Bipolar and unipolar transurethral resection of prostate : a comparative study

Abstract EN

Objective : Transurethral resection of the prostate (TURP) is the standard procedure for the surgical treatment of benign prostatic hyperplasia (BPH).

Monopolar TURP was recently challenged by bipolar TURP, which uses normal saline as an irrigant, thus avoiding the need for glycine or distilled water irrigation and it’s associated complications.

A prospective comparative observational study to compare the use of bipolar TURP with the conventional monopolar TURP regarding biochemical, hemodynamic changes and clinical results.

Methods : From February 2015 to July 2017, two hundred patients with symptomatic BPH were randomized into a prospective study comparing the two modalities.

All patients were fully assessed with detailed history, thorough physical examination and necessary investigations.

Resection time, weight of resected tissue, blood loss, the need for blood transfusion, decline of hemoglobin and serum sodium values were assessed.

Postoperative catheter time, irrigation time, hospital stay, intra-operative and postoperative complications were also recorded.

The improvements in International prostate symptoms score (IPSS), and Qmax (maximum flow rate) after 3 months were also recorded for all patients.

Results : The bipolar group showed significantly longer operative time (64.3 ± 5.5 minutes versus 54.7 ± 7.8 minutes), and required significantly more irrigant volume (20.6 ± 1.2 liters versus 17.7±1.4 liters).

It also showed less reduction in serum sodium level (1.2 ± 0.0 mmol/l versus 5.7 ± 0.2 mmol / l), and less reduction in hemoglobin level (0.7 ± 0.1 g / dl versus 2±0.0 g/dl).

The weight of the resected tiss ue was not significantly different between the two groups.

The bipolar group showed less postoperative irrigation time (23.6 ± 4.1 versus 36.7 ± 5.8 hours), hospital stay time (2.25 ± 0.4 versus 3.5 ± 0.5 days), catheterization time (5 ± 1 days versus 7.4 ± 1 days), and postoperative complications.

Both groups showed significant improvement in IPSS, Qmax, and quality of life; however, the difference between the two groups was not statistically significant.

Conclusions: Bipolar TURP seems to be a promising alternative for the treatment of patients with BPH, with comparable efficacy, shorter hospital stay, and faster recovery as compared to the conventional monopolar TURP, with less perioperative bleeding, serum sodium reduction and postoperative complications.