Pre- and post-operative clinical parameters and outcomes in benign prostatic hyperplasia (BPH) patients who underwent either monopolar or bipolar transurethral resection of the prostate (TURP) were compared in a recent study titled “Safety and Efficacy of Bipolar Versus Monopolar Transurethral Resection of the Prostate: A Comparative Study,” published in the Urology Journal. Both methods showed clinical benefit, although researchers found the bipolar surgery superior in some measures.
Benign prostatic hyperplasia (BPH), or an enlarged prostate gland, can result in bladder outflow obstruction and a series of lower urinary tract symptoms (LUTS). In patients unresponsive to drug therapy or who develop related complications, the condition is conventionally managed by a surgical method known as monopolar transurethral resection of the prostrate (M-TURP). Despite high success rates, this surgery is associated with side effects that can include bleeding, incontinence, and erectile dysfunction. In M-TURP, the inner prostate gland is removed via endoscopy with a diathermy unit. Bipolar TURP (B-TURP) consists of transurethral resection (TUR) using a high-frequency current generated between two electrodes. Importantly, this variant eliminates the development of potentially fatal TUR syndrome, another possible side effect of M-TURP.
Several minimally invasive alternatives, such as prostate ablation or vaporization, have also been developed.
To compare side effects and clinical outcomes of the M-TURP and B-TURP procedures, the researchers selected 590 BPH patients who had undergone TURP, performed by the same urologist, between June 2006 and June 2014. Patients were divided into two groups, according to the surgical procedure — M-TURP (300 patients) and B-TURP (290 patients). Researchers evaluated numerous pre-operative patient data and clinical outcome parameters, such as age, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post voiding residual urine volume (PVR), serum prostate specific antigen (PSA) levels, and prostate volume (Vp). A post-operative assessment was made, 12 months after the surgical procedure, and both groups were compared in terms of urethral catheterization time, operation time, hemoglobin (Hb) decrease, and IPSS, Qmax, and PVR values.
Results of pre- and post-operative IPSS, Qmax, and PVR showed significant improvements in both groups. However, B-TURP patients were found to have a shorter catheterization time than M-TURP patients (3.1 days versus 3.4 days, respectively), and also less hemoglobin decrease (16.9% vs 18.5%, respectively).
“Both methods proved to be effective and safe in the treatment of BPH. We determined that B-TURP is superior to conventional M-TURP in terms of catheterization time and Hb decrease,” the authors concluded.