Bipolar Transurethral Resection Of Prostate Research Articles

Duración del catéter urinario pos-RTUP como factor de riesgo para estenosis de uretra

Antecedentes: La estenosis de uretra es una entidad urológica que se presenta con relativa frecuencia, siendo una causa común de síntomas urinarios bajos (SUOB) con una prevalencia del 0.6%. En la actualidad existe controversia acerca de la modalidad de energía como factor de riesgo para el desarrollo de estenosis de uretra. Diversos autores han publicado datos contradictorios sobre la estenosis de uretra post resección transuretral de próstata (RTUP).
 Material y métodos: Se revisaron los expedientes de los pacientes sometidos a RTUP bipolar y monopolar en el Hospital General de Occidente en el período de 1 de enero de 2018 al 31 de diciembre del 2018, se investigó la cantidad de pacientes con presencia de sintomatología urinaria pos-RTUP; determinada por la presencia de sintomatología moderada (>8 puntos) en el cuestionario IPSS (International Prostate Symptom Score) y la determinación de estenosis de uretra mediante uretrograma retrogrado o el registro de haber sido sometidos a uretrotomía interna posterior a la RTUP. El objetivo principal fue determinar la incidencia de estenosis de uretra en pacientes sometidos a RTUP en el Hospital General de Occidente en el periodo comprendido del 1 de enero de 2018 al 31 de diciembre de 2018.
 Resultados: Se revisaron los expedientes de 113 pacientes, asignados en 2 grupos de pacientes de acuerdo con la modalidad de energía utilizada; energía monopolar (A) 59 pacientes (52.2%) y energía bipolar (B) 54 pacientes (47.8%), se analizaron 16 variables; 8 categóricas y 8 continuas.
 Se encontró una incidencia de 6.7% de estenosis de uretra en el grupo de energía monopolar y un 5.5% de estenosis de uretra en el grupo de energía bipolar, no se encontró un aumento significativo en la incidencia de estenosis en el grupo de energía bipolar.
 Conclusiones: Al comparar cada una de las variables de manera aislada, solo la duración de la sonda se asoció de manera estadísticamente significativa (p <0.05) con la aparición de estenosis de uretra, reportamos un riesgo de estenosis de 0.7% al utilizar sonda durante 2 días, 3% con 5 días elevándose a 46% con el uso de sonda por 12 días.
 El uso de sonda transuretral posterior a la RTUP por tiempo prolongado demostró ser el factor de riesgo más importante para la aparición de estenosis uretral.

Post-TURP urinary catheter duration as a risk factor for urethral stricture

Background: Urinary stricture is a relatively frequent urologic entity and is a common cause of lower urinary tract symptoms, with a prevalence of 0.6%.
 The energy modality utilized in transurethral resection of the prostate (TURP), as a risk factor for the development of urethral stricture, is currently a subject of debate. Different authors have published conflicting data on post-TURP stricture. 
 Materials and methods: The case records of patient that underwent bipolar and monopolar TURP at the Hospital General de Occidente, within the time frame of January 1, 2018 and December 31, 2018, were reviewed. The number of patients that presented with post-TURP urinary symptomatology, determined by the presence of moderate symptoms (>8 points) on the International Prostate Symptom Score (IPSS), were evaluated. Urethral stricture was determined through retrograde urethrogram or a record of having undergone internal urethrotomy after TURP. 
 The primary aim was to determine the incidence of urethral stricture in patients that underwent TURP at the Hospital General de Occidente within the abovementioned time frame.
 Results: The case records of 113 patients were reviewed. They were assigned to 2 groups, according to the energy modality utilized: Group A, monopolar energy, 59 patients (52.2%) and Group B, bipolar energy, 54 patients (47.8%). Sixteen variables (8 categorical and 8 continuous) were analyzed. 
 The incidence of urethral stricture was 6.7% in the monopolar energy group and 5.5% in the bipolar energy group. No statistically significant increase in the incidence of stricture was found in relation to the bipolar energy group.
 Conclusions: Upon comparing each of the variables separately, only catheter duration had a statistically significant association with the appearance of urethral stricture (p <0.05). We found a 0.7% risk for stricture with 2-day catheter use, a 3% risk with 5-day use, and a risk reaching 46% with 12-day catheter use.
 The prolonged use of a urethral catheter after TURP was shown to be the most important risk factor for the appearance of urethral stricture.

Возможности применения силденафила у пациентов с сердечно-сосудистой патологией, перенесших трансуретральную резекцию по поводу доброкачественной гиперплазии предстательной железы

AIM To study the efficacy and safety of using sildenafil in patients with erectile dysfunction (ED) and concomitant cardiovascular diseases (CVD) who underwent transurethral resection of the prostate (TURP). MATERIAL AND METHODS A total of 59 patients (age from 50 to 75 years) with a diagnosis of benign prostatic hyperplasia (BPH), requiring surgical treatment due to inefficiency of drug therapy, I-PSS score more than 20 points), who were sexually active, but had erectile dysfunction (IIEF score < 21), coronary heart disease (NYHA class I) and stage 1-2 hypertension with stable blood pressure. All patients underwent bipolar TURP. From the first day after the TURP, therapy was prescribed as following: tamsulosin 0.4 mg once a day for 90 days, ciprofloxacin 500 mg twice a day for 10 days. In addition, the patients received treatment for comorbidities. In the main group (n=30), men additionally received sildenafil (EFFEX Sildenafil Evalar) 50 mg daily for 60 days, starting from the 30th day postoperatively. We have chosen this drug from an economic standpoint. RESULTS At baseline, all patients in both groups had hemodynamic and microcirculatory disorders in the prostate, which got worse in the early postoperative period. During the long-term follow-up, hemodynamic and microcirculatory impairments decreased. This effect was more pronounced in patients who received sildenafil. In addition, patients had an improvement in sexual function. During follow-up, there was no adverse effects of sildenafil on hemodynamic parameters (blood pressure, heart rate). CONCLUSION Our results allow to recommend sildenafil in order to restore sexual function postoperatively in patients with BPH, including those with concomitant cardiovascular disorders.

Safety and Efficacy of Bipolar Transurethral Resection of the Prostate vs Monopolar Transurethral Resection of Prostate in the Treatment of Moderate-Large Volume Prostatic Hyperplasia: A Systematic Review and Meta-Analysis.

Aims: To compare outcomes of monopolar vs bipolar transurethral resection of the prostate (TURP) in the management of exclusively moderate-large volume prostatic hyperplasia in terms of maximum flow rate as a surrogate for clinical efficacy, duration of catheterization, hospital stay, operative time, resection weight, transurethral resection (TUR) syndrome, acute urinary retention (AUR), clot retention, and blood transfusion. Methods: We conducted a search of electronic databases (PubMed, MEDLINE, EMBASE, CINAHL, and CENTRAL), identifying studies comparing the outcomes of monopolar and bipolar TURP in the management of large-volume prostatic hyperplasia. The Cochrane risk-of-bias tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa scale for observational studies were used to assess included studies. Random effects modeling was used to calculate pooled outcome data. Results: Three RCTs and four observational studies were identified, enrolling 496 patients. No difference was observed in the clinical efficacy between each procedure at 3 months postoperatively (p = 0.99), 6 months (p = 0.46), and 12 months (p = 0.29). The use of bipolar TURP was associated with significantly shorter inpatient stay (p = 0.01) and a shorter duration of catheterization (p = 0.05). Monopolar TURP was associated with an increased risk of TUR syndrome (p = 0.03). Operative time (p = 0.58), resection weight (p = 0.16), AUR (p = 0.96), clot retention (p = 0.79), and blood transfusion (p = 0.39) were similar in both groups. Conclusion: Our meta-analysis demonstrated that bipolar TURP in the treatment of moderate-large volume prostatic disease may be associated with a significantly lower rate of TUR syndrome and shortened length of hospital stay, with similar efficacy when compared with monopolar TURP. Further high-quality RCTs with adequate sample sizes are required to compare both monopolar and bipolar TURP to open prostatectomy or laser enucleation in the treatment of exclusively large-volume prostates with stricter definition of size.

Development of a patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Development of a patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

IJU this issue

This issue contains 15 Original Articles, three of which are excellent prospective clinical trials, and one Urological Note. Cabozantinib is a multiple receptor tyrosine kinase inhibitor targeting MET (c-MET), VEGFR2, RET, AXL, KIT and TIE-2. In the phase III, randomized, open-label METEOR study, cabozantinib was associated with a significant progression-free survival benefit and a greater objective response rate versus everolimus in patients with metastatic renal cell carcinoma who had progressed after VEGFR-TKI. Tomita et al. (Niigata, Japan) carried out a bridging study to METEOR to evaluate the efficacy and safety of cabozantinib in Japanese patients. This phase II, open-label, single-arm study showed that cabozantinib provided clinical benefits in Japanese patients with renal cell carcinoma, with similar efficacy and safety to the non-Japanese population. Medical lasers are increasingly used to treat benign prostatic hyperplasia. Shoji et al. (Isehara, Japan) carried out a randomized prospective study to compare functional outcomes and complications over a period of 12 months in benign prostatic hyperplasia treated with thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate. This study showed that thulium laser enucleation of the prostate is superior to bipolar transurethral resection of the prostate in resected volume, resected rates per prostate volume and transition zone volume, hemostasis, catheterization and hospitalization time, and decrease in prostate-specific antigen. However, excessive laser irradiation time in thulium laser enucleation of the prostate has the possibility to delay improvement of overactive bladder symptoms and decrease sexual function. Loose seeds and stranded seeds are available for low-dose rate brachytherapy. Each method has its own advantages and disadvantages, such as flexibility and fixation. Tanaka et al. (Kashihara, Japan) carried out a randomized controlled trial to compare the post-implant dosimetric parameters between the conventional method (using only the loose seeds) and the hybrid method. This study showed that the hybrid method of low-dose rate brachytherapy can achieve a higher coverage of the periprostatic region compared with the conventional method, while maintaining an acceptable level of urethral and rectal doses. The intravesical recurrence rate after transurethral resection of bladder tumor carried out for non-muscle-invasive bladder cancer (NMIBC) is high, and some risk factors for recurrence have been identified. Sazuka et al. (Chiba, Japan) evaluated the risk of the residual urine volume and preoperative pyuria in intravesical recurrence after transurethral resection of bladder tumor among NMIBC patients. They found that the presence of residual urine and pyuria raised the risk of intravesical recurrence after transurethral resection of bladder tumor for NMIBC. Furthermore, especially in men, the recurrence-free survival was significantly higher in patients without than with residual urine by propensity score matching analysis. Iwasawa et al. (Tokyo, Japan) investigated the relationship between fluid intake and tumor recurrence in NMIBC patients by using urine-specific gravity as an indicator of daily fluid intake. They found that high urine-specific gravity was associated with tumor recurrence, especially in patients not receiving adjuvant bacillus Calmette–Guérin therapy. This showed that increasing fluid intake might prevent recurrence in relatively low-risk NMIBC patients. Testicular microlithiasis (TM) is a relatively rare condition occurring in the testicular parenchyma that is characterized by multiple bright and small foci without acoustic shadow limited to the testicle on scrotal ultrasonography. TM is a characteristic of testicular dysgenesis syndrome and was shown to be associated with infertility. Hiramatsu et al. (Tokyo, Japan) evaluated the correlation between the degree of severity in TM and several factors. This study showed the prevalence of TM in normal healthy Japanese men who are trying for first-time pregnancy. This also showed that men with TM might have poor semen findings, and that men with severe TM might have even worse semen parameters. None declared.

A Comparative Study Between Standard Monopolar Versus Bipolar Saline Turp: Our Experience in Armed Forces Hospital

Objective: To-evaluate the outcome of bipolar Versus conventional monopolar transurethral resection of the prostate (TURP) on urinary function. Material and Methods: A total of 300 patients with benign prostatic hyperplasia (BPH) were randomized to bipolar or monopolar conventional TURP treatment groups. Operative and early postoperative variables and complications were recorded and all patients were re-evaluated at 1, 3, 6 and 12 months after surgery using the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual urine volume (PVR). Results: The operating time was shorter in the monopolar TURP group. Postoperative bleeding and blood transfusion requirements did not significantly differ between the two groups. Sodium levels were significantly lower in the monopolar group than in the bipolar group. Transuretheral resection syndrome developed in two (1.4%) patients in the monopolar group. Both groups had similar and significantly improved IPSS values, maximum urinary flow rate values and PVRmeasurement. Conclusion: Bipolar TURP is a safe and effective procedure that is associated with a relatively longer operating time, a smaller reduction in serum sodium levels and a similar efficacy compared with conventional monopolar TURP. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p 66-70

Thulium laser vaporesection (ThuVaRP) versus bipolar transurethral resection of the prostate (TURP) in benign prostate hyperplasia in term of safety and efficacy: A two-year-follow-up study in Erbil, Iraq

Background and objective: Prostate Thulium laser vaporization is a novel treatment option for a bladder outlet obstruction caused by benign prostate enlargement. However, this surgical technique has not yet been standardized. We present our finding of using Tm vaporesection of the prostate. This study aimed to assess the efficacy and safety of thulium laser versus bipolar transurethral resection of the prostate for treating patients with benign prostatic obstruction. Methods: Sixty three consecutive patients with benign prostatic hyperplasia attending public and private clinics in Erbil city were included in a comparative study from June 2014 to July 2016. Thulium laser vaporesection of the prostate was done for Group I (n = 31), and transurethral resection of the prostate was done for Group II (n = 32). All cases were evaluated preoperatively and were evaluated at 6-24 months postoperatively by international prostate symptom score, post void residual urine volume, and quality of life. Forty four patients completed the two years of follow up. Results: Thulium laser vaporization was significantly superior to bipolar plasmakinetic resection of the prostate in term of catheterization time (1.2 ± 0.7 vs 4.9 ± 1.7 days, P ≤0.001), hospital stay (1.5 ± 0.9 days vs 3.2 ± 1.6 days, P = 0.001) and drop in hemoglobin (0.8 ± 0.3 vs 2.35 ± 0.4 g/dl, P ≤0.001) and inferior to PKRP operation time (68.2 ± 27.3 vs 58.3 ± 22.7, P = 0.122). Both groups resulted in a significant improvement from baseline in terms of subjective symptoms scoring, but no significant difference was found between the two groups. Conclusion: Thulium laser vaporesection of the prostate is a safe and effective procedure for the treatment of symptomatic benign prostatic obstruction, with low perioperative morbidity however, both procedures showed no significant difference in terms of international prostate symptom score, post void residual urine volume and quality of life.

Functional outcomes of transurethral thulium laser enucleation versus bipolar transurethral resection for benign prostatic hyperplasia over a period of 12months: A prospective randomized study.

To evaluate functional outcomes over a year for benign prostatic hyperplasia treated with thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate. In this study, we prospectively included 140 patients who were treated for benign prostatic hyperplasia from April 2017 to February 2019. A randomization list was used for non-blind assignment to treatment groups (thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate). The International Prostate Symptom Score, International Prostate Symptom Score quality of life, Overactive Bladder Symptom Score, uroflowmetry and International Index of Erectile Function-5 were used for the assessment of outcomes. Scores were taken before treatment, and at 1, 3, 6, 9 and 12months after treatment. Preoperatively, characteristics of patients in the thulium laser enucleation of the prostate group (n=70) and the bipolar transurethral resection of the prostate group (n=70) did not significantly differ. The thulium laser enucleation of the prostate group had a lower median decrease in hemoglobin (0.10g/dL vs 0.69g/dL, P<0.0001) and shorter median catheterization (2days vs 3days, P<0.0001) than the bipolar transurethral resection of the prostate group. Both groups had significantly improved International Prostate Symptom Score, International Prostate Symptom Score quality of life, Overactive Bladder Symptom Score, maximum flow rate and residual urine compared with preoperative values. In the thulium laser enucleation of the prostate group, erectile function was significantly impaired at 1month post-treatment compared with pretreatment, but improved to baseline at 3months; however, the transurethral resection of the prostate group did not recover. However, total energy (P=0.001) and laser irradiation time (P=0.025) were significantly different between the patients who had preserved erectile function and those who did not after the treatment in the thulium laser enucleation of the prostate group. Thulium laser enucleation of the prostate is superior to bipolar transurethral resection of the prostate in resection efficacy, hemostasis, catheterization time and preservation of erectile function. However, excessive laser irradiation time in thulium laser enucleation of the prostate has the possibility to delay improvement of overactive bladder symptoms and decrease sexual function.

BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE VERSUS OPEN PROSTATECTOMY IN PATIENTS WITH PROSTATIC VOLUMES FROM 80-120 GM: A PROSPECTIVE RANDOMIZED STUDY.

Background: Transurethral resection of the prostate (TURP) is still considered the gold standard in the treatment of benign prostatic hyperplasia (BPH). However, open prostatectomy is indicated for prostate glands over 80 ml. There have been few reports concerning the use of TURP for large prostate glands over 100 ml. Objective: To prospectively compare the effectiveness and safety of bipolar TURP and open prostatectomy in prostate glands ranging from 80-120 ml. Patients and Methods: We reviewed the data of 60 patients with prostate glands ranging from 80-120 ml. which were randomized 30 patients underwent bipolar TURP (group A), and another 30 underwent open prostatectomy (group B). Preoperative International Prostate Symptom Score (IPSS), flow rate (Qmax), prostate volume, resected tissue volume, and operative time were documented. Postoperative hemoglobin, serum sodium change, hospital stay, duration of catheter indwelling and postoperative 6-month IPSS and Qmax were evaluated. Results: The Bipolar TURP (B-TURP) and open prostatectomy (OP) emphasized similar mean operating durations as well as the mean hemoglobin drop, catheterization period and hospital stay were significantly improved for bipolar group. During the follow up period, no statistically significant difference was determined in terms of IPSS, Qmax, QOL, PVRU between the two series. Conclusion: Bipolar TURP represented a promising endoscopic approach in very large BPH cases compared with standard open prostatectomy as patients benefited from significantly satisfactory follow up symptom scores and voiding parameters.

BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE VERSUS OPEN PROSTATECTOMY IN PATIENTS WITH PROSTATIC VOLUMES FROM 80-120 GM: A PROSPECTIVE RANDOMIZED STUDY.

Background: Transurethral resection of the prostate (TURP) is still considered the gold standard in the treatment of benign prostatic hyperplasia (BPH). However, open prostatectomy is indicated for prostate glands over 80 ml. There have been few reports concerning the use of TURP for large prostate glands over 100 ml. Objective: To prospectively compare the effectiveness and safety of bipolar TURP and open prostatectomy in prostate glands ranging from 80-120 ml. Patients and Methods: We reviewed the data of 60 patients with prostate glands ranging from 80-120 ml. which were randomized 30 patients underwent bipolar TURP (group A), and another 30 underwent open prostatectomy (group B). Preoperative International Prostate Symptom Score (IPSS), flow rate (Qmax), prostate volume, resected tissue volume, and operative time were documented. Postoperative hemoglobin, serum sodium change, hospital stay, duration of catheter indwelling and postoperative 6-month IPSS and Qmax were evaluated. Results: The Bipolar TURP (B-TURP) and open prostatectomy (OP) emphasized similar mean operating durations as well as the mean hemoglobin drop, catheterization period and hospital stay were significantly improved for bipolar group. During the follow up period, no statistically significant difference was determined in terms of IPSS, Qmax, QOL, PVRU between the two series. Conclusion: Bipolar TURP represented a promising endoscopic approach in very large BPH cases compared with standard open prostatectomy as patients benefited from significantly satisfactory follow up symptom scores and voiding parameters.

Bipolar vs. monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction: A Cochrane review

There remains uncertainty regarding the differences in patient outcomes between monopolar transurethral resection of the prostate (MTURP) and bipolar TURP (BTURP) in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). A systematic literature search was carried out up to March 19, 2019. Methods in the Cochrane Handbook were followed. Certainty of evidence (CoE) was assessed using the GRADE approach. A total of 59 randomized controlled trials (RCTs) with 8924 participants were included. BTURP probably results in little to no difference in International Prostate Symptom Score (IPSS) at 12 months (mean difference -0.24, 95% confidence internal [CI] -0.39--0.09; participants=2531; RCTs=16; moderate CoE) or health-related quality of life (HRQOL) at 12 months (mean difference -0.12, 95% CI -0.25-0.02; participants=2004, RCTs=11; moderate CoE), compared to MTURP. BTURP probably reduces TUR syndrome (relative risk [RR] 0.17, 95% CI 0.09-0.30; participants= 6,745, RCTs=44; moderate CoE) and blood transfusions (RR 0.42, 95% CI 0.30-0.59; participants=5727, RCTs=38; moderate CoE), compared to MTURP. BTURP may carry similar risk of urinary incontinence at 12 months (RR 0.20, 95% CI 0.01-4.06; participants=751; RCTs=4; low CoE), re-TURP (RR 1.02, 95% CI 0.44-2.40; participants=652, RCTs=6, I2=0%; low CoE) and erectile dysfunction (International Index of Erectile Function [IIEF-5]) at 12 months (mean difference 0.88, 95% CI -0.56-2.32; RCTs=3; moderate CoE), compared to MTURP. BTURP and MTURP probably improve urological symptoms to a similar degree. BTURP probably reduces TUR syndrome and blood transfusion slightly postoperatively. The moderate certainty of evidence available for primary outcomes suggests no need for further RCTs comparing BTURP and MTURP.

Syndrome of inappropriate antidiuretic hormone secretion following bipolar transurethral resection of the prostate

Syndrome of inappropriate antidiuretic hormone secretion following minimally invasive surgery is extremely rare, having only been reported in a handful of cases. We present the second documented case of syndrome of inappropriate antidiuretic hormone secretion following transurethral resection in an 80-year-old male undergoing bipolar transurethral resection of the prostate for bladder outflow obstruction. Level of evidence: 5

Prostatic artery embolization versus transurethral resection of the prostate in management of benign prostatic hyperplasia.

BackgroundTransurethral resection of the prostate (TURP) is considered the gold standard surgical intervention for prostate size less than 80 g. Prostatic artery embolization (PAE) has been suggested as a minimally invasive interventional radiological procedure in the management of benign prostatic hyperplasia (BPH), especially by using the PErFecTED technique. We aim through our study to evaluate the efficacy and safety of PAE compared with those of monopolar transurethral resection of prostate (M-TURP) and bipolar transurethral resection of prostate (B-TURP) in treating lower urinary tract symptoms (LUTSs) secondary to BPH.MethodsWe randomized 60 patients into 3 equal groups representing M-TURP, B-TURP, and PAE. Patients were followed up at 1 and 6 months postoperatively with regard to the International prostate symptom score (IPSS) score; uroflowmetry; prostate volume by transrectal ultrasound; and postvoid residual urine.ResultsThe mean operative time was 59, 68, and 89 minutes for the M-TURP group, the B-TURP group, and the PAE group, respectively; only one patient, who represented 5% of the M-TURP group and 1.7% of the whole study population, developed transurethral resection syndrome. Four patients of the PAE group complained of postembolization syndrome, which represented 20% of the cases. Only two patients in our study, both belonging to the PAE group, developed acute urinary retention after catheter removal, representing 10% of the PAE group and 3.33% of the whole study population. The improvement in the IPSS score, the average uroflowmetry (Q-average) score, postvoid residual urine, and prostate volume reduction was noted in all groups, with more statistically significant improvement in each of the M-TURP and the B-TURP groups than in the PAE group.ConclusionPErFecTED technique is a novel way of embolization, with statistically significant improvement for patients complaining of LUTSs due to BPH in terms of improvement of IPSS, uroflowmetry, prostate size, and amount of postvoid residual urine, yet these results are still not comparable with either the results of M-TURP or B-TURP that still show more effective improvement.

Electrocoagulation Accounts for a Significant Portion of Discrepancy Between Preoperative Ultrasonography Prostate Size Estimation and Resected Tissue Weight.

Background and Objectives: Transurethral resection of the prostate (TURP) is considered to be the gold standard surgical procedure for medium-sized prostates. However, there is a drastic difference between the weight of resected tissue reported by the pathologist and the sonographic estimate of prostate weight before the operation. The present study investigates the role of electrocoagulation in tissue loss during monopolar (M-) and bipolar (B-) TURP. Methods: In this experimental in vitro study, 33 prostate glands removed from patients by open suprapubic prostatectomy were roughly divided in half and the weight of each half was recorded precisely. One half of the specimen was resected using a monopolar resectoscope and the other half was resected by bipolar resectoscope in an out-of-body simulated condition. The weight of obtained chips was measured and the amount of lost tissue was calculated. Data from prostates with final pathologic diagnosis of benign prostatic hyperplasia were included in the analysis. The mean difference of prostate weight before and after out-of-body resection and also the proportion of tissue loss between M-TURP and B-TURP were compared using t-test. Results: Data from 62 prostate halves were included in the final analysis. The mean weight of samples after M-TURP was considerably lower than before resection (38.0 ± 6.9 and 48.7 ± 9.0, respectively, p < 0.001). Similarly, the mean weight of prostate samples after B-TURP was lower than the weight before resection (36.2 ± 7.3 and 48.4 ± 9.1, respectively, p < 0.001). However, the ratio of tissue loss in B-TURP (25.3% ± 2.5%) was significantly higher than in M-TURP (21.3% ± 3.7%) (p < 0.001). Conclusion: Prostate resection using electrocoagulation leads to a significant prostate tissue loss due to heat effect. Furthermore, tissue loss in B-TURP is slightly more than M-TURP.

Randomized Comparison of Prostatic Artery Embolization versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia

PurposeTo compare clinical and functional outcomes of prostatic artery embolization (PAE) with those of transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Materials and MethodsNoninferiority randomized trial was conducted involving men over 60 years of age with LUTS secondary to BPH. From November 2014 to January 2017, 45 patients were randomized to PAE (n = 23) or to TURP (n = 22). PAE was performed with 300- to 500-μm microspheres with the patient under local anesthesia, whereas bipolar TURP was performed with the patients under spinal or general anesthesia. Primary outcomes were changes in peak urinary flow (Qmax) and international prostate symptoms score (IPSS) from baseline to 12 months. Quality of life (QoL), and prostate volume (PV) changes from baseline to 12 month were secondary outcomes. Adverse events were compared using the Clavien classification. ResultsMean Qmax increased from 6.1 mL/s in the PAE group and from 9.6 mL/s in the TURP patients (P = .862 for noninferiority), and mean IPSS reduction was 21.0 points for PAE and 18.2 points for TURP subjects (P = .080) at 12 months. A greater QoL improvement was reported in the PAE group (3.78 points for PAE and 3.09 points for TURP; P = .002). Mean PV reduction was 20.5 cm³ (34.2%) for PAE subjects and 44.7 cm³ (71.2%) for TURP subjects (P < .001). There were fewer adverse events reported in the PAE group than in the TURP group (n = 15 vs n = 47; P < .001). ConclusionsReduction of LUTS in the PAE group was similar to that in the TURP group at 12 months, with fewer complications secondary to PAE. Long-term follow-up is needed to compare the durability of the symptomatic improvement from each procedure.

V08-05 COMBINED BIPOLAR VAPORIZATION AND RESECTION IN TREATMENT OF BPH

You have accessJournal of UrologyBPH & Bladder Outlet Obstruction (V08)1 Apr 2020V08-05 COMBINED BIPOLAR VAPORIZATION AND RESECTION IN TREATMENT OF BPH Osama Abdelwahab*, Tarek Soliman, Hammoda Sherif, Mohamed Habous, and Mohanad Aboanza Osama Abdelwahab*Osama Abdelwahab* More articles by this author , Tarek SolimanTarek Soliman More articles by this author , Hammoda SherifHammoda Sherif More articles by this author , Mohamed HabousMohamed Habous More articles by this author , and Mohanad AboanzaMohanad Aboanza More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000909.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bipolar TURP by resection loop and vaporization button are commonly used nowadays for treatment of BPH because it causes less intraoperative bleeding, and avoids free water absorption. However, bipolar vaporization may be associated with increased operative time and postoperative morbidity. By adding resection, we can minimize operative time and clean prostatic fossa from prostatic tissue shreds making prostatic fossa more smooth and regular. This video demonstrated the technique of combined bipolar vaporization and resection in case of BPH. We compared results of combined Bipolar TURP using the resection loop and vaporization versus vaporization alone for BPH to determine the relative safety and efficacy of both technique. METHODS: 77 patients with BPH were included in this study and randomized to operation either by Olympus (Gyrus) Bipolar loop TURP and Olympus (Gyrus) Bipolar button vaporization (Group 1) 40 patients or Olympus (Gyrus) Bipolar button vaporization alone( Group 2) 37 patients. Inclusion criteria were; BPH with qmax <10ml/sec, IPSS score>18 and prostate volume >40 gm. All patients were evaluated preoperatively and at 1, 3 and 9 months postoperatively by IPSS, uroflowmetry and prostate ultrasound. Clavien complications and operative time were recorded. RESULTS: There was no significant difference as regard age (51 + 9.9 and 52.5 + 8.2), hospital stay (1-2 days) or catheterization period (1-2 days) in both groups. Preoperative prostate volume (58 g v 55 g p=0.51) and IPSS (20 v 22 p=0.38) was equivalent. Significant increase in operative time was noticed in Group 2 (79± 15 minutes range 45-105 p <0.001), versus (mean 59 ± 10 minutes range 35-75 minutes, smale non-significant difference in blood loss occurred in both Groups (0.8% compared to 0.9% drop in hemoglobin, p<0.55) but increased postoperative urinary frequency (75% in G2 vs 45% in G1 (p <0.001), hematuria with clots as long as 3 weeks after surgery (18% vs 2%, p <0.001s p=0.22), :) and postoperative urethral stricture (4% vs 0%). There was No significant difference in Q max improvement Qmax (20 cc/s vs 18 cc/s) or postoperative prostate volume (32 vs 31 g p=0.31) and IPSS (6 v 5 p=0.22) equivalently. CONCLUSIONS: Combined Bipolar vaporization and resection of the prostate, is superior to Bipolar Vaporization alone as regard operative time and postoperative morbidity without compromising its efficacy and safety. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e735-e735 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Osama Abdelwahab* More articles by this author Tarek Soliman More articles by this author Hammoda Sherif More articles by this author Mohamed Habous More articles by this author Mohanad Aboanza More articles by this author Expand All Advertisement PDF downloadLoading ...

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article.

Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

Prostatic Artery Embolization (The PErFecTED Technique) versus TURP for treating Benign Prostatic Hyperplasia (BPH)

Abstract Background Benign prostatic hyperplasia (BPH) is a prevalent issue in aging men and transurethral resection of the prostate (TURP) still represents the gold standard of surgical treatment. Recently, prostatic artery embolization (PAE) was described as a new less invasive treatment alternative. Some modifications are being made to the technique presenting “The PErFecTED Technique” in order to propose better results to PAE and studies are needed to compare this novel technique to the gold standard TURP. Aim of the Study To compare results, safety and outcome of PAE (the PErFecTED Technique) and Bipolar TURP versus Monopolar TURP for treating LUTS due to BPH in aging males Methods/Design This is a single-centre, prospective, randomized, trial comparing treatment effects and adverse events among PErFecTED PAE, Bipolar TURP and Monopolar TURP in a tertiary referral centre. 60 patients who are electable for the three treatment options are randomized to a one of them. Immediate postoperative follow up of Na+ and Haemoglobin are assessed just postoperatively. 6 months later, Changes of the International Prostate Symptom Score (IPSS) and Quality Of Life (QOL) Changes in uroflowmetry, prostate size, post-void residual urine. Discussion The aim of the study is to compare results, safety and outcome of PAE (the PErFecTED Technique), Bipolar TURP and Monopolar TURP for treating LUTS due to BPH in aging males. Conclusion PErFecTED PAE may represent a good treatment option in highly selective patients, those who are complaining of LUTS due to BPH, yet they are unfit for surgery or where undergoing surgery is very risky. There is little to be lost by trying PErFecTED PAE, as it is safe, with minimal complications and a modest failure rate. Whilst it may not be a true replacement for TURP.

Clinical outcome of transurethral enucleation of the prostate using the 120-W thulium Laser (Vela™ XL) compared to bipolar transurethral resection of the prostate (TURP) in aging male

This study compared the surgical outcomes of the 120-W Thulium laser (Vela™ XL) enucleation of the prostate and bipolar transurethral resection of the prostate (TURP) in terms of efficacy, safety, and improvements of quality of life (QoL) in patients with benign prostate hyperplasia (BPH). Records were obtained from January 2014 to September 2018 for selected patients with symptomatic BPH who underwent 120-W Thulium laser (Vela™XL) prostate enucleation and bipolar TURP in our institution. All the patients selected met the surgical criteria for TURP and had received medical treatment for at least 3 months. Patients were excluded if their ECOG performance status was >1, if they had active malignant disease, of if they had a history of prostate surgery or reconstruction surgery of the urinary system. Patients decided which treatment option would be performed. Both the procedures were conducted by a single surgeon. Clinical outcomes such as changes in the International Prostate Symptom Score (IPSS) score, urodynamic parameters, drug consumption, pain scores, and QoL were evaluated. The rate of urinary tract infection, recatheterization, additional analgesic requirement, return to the emergency department for treatment, and other surgical complications was analyzed and compared between the two cohorts. A total of 276 patients met the inclusion criteria. Among them, 141 patients received bipolar TURP, where as 135 decided to receive laser vaporesection. No significant difference was observed in age, PSA level, prostate volume, and comorbidities between the two cohorts. Pre-operative (pre-op) urodynamic parameters were also identical, except that the laser surgery group had a higher rate of admission with a urinary catheter (24.4% vs. 14.2%, p=0.044). The operating time was longer in the laser surgery group (79.3 minutes vs. 62.4 minutes, p<0.001). However, enucleation using the Thulium laser was superior to bipolar TURP in terms of post-operative (post-op) pain status, including the numeric rating scale of pain, rate of additional narcotic use, and oral analgesic requirement. Compared with bipolar TURP, laser enucleation achieved a higher improvement in the QoL score at post-op follow-up at 2 weeks and 3 months. Nevertheless, the complication rate, changes in IPSS score, Qmax, and post-op medication-free survival were statistically identical in the two cohorts. Our data revealed that compared with bipolar TURP, 120-W Thulium laser (Vela™ XL) enucleation of the prostate achieved lower post-op pain and higher improvement in the short-term QoL of patients after surgery.