Bipolar Transurethral Enucleation of the Prostate: Is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia?

Abstract

Background Bipolar Transurethral Enucleation of the Prostate (B-TUEP) is recommended as a first-choice treatment for benign prostatic obstruction in prostates >80 ml. Differently, B-TUEP is only considered as an alternative option after TURP for smaller prostates (30–80 ml). The aim of our study is to assess the relation between prostate size and surgical outcomes after B-TUEP. Methods We performed a retrospective analysis of data collected from 172 patients submitted to B-TUEP. Patients were segregated according to tertiles of prostate volume (PV) (≤60 ml, 61–110 ml, >110 ml). For each group we evaluated enucleation efficacy (enucleated weight/enucleation time), complication rates, urinary and sexual function parameters. Functional and sexual parameters were compared between groups at baseline, 1 and 3 months follow up. Descriptive statistics and linear and logistic regression models tested the association between PV and postoperative complications/outcomes. Results Operative time and weight of enucleated adenomas increased along with prostate volumes (all p≤0.01). Enucleation efficacy was higher in men with PV >110 ml compared to other groups (p≤0.001). Length of hospital stay, catheterization time and rates of postoperative complications, such as transfusion and clot evacuation rates and bladder neck/urethral strictures, were comparable between groups. Urinary symptoms improved at 1-and 3-months in each group as compared to baseline evaluation (all p<0.01) but they did not differ according to PV. In each group maximum urinary flow and post-void residual volume significantly improved at 3 months compared to baseline (all p≤0.01), without differences according to PV. Sexual symptoms were similar between groups at each follow up assessment. At multivariable linear and logistic regression analysis, prostate volume was not associated with postoperative functional outcomes and complications. Conversely, patient’s comorbid status and antiplatelet/anticoagulation use were independently associated with postoperative complications. Conclusion According to our findings, B-TUEP should be considered a “size independent procedure” as it can provide symptom relief in men with prostates of all sizes with the same efficacy and safety profile.

Evaluation of the efficiency of transurethral enucleation with bipolar energy according to prostate volume for patients with benign prostate hyperplasia

“…Moreover, to the best of our knowledge, only one previous study has compared surgical efficiency, postoperative functional outcomes, and complication rates according to various prostate volume ranges. 7 Furthermore, few studies have evaluated the association between a wide range of prostate volumes and the surgical outcomes of TUEB, especially with long-term follow-up. Therefore, we aimed to evaluate the perioperative efficiency and postoperative functional outcomes according to a wide range of prostate volumes within a 1-year postoperative follow-up period.…”

“…1 B). Our surgical technique is similar to that reported by Bebi et al.. 7 TUEB was performed as described below ( Fig. 2 ), which was applied to every TUEB case, regardless of the prostate volume or shape of the prostatic lobes.…”

“… 5 , 6 However, few studies have compared the surgical outcomes and safety of TUEB according to various prostate volume ranges. 7 Furthermore, there are few studies evaluating the surgical outcomes of TUEB in patients with small prostates, although there are several studies on HoLEP. 8 .…”

Is the Peripheral Zone Thickness an Indicator of a Learning Curve in Bipolar Transurethral Plasma Enucleation of the Prostate?—A Single Center Cohort Study

“…B-TUEP has been recognized to provide symptom relief for BPH patients with prostates of almost any size, with definite efficacy and safety (15). Moreover, some researchers have confirmed that the incidence of body pain/discomfort, decreased physical pleasure, and difficulty in ejaculation of patients after B-TUEP is lower than that of holmium laser enucleation of prostate (HoLEP) (16).…”

Modified plasmakinetic enucleation and resection of the prostate by three glands: proposal of a novel anatomical treatment for benign prostatic hyperplasia

“…Considering the excellent hemostatic effect of bipolar technologies in treating BPH, Professor Liu, a Chinese scholar, innovatively combined bipolar plasma with his proposed intraluminal prostate enucleation using the mirror sheath as a finger in 2002 to gradually peel off the hyperplastic glands along the prostate surgical envelope under direct visualization and thoroughly treat prostate hyperplasia [4]. Subsequently, multiple randomized controlled studies have shown that bipolar plasma endoscopic enucleation of the prostate was associated with less blood loss, shorter hospital stay and catheter indwelling time, and was not limited by prostate volume [5][6][7]. Additionally, it has become increasingly widely used with the emergence of various energy platforms.…”