Mono-Polar Versus Bi-Polar TURP In High Risk Patients With Large Prostate Gland: A Prospective Observational Study

Abstract

Background: Monopolar-transurethral resection of the prostate (M-TURP) is considered as a gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia but is associated with a number of complications and has less safety margin in patients with comorbidities. Bipolar-TURP (B-TURP) is a modification of conventional M-TURP procedure and has the potential to overcome its most prominent shortcomings with a better safety profile in patients with comorbidities.

Objectives: To find out the perioperative outcome, efficacy, and safety between M-TURP and B-TURP in high-risk large prostate gland patients.

Participants and study design: A prospective randomized comparative study, enrolling total of 100 patients with one or more comorbidities and prostate weight ≥ 60gm.

Methods: In group 1, 50 patients were operated with M-TURP technique and in group 2, 50 patients were operated with B-TURP technique. Operative and postoperative parameters were recorded and patients were followed for a period of 6-weeks.

Results: There was no statistically significant difference in preoperative parameters of our patients undergoing M-TURP and B-TURP. No significant difference in operative time and amount of gland resected was seen between the two groups. However statistically significant decrease of serum sodium between the two resection techniques was observed (p < 0.001). TUR syndrome was detected in 1(2%) patient of the M-TURP group, while none of the B-TURP group patients (0%) developed TUR syndrome however these results did not translate into significant differences in TUR syndrome rates. Comparison of irrigation time and hospital stay showed a significant difference in favor of B-TURP. Significant improvements over preoperative values in Qmax and PVRU, comparable in both arms, were observed in this study at a 6-week follow-up.

Conclusions: B-TURP definitely holds promise in reducing the two common complications of M-TURP, i.e. bleeding and dilutional hyponatremia with the advantages of shorter irrigation time and hospital stay.

Implications: B-TURP has the potential to become the procedure of choice or is as effective as M-TURP for the surgical management of BPH with an improved safety profile in patients with underlying comorbidity and large prostate gland.