporizes prostatic or vesical tissue.

Benefits

  • Strong safety profile compared to monopolar resection (valid for all PLASMA procedures) 5
  • High tissue ablation rate 23,24,25
  • More precise cutting and coagulation compared to monopolar resection 26
  • Short learning curve 27
  • Enables preservation of sexual function, including antegrade ejaculation, via the ejaculation-preserving resection technique 28
  • High-quality pathological samples

Recommended Resection Electrodes

Apart from applying various technical approaches (Nesbit, Barnes, etc.), resections can be done using a wide variety of color-coded electrodes for prostate and bladder procedures. The choice will depend on the procedure and telescopes used. Specifically,

  • small loop electrodes are particularly suitable for treating bladder tumors;
  • medium loop electrodes are the standard loop and used in over 80% of TURs;
  • large loop electrodes, due to their size, can facilitate faster and smoother operations, especially for large prostates; and
  • angled loop electrodes enable better access to the anterior bladder wall.

PLASMA Vaporization

PLASMA vaporization provides a safe, easy-to-use solution for TUR tissue management procedural needs in which energized gas smoothly vaporizes the tissue.

The vaporization electrode’s new, optimized oval shape, combined with the easy-to-learn “hovering technique,” enables effective, fast ablating and virtually bloodless smooth tissue vaporization.

Benefits

  • Ideal for smaller to medium-sized prostates
  • Fewer severe complications compared to TURP 6
  • Fewer readmissions compared to TURP 7
  • Shorter hospital stay compared to TURP 21
  • Continuous, safe hemostasis
  • Potential for day-case surgery due to a shorter catheterization period and hospital stay 21
  • Demonstrated use in patients on anticoagulants 22
  • Clear, unobstructed view through operations as the tissue and laser impulses do not impair vision
  • Significantly lower material cost compared to photoselective vaporization (PVP)

Recommended Vaporization Electrodes

With its optimized shape the new Plasma-OvalButton allows 21% faster vaporization compared to the existing PlasmaButton (round).*
* Olympus internal lab testing

PLASMA Enucleation

This revolutionary technique uses the natural anatomy by “peeling” prostate tissue out of the capsule. Once the right layers have been located, each prostate lobe is peeled off in one piece. For complete enucleation the lobes are pushed into the bladder, where they are fragmented by a morcellator.

In the case of incomplete enucleation the removed lobes are still connected with the capsule through an adenoma bridge and are then resected with a PLASMA loop. For the treatment of large prostates, transurethral enucleation with bipolar (TUEB) provides an alternative to laser enucleation.

Benefits

  • Treatment of any prostate gland size with excellent tissue preservation for pathologic examination
  • Complete excision of obstructing adenoma down to the prostate capsule if needed
  • Minimum intra-operative blood loss29,30
  • Shorter catheterization time and hospital stay compared to resection and open prostatectomy (OP)


Plasma Enucleation Compared to Bipolar Resection

  • Greater resected prostate weight29
  • Better results in long-term postoperative improvement in IPSS, QoL, Qmax, and PVR (36, 48, 60 months)29


Plasma Enucleation Compared to Open Prostatectomy

  • Less decrease in hemoglobin and fewer blood transfusion11
  • Higher International Index of Erectile Function score (IIEF-5) after 12 months11
  • Reduced complications, shorter convalescence, and satisfactory follow-up symptoms19

Recommended Enucleation Electrode

The TUEB electrode’s wire loop can be used to locate the layers and coagulate any bleeding. The black runner (spatula) is used to gently peel off the prostate lobes.

Natural Occurrences of PLASMA

PLASMA is common to our world and appears in different variations in nature. It is especially prevalent in atmospheric and outer space phenomena such as the sun and initiates polar lights as well.

"PLASMA is a technology with which fine biopsy cuts, the resection of big ademonas as well as efficient coagulation is possible. It transforms the resectoscope into a universal tool for the lower urinary tract." (January 2017)


Prof. Dr. Jörg Raßler
Urology Department, St. Elisabeth-Krankenhaus, Leipzig

Explore PLASMA Live

Are you interested in the smart choice for a safe, cost- and time-effective, proven therapy for patients with BPH and NMIBC? Request a live demonstration of the PLASMA system and an Olympus consultant will contact you.

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References

  1. 1.Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. Akman T, et al. BJU Int 2013;111:129–36.
  2. 2.A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH study. Bachmann A et al. J Urol. 2015 Feb;193(2):570-8.
  3. 3.Bipolar transurethral resection in saline vs traditional monopolar resection of the prostate: results of a randomized trial with a 2-year follow-up. Chen Q et al. BJU Int 2010;106:1339–43.
  4. 4.Bipolar transurethral resection in saline system versus traditional monopolar resection system in treating large-volume benign prostatic hyperplasia. Chen Q et al. Urol Int 2009;83:55–9.
  5. 5.EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). EAU Guidelines
  6. 6.Complications and clinical outcome 18 months after bipolar and monopolar transurethral resection of the prostate. Fagerström T et al. J Endourol. 2011 Jun; 25(6):1043-9.
  7. 7.Bipolar PLASMA vaporization vs monopolar and bipolar TURP–a prospective, randomized, long-term comparison. Geavlete B et al. Urology 2011;78: 930–935.
  8. 8.Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Gravas S et al.
  9. 9.A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline (TURIS) system. Ho HS et al. Eur Urol 2007;52:517–22.
  10. 10.Incidence of urethral stricture after bipolar transurethral resection of the prostate using TURis: results from a randomised trial. Komura K et al. BJU Int 2015;115:644–52.
  11. 11.Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a metaanalysis of randomized controlled trials. Li M et al. PLoS One 2015 Mar 31;10(3):e0121265. eCollection 2015.
  12. 12.Bipolar Resection in Saline – An Alternative Surgical Treatment for Bladder Outlet Obstruction? Michielsen DPJ et al. in: European Urology 178 (2007) November: 2035-2039.
  13. 13.Bipolar transurethral resection in saline: the solution to avoid hyponatraemia and transurethral resection syndrome. Michielsen DC et al. Scand J Urol Nephrol 2010;44: 228–35.
  14. 14.Urethral strictures and bipolar transurethral resection in saline of the prostate: fact or fiction? Michielsen DP et al. J Endourol 2010;24:1333–7.
  15. 15.The TURis system for transurethral resection of the prostate. National Institute for Health and Care Excellence. NICE medical technology guidance MTG23. February 2015
  16. 16.GreenLight XPS for treating benign prostatic hyperplasia. National Institute for Health and Care Excellence. NICE medical technology guidance MTG29. June 2016.
  17. 17.Transurethral Bipolar Enucleation of the Prostate Is an Effective Treatment Option for Men With Urinary Retention. Tracey JM et al. Urology. 2016 Jan;87:166-71. doi: 10.1016/j.urology.2015.10.011. Epub 2015 Oct 21.
  18. 18.Economic value of the TURis system for treatment of benign prostatic hyperplasia in England and Wales: systematic review, meta-analysis and cost-consequence model. Treharne C et al. EU Focus, March 2016
  19. 19.Bipolar PLASMA enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases - a medium term, prospective, randomized comparison. Geavlete B et al. BJU Int. 2013 May;111(5):793-803.
  20. 20.“Button type” bipolar Plasma vaporisation of the prostate compared with standard transurethral resection: a systematic review and meta-analysis of short-term outcome studies. Wroclawski ML et al. BJU Int. 177 (2016): 662–668.
  21. 21.Transurethral resection (TUR) in saline PLASMA vaporization of the prostate vs standard TUR of the prostate: “the better choice” in benign prostatic hyperplasia? Geavlete B et al. BJUI 106 (2010): 1695–1699.
  22. 22.Surgical management of BPH in patients on oral anticoagulation: transurethral bipolar PLASMA vaporization in saline versus transurethral monopolar resection of the prostate. Delongchamps NB et al. Canadian Journal of Urology 18 (2011): 6007–6012.
  23. 23.A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup. Chen YB et al. J Urol. 2013 Jan;189(1):217–22.
  24. 24.Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose? Fayad AS et al. J Endourol. 2011 Aug;25(8):1347–52.
  25. 25.Comparison of outpatient versus inpatient transurethral prostate resection for benign prostatic hyperplasia: Comparative, prospective bi-centre study. Kim JH et al. Can Urol Assoc J. 2014 Jan–Feb;8(1–2):E30-5.
  26. 26.Histologic Effects of the GYRUS Resection System Versus Standard Electrocautery Resection in the Treatment of Bladder Tumors. Moy ML et al. J Endourol 15 (suppl 1): A63, 2001.
  27. 27.Management of large prostatic adenoma: Lasers versus bipolar transurethral resection of prostate. Gupta NP et al. Indian J Urol (2013) Jul;29(3): 225–35.
  28. 28.Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique. Alloussi SH et al. J Endourol. 2014 Jan;28(1):84–9.
  29. 29.Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70 ml: a prospective, randomized trial with 5-year followup. Zhu L et al. J Urol. 2013 Apr;189(4):1427–31.
  30. 30.A study comparing plasmakinetic enucleation with bipolar plasmakinetic resection of the prostate for benign prostatic hyperplasia. Liao N, Yu J. J Endourol. 2012 Jul;26(7):884–8.

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In the patients website www.bph-plasma.eu Olympus is offering support when patients' questions occur. Among other things, patients will find more detailed information about the development of benign prostatic hyperplasia (BPH), PLASMA technology and the transurethral resection of the prostate (TURP) procedure.

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