Bipolar versus Monopolar Transurethral Resection of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Mamoulakis, Charalampos; Ubbink, Dirk T.; Rosette, Jean J.M.C.H. de la

doi:10.1016/j.eururo.2009.06.037

Cited by 238 publications

(208 citation statements)

References 47 publications

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“…24 Differences in the stricture rate found by other authors 20 were later reported to be statistically insignificant. 25 Our study is the largest comparison of two surgical approaches, with more than 2 years of follow-up so far (Table 6). Although it was not randomized, the two consecutive staggered series were not selected, thus largely avoiding selection bias; this is evident in the homogeneous baseline criteria in our patients.…”

Section: Discussionmentioning

confidence: 99%

Bipolar versus monopolar TURP: a prospective controlled study at two urology centers

Engeler

Schwab

Neyer³

et al. 2010

Prostate Cancer Prostatic Dis

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We compared bipolar and monopolar TURP in a prospective controlled study at two urology centers. The objective of the study was to establish whether there were differences between the two methods with regard to frequency of the transurethral resection (TUR) syndrome, amount of fluid absorbed during surgery, risk of hemorrhage, duration of postoperative catheterization and duration of hospitalization. The duration of surgery, improvement in maximum flow rate (Q-max), residual urine volume, International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score were also compared. Overall, our study showed that there were no major differences between bipolar and monopolar TURP. During follow-up, the clinical efficacy of bipolar TURP has been maintained to the same degree as with the traditional method, with no significant differences for Q-max, IPSS and QoL scores after 1 year. Although the risk of developing TUR syndrome seemed to be smaller with bipolar resection (serum sodium change bipolar versus monopolar: þ 1.2 versus À0.1 mmol l À1 ), the bleeding tendency with both methods was the same (14.0 g l À1 hemoglobin loss after 1 day in both groups). On the basis of our findings, we think that the monopolar technique has still a place in TURP.

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Section: Discussionmentioning

confidence: 99%

Bipolar versus monopolar TURP: a prospective controlled study at two urology centers

Engeler

Schwab

Neyer³

et al. 2010

Prostate Cancer Prostatic Dis

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“…[4][5][6] On the other hand, these previous RCTs had several limitations, 7 and the sample sizes were too small to detect low incidences of events. Furthermore, the clinical situations in RCTs, such as surgeons and facilities, do not necessarily reflect average clinical practices.…”

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confidence: 99%

In-Hospital Outcomes and Cost Assessment Between Bipolar Versus Monopolar Transurethral Resection of the Prostate

Sugihara

Yasunaga

Horiguchi

et al. 2012

Journal of Endourology

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Purpose: We compared the in-hospital outcomes between bipolar and monopolar transurethral resection of the prostate (B-TURP and M-TURP, respectively) on a real-world practice using a large database. Patients and Methods: Patients who underwent TURP were extracted from the Diagnosis Procedure Combination database, which is a case-mix administrative claims database in Japan. TURP procedures were classified into M-TURP and B-TURP groups according to intraoperative use or nonuse of D-sorbitol solution, respectively, which is the only nonelectrolyte bladder irrigation fluid for M-TURP available in Japan. To exclude causality among autologous and homologous transfusion events, we confined eligible hospitals to those in which no autologous blood preparation was undertaken for TURP and whose annual surgical caseloads were 15 cases or more. Multivariate analyses were conducted for homologous transfusion, postoperative complications, operative time, postoperative length of stay, and total costs. Results: There were 5155 M-TURP and 1531 B-TURP patients identified. The results for M-TURP vs B-TURP (effect sizes were evaluated with reference to M-TURP) were 2.3% vs 1.3% for transfusion (odds ratio [OR] = 0.54; P = 0.013), 3.3% vs 1.7% for postoperative complications (OR = 0.46; P < 0.01), 98 vs 116 minutes for operative time (20.5% increase; P < 0.001), 8.65 vs 8.45 days for postoperative stay (3.6% reduction; P = 0.003), and $6103 vs $6062 for cost (1.7% reduction; P = 0.018). Conclusion: B-TURP had significantly lower rates of transfusion and postoperative complications, but a longer operative time. The impacts of B-TURP on shortening the hospital stay and lowering the costs were of little clinical significance.

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“…10 One issue raised in the literature is the possibility of an increased incidence of urethral strictures in bipolar TURP patients (6.1%). 2,7 Reports from randomized trials comparing outcomes between monopolar and bipolar TURP, failed to observe higher rates of stricture formation with the bipolar devices.…”

Section: Discussionmentioning

confidence: 99%

“…The results are based on a single type of bipolar electrosurgical unit which might not accurately represent or be applicable to other platforms, although data exists that suggest that clinical results are not machine dependent. 10 The strengths of the trial are that it was a prospective study, treatment allocation was randomized and the patient was blinded to treatment assignment for the duration of the study. It was multicentered to reduce referral and single surgeon bias with the intent that each centre perform similar numbers of each procedure, however with the premature conclusion of the trial, this was not achievable.…”

Section: Discussionmentioning

confidence: 99%

A multicentre single-blind randomized controlled trial comparing bipolar and monopolar transurethral resection of the prostate

Méndez-Probst

Nott

Pautler

et al. 2011

cuaj

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Introduction: Monopolar transurethral resection of the prostate (TURP) is the gold standard surgical therapy for men with lower urinary tract symptoms due to benign prostatic hyperplasia. Although generally considered safer, TURP experience is limited in Canada. Methods: Forty-three patients from 5 Canadian centres were randomized to TURP with either bipolar or monopolar platforms. Patients underwent baseline determinations of American Urological Association (AUA) symptom score, peak urinary flow rate, postvoid residual bladder volume and transrectal ultrasound prostate volume. Primary outcome measures were improvement in AUA symptom score, quality of life assessment and bother assessment. Secondary outcomes included procedural times, duration of catheterization, length of hospitalization, complications and the degree of thermal artifact in tissue specimens. Patients were followed for 6 months. Results: Twenty-two patients were treated with bipolar and 21 with monopolar TURP. Preoperative demographics were not statistically different between groups. Postoperative data collection times were equivalent in AUA symptom, quality of life, bother and sexual function assessments. No differences were observed in the procedure time (60.7 min, bipolar vs. 47.4, monopolar) or the duration of urethral catheterization (1.5 days, bipolar vs. 1.1, monopolar). More patients in the bipolar group were discharged on the same day of surgery. There were no differences in the degree of tissue thermal artifact or complication rate. Conclusion: This trial suggests equivalent short-term outcomes for men undergoing monopolar or bipolar TURP.

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Bipolar versus Monopolar Transurethral Resection of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Cited by 238 publications

References 47 publications

Bipolar versus monopolar TURP: a prospective controlled study at two urology centers

Bipolar versus monopolar TURP: a prospective controlled study at two urology centers

In-Hospital Outcomes and Cost Assessment Between Bipolar Versus Monopolar Transurethral Resection of the Prostate

A multicentre single-blind randomized controlled trial comparing bipolar and monopolar transurethral resection of the prostate

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