Bipolar versus monopolar transurethral resection for benign prostatic hypertrophy: A prospective observational study
Main Article Content
Abstract
Background: Benign prostatic hyperplasia (BPH) is one of the most common diseases that affect aging males. The lower urinary tract symptoms (LUTS) caused by BPH–related obstruction (BPO) continue to be a major problem in the medical care of aging males. Aim: To compare the effects of bipolar and monopolar TURP in terms of symptom improvement and perioperative results for benign prostatic hyperplasia (BPH).
Methods: A total of 80 patients who underwent transurethral resection of prostate (TURP) surgical procedure, (n = 40 for monopolar TURP) and (n = 40 for bipolar TURP) for BPH enrolled at the Department of Urology in Government Medical College Srinagar. Patients were grouped into group I, who underwent bipolar TURP and group II , who underwent monopolar. Preoperatively, by using IPSS (international prostate symptom scale) and IIEF-5 (international index of erectile function-5) questionnaires severity of LUTS and Erectile function were assessed. All patients were submitted to transrectal ultrasonography and PSA determination. Surgical and immediately postsurgical variables and complications were recorded. Urethral stricture incidence, post-surgical reoperation rate, total postoperative catheter time and hospital stay, change in serum sodium, and hemoglobin were also recorded in two groups.
Results: Study groups were comparable with regard to demographic profile with statically no significant differences p>0.05. Significant differences were found in operating time in minutes (48.11 ± 5.29 vs 43.99 ± 6.28, P < 0.025) between Group I and Group II. A significant drop in serum sodium was seen in post-operative period in Group I as compared to Group II which was statistically significant (P<0.5). Catheterization time and duration of hospitalization were clearly shorter in the Group II. Transurethral resection (TUR) syndrome was reported in two patients who had undergone monopolar resection without any incidence in bipolar group. Fall in haemoglobin (Hb) and packed cell volume (PCV) was more in Group I as compared to Group II, but statically insignificant (p>0.05).
Conclusion: Bipolar TURP is safe and equally effective as monopolar TURP that is correlated with a distinctly shorter catheterization time, shorter hospital stay, less decrement in the levels of serum sodium.
Article Details
References
Verhamme KM, Dieleman JP, Bleumink GS, et al. Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care—the Triumph project. Eur Urol 2002;42:323-328.
Ho HSS, Yip SKH, Lim KB, et al. A prospective randomized study comparing monopolar and bipolar Transurethral Resection of Prostate Using Transurethral Resection in Saline (TURIS) System. European Urology 2007;52(2):517-524.
Gravas S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Mamoulakis C, et al. EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), including Benign Prostatic Obstruction (BPO). European Association of Urology; 2019.
Foster HE, Barry MJ, Dahm P, Gandhi MC, Kaplan SA, Kohler TS, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline. J Urol. 2018;200:612-9.
Theyer G, Kramer G, Assmann I, et al. Phenotypic characterization of infiltrating leukocytes in benign prostatic hyperplasia. Lab Invest 1992;66(1):96-107.
Issa MM. Technological advances in transurethral resection of the prostate: bipolar versus monopolar TURP. J Endourol. 2008;22:1587-95.
Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006;50:969-79; discussion 980.
Dincel C, Samli MM, Guler C, Demirbas M, Karalar M. Plasma kinetic vaporization of the prostate: Clinical evaluation of a new technique. J Endourol 2004;18:293–298.
de Sio M, Autorino R, Quarto G, Damiano R, Perdona` S, di Lorenzo G, Mordente S, D’Armiento M. Gyrus bipolar versus standard monopolar transurethral resection of the prostate: A randomized prospective trial. Urology 2006;67:69–72.
Autorino R, De Sio M, D’Armiento M. Bipolar plasma kinetic technology for the treatment of symptomatic benign prostatic hyperplasia: evidence beyond marketing hype? BJU Int 2007;100(5):983-985.
Fagerström T, Nyman CR, Hahn RG. Complications and clinical outcome 18 months after bipolar and monopolar transurethral resection of the prostate. J Endourol 2011;25(6):1043-1049.
Kshitij R, Abid R, Devendra KJ, et al. Comparative assessment of monopolar versus bipolar transurerthral resection of prostate for the management of benign prostatic enlargement. Urological Science 2019;30(6):262-265.
Huang X, Wang XH, Wang HP, Qu LJ. Comparison of the microvessel diameter of hyperplastic prostate and the coagulation depth achieved with mono- and bipolar transurethral resection of the prostate. A pilot study on hemostatic capability. Scand J Urol Nephrol 2008;42:265–268.
Karaman MI, Gurdal M, Zturk M, et al. The comparison of transurethral vaporization using plasma-kinetic energy and transurethral resection of prostate: a randomized prospective trial with 1 year follow-up. J Endourol 2004;18(Supp 1):A77.
Patankar S, Jamkar A, Dobhada S, et al. Plasma-Kinetic Superpulse transurethral resection versus conventional transurethral resection of prostate. J Endourol 2006;20(3):215-219.
Michielsen DP, Debacker T, De Boe V, et al. Bipolar transurethral resection in saline--an alternative surgical treatment for bladder outlet obstruction? J Urol 2007;178(5):2035-2039; discussion 2039.
Madduri VKS, Bera MK, Pal DK. Monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: operative outcomes and surgeon preferences, a real-world scenario. Urol Ann 2016;8(3):291-296.
Kong CH, Ibrahim MF, Md. Zainuddin Z. A prospective, randomized clinical trial comparing bipolar plasma kinetic resection of the prostate versus conventional monopolar transurethral resection of the prostate in the treatment of benign prostatic hyperplasia. Ann Saudi Med 2009;29(6):429-432.
Mamoulakis C, Skolarikos A, Schulze M, et al. Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs. monopolar transurethral resection of the prostate. BJU Int 2012;109(2):240-248.
Lee YT, Ryu YW, Lee DM, et al. Comparative analysis of the efficacy and safety of conventional transurethral resection of the prostate, transurethral resection of the prostate in saline (TURIS) and TURIS-plasma vaporization for the treatment of benign prostatic hyperplasia: a pilot study. Korean J Urol 2011;52(11):763-768.