Standard monopolar transurethral resection of prostate (TURP) remains the gold standard surgical treatment of benign prostatic hyperplasia-related lower urinary tract symptoms.
Bipolar salin TURP offers rapid tissue removal and haemostasis during resection with better vision under saline irrigation while eliminating risk of TUR syndrome. Few prospective randomized studies have investigated the effect of bipolar and monopolar TURP on erectile function. The study found that bipolar saline TURP is a safe and effective procedure that is associated with a significantly shorter operating time, a smaller reduction in serum sodium levels and similar efficacy compared with conventional monopolar TURP.
OBJECTIVE: To evaluate the outcomes of bipolar vs conventional monopolar transurethral resection of the prostate (TURP) on urinary and erectile function.
MATERIAL AND METHODS: A total of 286 patients with benign prostatic hyperplasia (BPH) were randomized to bipolar or monopolar conventional TURP treatment groups. Operative and early postoperative variables and complications were recorded and all patients were re-evaluated at 1, 3, 6 and 12 months after surgery using the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual urine volume (PVR) and the erectile function domain of the International Index of Erectile Function (IIEF-ED). A comparative evaluation of erectile function was performed on 188 preoperatively non-catheterized patients with regular sexual partners.
RESULTS: The operating time was shorter in the bipolar TURP group. Postoperative bleeding and blood transfusion requirements did not significantly differ between the two groups. Sodium levels were significantly lower in the monopolar group than in the bipolar group. Transuretheral resection syndrome developed in two (1.4%) patients in the monopolar group. Both groups had similar and significantly improved IPSS values, maximum urinary flow rate values and PVR measurement. ED worsened in 32 (17.0%) patients, improved in 53 (28.2%) patients, and was unchanged in 103 (54.8%) patients. Changes in the IIEF scores during the follow-up period were similar between the bipolar and monopolar groups.
CONCLUSION: Bipolar TURP is a safe and effective procedure that is associated with a significantly shorter operating time, a smaller reduction in serum sodium levels and a similar efficacy compared with conventional monopolar TURP.
Written by:
Akman T, Binbay M, Tekinarslan E, Tepeler A, Akcay M, Ozgor F, Ugurlu M, Muslumanoglu A. Are you the author?
Department of Urology, Faculty of Medicine, Bezmialem Vakif University Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey.
Reference: BJU Int. 2012 Jun 6. Epub ahead of print.
doi: 10.1111/j.1464-410X.2012.11266.x
PubMed Abstract
PMID: 22672229
