Complications and Clinical Outcome 18 Months After Bipolar and Monopolar Transurethral Resection of the Prostate

Abstract

Purpose: To compare bipolar resection with the conventional monopolar transurethral resection of the prostate (TURP) with respect to peri-and postoperative complications and long-term outcome. Patients and Methods: Patients with consecutive benign prostatic hyperplasia needing surgery (n = 185) from the hospital's waiting list were randomized to TURP using either a bipolar or a monopolar system. Peri-and postoperative parameters were monitored, complications were registered, and timed micturition/International Prostate Symptom Score (TM/IPSS) forms were collected at 3 and 6 weeks and at 6 and 18 months. Results: Bipolar surgery was followed by a 16% to 20% higher percentage of the patients reporting ongoing improvement (fractional IPSS change > 2) at 3 and 6 weeks after the surgery ( p < 0.05). There were fewer readmissions in the bipolar group than in the monopolar (5 vs. 13, p < 0.05). No differences between the groups with respect to hospital stay and catheter duration was recorded. Bipolar and monopolar TURP resulted in marked and sustained improvements of IPSS, bother score, and TM. Conclusions: Bipolar TURP, using the transurethral resection in saline (TURis) system, resulted in significantly fewer postoperative readmissions, faster postoperative recovery, and equally long-lasting good results in TM/ IPSS and bother score, as in monopolar TURP.

Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP

“…But for reducing adverse events such as bleeding and clot retention, TUR syndrome, damage of surrounding or deeper tissues, and urethral stricture, bipolar technology and conductive irrigation fluid of normal saline have been applied instead of monopolar energy and glycine nonconductive medium as the popular and the most important alternatives in the recent years (18,23,28,29,31,36). The bipolar TURP is a proper procedure with shorter learning curve (30), better outcomes concerning duration of irrigation and catheterization (31), depths of coagulation zone (28), decrease in serum sodium (15,29,31,38), occurrence of TUR syndrome (18,29,31,39) bleeding (23,28,38), clot retention (31,39) and re-admission (23), comparative efficacy and other similar results in comparison with M-TURP (15,23,(29)(30)(31)38).…”

“…Also fluid absorption betides in the bipolar TURP and volume overload may be problematic in patients with severe cardio-pulmonic disorders (23,27,31,36). In the last decade, laser energy has been applied with high safety and efficacy for vaporization or enucleation of hypertrophic large volume prostate (6,9,(11)(12)(13)(40)(41)(42).…”

“…Although conventional monopolar transurethral resection (TUR) of the prostate (TURP) has been applied as a gold standard surgical modality in the recent decades (6)(7)(8)(9)(10)(11)(12), but its outcomes including patient discomfort, prolonged catheterization and hospitalization durations, need to transfusion and re-admission due to hemorrhage or clot retention, high volume of irrigation fluid, electrolyte imbalance and TUR syndrome, urinary retention, urethral stricture, incontinence, retrograde ejaculation or erectile dysfunction (6)(7)(8)(13)(14)(15)(16)(17)(18)(19)(20) elicited the tendency to the use of the newer technologies such as bipolar energy or laser energy for resection, vaporization, ablation or enucleation and changing the irrigation fluid from glycine to normal saline in the endoscopic management of BPH (6,8,(13)(14)(15)(20)(21)(22)(23)(24)(25)(26).…”

“…Nowadays, bipolar TURP is used in many centers due to several benefits and superior or similar results in comparison with monopolar TURP (8,14,23,(29)(30)(31). Bipolar transurethral vaporization of the prostate (TUVP) in saline using hovering technique is an easy learning and low cost procedure in comparison to laser technique (12,14,20).…”

From gold standard to platinum standard in BPH surgery: a perspective from a tertiary care center of the Indian subcontinent

“…8 Studies comparing monopolar and bipolar TURP reported similar and durable long term efficacy of either procedures. [9][10][11][12] Nonetheless, in one prospective study, where 36 patients finished 6 years follow up, authors concluded that Qmax and IPSS values were notably inferior to b-TURP compared to m-TURP (P<0.05). 13 In a meta-analysis of 9 RCT's, 448 and 441 patients underwent PVP and m-TURP respectively, where it was concluded that functional outcomes were similar in six studies, favoured m-TURP in two and PVP in one study.…”