MONOPOLAR VERSUS BIPOLAR TRANSURETHRAL ENUCLEATION OF THE PROSTATE FOR LARGE VOLUME BENIGN PROSTATIC HYPERPLASIA

Abstract

Background: The choice of treatment modality in patients with Benign Prostatic Hyperplasia (BPH) is one of the most discussed issues in urology. In recent years, the surgical treatment of prostates of large sizes by means of enucleation has become increasingly popular. The emergence of special loops to perform bipolar and monopolar enucleation using standard equipment for TURP has opened up new possibilities for the treatment of patients by transurethral monopolar enucleation.Aim of the Work: To evaluate the efficacy and safety of Monopolar versus Bipolar Transurethral Enucleation of the Prostatefor Large volume Benign Prostatic Hyperplasia. Patients and Methods: 40 patients with BPH were randomly divided into two groups: Group 1 underwent Monopolar Transurethral Enucleation of the Prostate (M-TUEP) (n=20), and Group 2 underwent Bipolar Transurethral Enucleation of the Prostate (B-TUEP) (n=20). Operation time, incidence of hyponatremia,estimated blood loss by drop of haemoglobin, improvement of International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score, Uroflowmetry (Qmax and Qave), Post Voiding Residual Urine (PVR) and Prostate volume and other complications ( as reintervention for clots and bleeding control, recatheterization, UTI, incidence of TUR syndrome, incidence of infarction, incontinence, bladder neck contracture and urethral stricture) were compared. Results: Operation was successfully performed in all 40 cases, and no open surgery was converted in any case or blood transfusion was needed. There was no statistically significant difference between both groups in operative time, postoperative haemoglobin and serum sodium levels decline, or improvement in postoperative IPSS, QoL score, Qmax, Qave, Prostate volume and PVR. All patients were followed up to 6 months postoperatively, and no complications occurred except one patient in Group 1 (5% of Group 1 and 2.5 % of the whole study) developed Urethral stricture. Conclusion: M-TUEP was shown to be a safe and highly effective technique for relief of Bladder Outlet Obstruction (BOO). The clinical efficacy of M-TUEP is sustainable for up to 6 months of follow-up. Our single-center results show that M-TUEP has the same efficacy as B-TUEP for the surgical treatment of symptomatic BPH, so M-TUEP can replace B-TUEP with the same efficacy and comparable safety.