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

Abstract

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.

Systematic review and meta‐analysis of the clinical effectiveness of bipolar compared with monopolar transurethral resection of the prostate (TURP)

“…These results are consistent with the study conducted by Sugihara et al. who reported 20/1531 (1.3%) patients undergoing B‐TURP and 118/5155 (2.3%) patients undergoing M‐TURP required homologous blood transfusion. Clot retention was relatively more common in patients undergoing M‐TURP.…”

“…Sugihara et al. reported that 16/5155 (0.03%) participants developed TUR syndrome in their database study. When excluding the trial undertaken by Yousef et al.…”

Short‐stay transurethral prostate surgery: A randomized controlled trial comparing transurethral resection in saline bipolar transurethral vaporization of the prostate with monopolar transurethral resection

“…The duration of hospitalization was recognized as a significant contributor to the cost of TURP (19). In fact, as demonstrated by Goh and Gonzalez and by Sugihara et al (20,21), the impact of prolonged hospitalization can be more important than the type of treatment modality on cost savings. The study by Shum et al reported a 45.6% reduction in bill size if hospital stay was reduced from 3 days to 2 days in their center (22).…”

The TURis System for Transurethral Resection of the Prostate: A NICE Medical Technology Guidance

“…The company identified three economic studies [ 39 – 41 ], and the EAC identified one additional study, which included an economic estimation [ 36 ], but these were not used as evidence for TURis by the company or by the EAC, because of low applicability to the scope.…”