Bipolar transurethral enucleation and resection of the prostate: Whether it is ready to supersede TURP?

Abstract

ObjectiveAccording to the EAU Guidelines, transurethral resection of the prostate (TURP) has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia (BPH). However, its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique. We reported the patient outcomes with our technique.MethodsWe retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate (B-TUERP) between March 2015 and September 2015. Pre- and perioperative parameters were obtained from medical charts. Postoperative follow-ups were administrated at 1, 3, 6, 12 and 24 month(s) after surgery, respectively.ResultsAll the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%. Qmax was significantly improved immediately after surgery, followed by a continuous improvement throughout the follow-ups. Following a steep decrease in mean prostate specific antigen (PSA) and post void residual (PVR) observed within the first half year after surgery, the serum PSA was then maintained at a constant level of 0.61 ng/mL. Temporary urinary retention was found in four cases (7.7%). Stress urinary incontinence occurred in five patients (9.6%), with the condition resolved in 1–2 weeks without extra treatment. Urethral strictures and bladder neck contractures, as the most commonly observed long-term complications, developed in four patients (7.7%). No recurrence was found during 2 years of follow-ups. An improvement in International Index of Erectile Function (IIEF-5) scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery, and sustained throughout the 24-month period.ConclusionsEnucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practice. Currently, bipolar resection is a commonly employed procedure in clinical settings, and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists. Based on these findings, we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.

Current consensus and controversies on male LUTS/BPH (part two)

“…These two techniques are described and their results reviewed in this issue. It is interesting to note that voiding function and sexual function may improve with restoration of normal anatomy by total enucleation, as postulated by Xu et al [7] . Enucleating only the PA and preserving the bladder neck and normal prostate tissue may allow the patient to retain normal ejaculation, a hypothesis that requires validation with further studies.…”

“…The bipolar enucleation technique by Xu et al. [7] and the use of the vaportrobe (Xie's technique) [8] may be cost effective methods in the developing countries of Asia. These two techniques are described and their results reviewed in this issue.…”

Transurethral Enucleation and Resection of the Prostate: Contemporary Role in the Surgical Treatment of Benign Prostatic Hyperplasia

“…Although stress type has been reported, urge-related incontinence was more common in the majority of cases [28,32]. Nevertheless, almost all patients experience gradual improvement over a period of 3-6 months [32,33]. Moreover, looking at the rate of urethral stricture and bladder neck contracture, no difference has been noticed between TUERP and TURP [27].…”

“…One of the most commonly reported TUERP complications is transient incontinence, which occurs in 4.7%-17% of cases [28,[32][33][34]. Although stress type has been reported, urge-related incontinence was more common in the majority of cases [28,32].…”

“…The type and rate of those complications depend on several factors including prostate size, comorbidities, duration of surgery, type of electro-cautery and surgeon's experience. These complications include TURS, infection, bleeding requiring blood transfusion, urethral stricture, bladder neck contracture, reoperation and transient incontinence [29,32,33].…”