Bipolar Transurethral Resection Of Prostate Research Articles

Current era HOLEP with MOSES 2.0 technology compared to the gold standard TURP.

Bipolar TURP is regarded as the gold standard for treatment of BPH. Historically, when compared to HOLEP, bTURP has been found to have shorter operative times and is considered more efficient. We sought to compare the efficiency, efficacy, and safety of current era HOLEP with MOSES 2.0 technology (MOLEP) and bTURP. We performed a retrospective review of patients who underwent bTURP or MOLEP at our institution between 2018 and 2023. Preoperative, intraoperative, and postoperative characteristics were collected for analysis. Analysis was done with SPSS software with significance defined as p < 0.05. We identified 195 bTURPs and 918 MOLEPs performed at our institution. Men undergoing MOLEP had significantly higher pre-op prostate volume and resected weight (61ml v 123ml and 15g v 70g, p < 0.001, respectively) when compared to bTURP patients. MOLEP was completed in significantly less OR and procedure time compared to bTURP (66min vs. 73min, p < 0.001; 90min vs. 111min, p = 0.026, respectively). These results remained significant when controlling for age and prostate volume. At a mean follow up of 3.7 months, HOLEP patients were significantly more likely to be medication (0 vs. 35.84% p < 0.001) and catheter free post-operatively (0.95% vs. 5.68%, p < 0.001) compared to bTURP. In our contemporary cohort, MOLEP is faster and more efficient than bTURP. These findings remained significant despite being performed on larger prostates and in patients more likely to be anticoagulated. Furthermore, MOLEP patients are more likely to remain catheter and medication free at follow-up when compared to bTURP.

Safety and efficacy of transurethral holmium laser enucleation of the prostate versus bipolar transurethral resection of the prostate in the treatment of benign prostatic hyperplasia: a prospective randomized controlled trial.

To evaluate the safety and efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) compared to bipolar transurethral resection of the prostate (bTUR-P) in the treatment of benign prostatic hyperplasia (BPH). A total of 220 BPH patients hospitalized from January 2022 to September 2023 were included in this study. These patients were randomly assigned to HoLEP and bTUR-P groups, with 110 participants in each group. We collected preoperative general information, perioperative data, complications, and postoperative follow-up indicators from both groups of patients. The baseline characteristics of patients in both groups were similar, with no statistical significance (P > 0.05). Compared to the bTUR-P group, the HoLEP group exhibited significantly less intraoperative bleeding (P < 0.001), shorter bladder irrigation time (P = 0.002), shorter catheter retention time (P < 0.001), and reduced postoperative hospitalization (P = 0.002). Additionally, the pain score during urination after catheter removal was significantly lower in the HoLEP group (P < 0.001). Postoperative complications occurred in both groups; however, they were less frequent in the HoLEP group (4 cases), primarily consisting of urinary retention and postoperative bleeding. The bTUR-P group experienced more complications (9 cases). Significant reductions in postoperative residual urine volume (RUV) were observed in both groups (P < 0.001). Both groups also showed significant improvements in Quality of Life (QoL) scores and International Prostate Symptom Scores (IPSS), with the HoLEP group demonstrating a more significant decrease in IPSS (P < 0.001). After comprehensive evaluation, HoLEP was superior to bTUR-P in terms of safety and efficacy. Therefore, HoLEP may be a preferable choice for the treatment of BPH.

Video Demonstration of Step-by-step Technique of Bipolar Transurethral Resection of Prostate as: An Educational Tool for Residents

Video Demonstration of Step-by-step Technique of Bipolar Transurethral Resection of Prostate as: An Educational Tool for Residents

Transvesical open prostatectomy versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia, Iraq: A retrospective study

Background and Objective: Surgical treatment is an effective option for symptomatic benign prostatic hyperplasia (BPH), after failed conservative therapy. Transurethral resection of the prostate (TURP) is considered as a standard treatment method for the management of the small to medium prostate while transvesical open prostatectomy (OP) is a standard option for great prostate. The objective of this study is to evaluate the efficacy and safety of both (B-TURP) and (OP). Methods: The present study included 73 patients underwent either transvesical open prostatectomy (31 patients) or bipolar transurethral resection of the prostate (42 patients) between May 2019 to May 2021, in Erbil-city. The baseline characteristics, intraoperative and postoperative characteristics plus early and late adverse effects were obtained from medical records for all patients in both groups, retrospectively. The data analyzed and compared statistically. Results: The baseline characteristics in the studied groups showed no significant differences except for the prostate size which was more on the OP group. According to the results, operative time was significantly (P &lt;0.001) lower in the OP group. The means of the following variables in the OP group were significantly higher than those of the B-TURP group: Hospitalization days (P &lt;0.001), days of catheter removal, back to normal activity (P &lt;0.001), QoL score (P = 0.027), Qmax (P &lt; 0.001), and PVR (P = 0.046), while no significant difference was detected regarding IPSS (P = 0.404). Conclusion: B-TURP was superior to OP regarding the hospitalization days, recovery time back to normal day-activity, and quality of life. Otherwise, both mentioned approaches work well for the treating symptomatic BPH.

Comparative Outcomes of Monopolar and Bipolar Transurethral Resection of the Prostate: An Institutional Perspective.

Objective This prospective comparative study aimed to highlight and compare two types of transurethral resection of the prostate (TURP), namely M-TURP (monopolar) and B-TURP (bipolar), in the endoscopic management of benign prostatic hyperplasia (BPH). Methods and materials This research was conducted between 2022 and 2023 at a tertiary care health center. Included in the investigation were 100 consenting study participants undergoing M-TURP and B-TURP at our center. All referred patients presenting with clinical, ultrasound, or uroflowmetry features of BPH and those with failed attempts at medical management were included in the study. Patients with carcinoma of the prostate were excluded from the study. Post-operatively, the endpoints for comparison included maximal urinary flow rate (Qmax), prostate volume, duration of hospital stay, duration of catheterization, drop in serum sodium concentration, and drop in hemoglobin levels. Descriptive statistics were computed to delineate the study sample. After the completion of data collection, data analysis was performed using SPSS for Windows, Version 16.0 (Released 2007; SPSS Inc., Chicago, IL, USA), and the correlations sought were achieved using the Chi-square test of significance. Results The peak incidence of BPH was seen in the sixth decade of life: the M-TURP group was 65.16 ± 7.07 years (mean ± standard deviation), while that in the B-TURP group was 62.32 ± 8.16 years (mean ± standard deviation). Nine percent of the study participants did not show any comorbidities. The most frequent symptom of BPH at presentation was a poor urinary stream (78%, n = 100), followed by nocturia (67%, n = 100). In our study, patients undergoing M-TURP had a mean serum prostate-specific antigen (PSA) level of 4.31 ± 1.03 ng/mL, while patients undergoing B-TURP had a mean serum PSA of 4.24 ± 0.99 ng/mL (p = 0.820; p > 0.05). The study found that patients undergoing M-TURP had a mean prostate size of 35.04 ± 3.57 cc, while those undergoing B-TURP had a mean prostate size of 35.72 ± 3.22 cc (p = 0.765). For the B-TURP group, the mean decrease in postoperative serum sodium concentration was 4.3 mEq/L, while for the M-TURP group, it was 6.4 mEq/L (p = 0.903). In the M-TURP group, there were three cases of transurethral resection (TUR) syndrome, while the B-TURP group had only one case. Conclusion BPH is a common problem affecting the quality of life of several male patients. Both M-TURP and B-TURP are comparable in their efficacy in treating BPH, with the exception of a higher incidence of hyponatremia and TUR syndrome in the M-TURP group.

Multimodal Approach Combining Thulium Laser Vaporization, Bipolar Transurethral Resection of the Prostate, and Bipolar Plasma Vaporization versus Bipolar Transurethral Resection of the Prostate: A Matched-Pair Analysis.

Background/Objectives: The aim of our study is to compare the perioperative and functional outcomes of a multimodal approach combining thulium laser vaporization, bipolar TURP, and bipolar plasma vaporization (TLP) with bipolar TURP in a matched-pair analysis. Methods: A nonrandomized, observational, retrospective, and matched-pair analysis was performed on two homogeneous groups of 60 patients who underwent TLP versus bipolar TURP at our center between March 2018 and December 2021. The American Society of Anesthesiologists (ASA) score and prostate volume (PV) were the main parameters used to match patients between the two groups. Follow-up was evaluated at 3, 6, 12, and 24 months after surgery. Results: There was a shorter operative time in favor of TLP (42 versus 45 min, p = 0.402). Median hemoglobin drop (-0.3 versus -0.6, p < 0.001) and median sodium drop (-0.3 versus -0.7, p < 0.001) after surgery were statistically significantly lower in TLP compared to bipolar TURP. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were significantly lower, and the maximum urinary flow rate was higher in the TLP group. The median PSA decrease 2 years after surgery was 73.92% in the TLP group versus 76.17% in the bipolar TURP group (p = 0.578). The complication rate was lower in the TLP group (20% versus 21.67%, p = 1). Conclusions: The results show that both procedures are equally effective and safe in the treatment of symptomatic BPH with some advantages regarding the TLP technique.

Evaluation of the Efficacy and Safety of Bipolar and Monopolar Transurethral Prostate Resection in Geriatric Patients.

Benign prostatic hyperplasia unresponsive to medical treatment is an important problem for elderly patients. Although the gold standard surgical treatment is monopolar transurethral resection of the prostate (MTURP), postoperative complications are still a concern. The aim of this study was to determine which transurethral prostate resection (TURP) methods are more effective and safer in elderly patients. Patients who underwent TURP in our clinic between 2012 and 2021 were analyzed retrospectively and divided into three groups according to their ages. Patients were treated with MTURP (n = 169) and bipolar transurethral resection of the prostate (BTURP) (n = 1152). Pre- and post-operative data for age groups were compared according to TURP methods. The resection speed in the BTURP method was statistically significantly faster in groups 2 and 3 (P < 0.05). Although not statistically significant (P > 0.05), there was a numerically smaller decrease in hemoglobin (Hb) value in group 2 and a numerically greater decrease in post-voiding residual (PVR) volume in groups 1 and 3 in the BTURP method. The increase in maximum urine flow (Qmax) was significantly higher only in group 2 (P = 0.032), but it was numerically higher in all groups in the BTURP method. The results of this study showed that BTURP was at least as effective and safe as MTURP in geriatric patients and also better in terms of Hb decrease, resection speed, Qmax increase, and PVR volume decrease.

Long-term results of multimodal treatment of the prostate using the Thulium Laser.

To evaluate a novel multimodal treatment (TLP) that integrates the use of a thulium laser, bipolar transurethral resection of the prostate (TURP), and "button-type" bipolar plasma vaporization for the endoscopic treatment of benign prostatic hyperplasia (BPH). From March 2018 to December 2021, we prospectively evaluated 220 patients with symptomatic BPH who underwent TLP. Patients were assessed based on the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). Perioperative and postoperative follow-up data were analyzed. The mean age at surgery was 66.74 years (SD 8.21). The median prostate size was 80 (IQR 70 - 110). The median operative time was 45 (IQR 35 - 55) minutes and the hospital stay was 2 (IQR 1 - 2) days. Patients were discharged with the urinary catheter in place, which was removed approximately 7 days after surgery when the histopathological result was discussed with the patient. Postoperatively, IPSS, QoL, Qmax and PVR showed a significant improvement starting at 3 months and continued through the postoperative follow-up visits (6-12-24-36-48-60 months). Urethral stricture and bladder neck contracture occurred in 1 (0.45%) and 2 (0.91%) patients, respectively. Recurrence of BPH occurred in 2 patients (0.91%) who underwent a second procedure. In conclusion, we report that the multimodal surgical treatment of BPH consisting of combining Thulium laser vaporization, bipolar TURP and plasma vaporization (TLP) represents an efficient and durable therapeutic method for BPH patients with low a complication rate at 5-year follow-up.

Evaluation of perioperative risk factors for bladder neck contracture after bipolar transurethral resection of the prostate.

Bladder neck contracture after transurethral resection of the prostate is a common complication but without clear predisposing factors. In this prospective study, we evaluated the perioperative risk factors associated with bladder neck contracture after bipolar transurethral resection of the prostate. The study included 391 patients who were admitted for bipolar transurethral resection of the prostate between October 2020 to October 2023 by three experienced surgeons. Forty three patients had bladder neck contracture and their perioperative parameters were compared with randomly chosen 172 patients without bladder neck contracture. There were no significant differences between the studied groups regarding the general and present history characteristics. Re-catheterization after transurethral resection of the prostate, post-operative recurrent urinary tract infection, resection speed, and associated urethral stricture were significantly higher among the bladder neck-contraction group (P < 0.05), while total PSA, total prostate weight, post void residual urine volume, resected gland weight, resection time and catheter duration were significantly lower among the bladder neck-contraction group (P < 0.05). Bladder neck contracture after bipolar transurethral resection of the prostate is more common among patients with small fibrotic prostate, low total PSA, small post- void residual urine volume, those with a higher incidence of post-operative recurrent urinary-tract infection and patients with a higher incidence of re-catheterization after transurethral resection of the prostate.

Histological Depth of Burn with Bipolar Plasma Arc – Is That the Cause for Urethral Sphincter Damage in Bipolar Transurethral Resection of the Prostate?

Introduction: The bipolar plasma button is gaining acceptance as a modality to perform endoscopic enucleation of the prostate. The plasma arc during activation of the button electrode extends for a distance beyond the edge of the evaporated area as seen on endoscopy. The extent of tissue affected by the intense heat of the arc is not certain. The histologically measurable depth of burn may have relevance during apical dissection, where thermal spread has been implicated in sphincter injury. Objectives: Our objective was to assess the histological depth of burn in animal tissue using a bipolar button electrode. Materials and Methods: Using a KENTAMED hARTT 400 electrosurgical unit machine, the following cuts were made over three freshly acquired goat liver specimens in a normal saline bath: (a) 280 W single superficial cuts using cutting current, (b) 280 W multiple deep cuts in the same groove using cutting current, and (c) 140 W, 2 s contact with coagulation current. Samples were fixed in neutral buffered formalin and processed paraffin embedded, and sections were stained with hematoxylin and eosin. The extent of thermal effect beyond the evaporated tissue edge was assessed on histopathology by a senior pathologist. Results: The histological depth of injury (involving about 5–6 rows of hepatocytes) did not extend more than 0.5 mm beyond the grossly visible edge of evaporated tissue. Conclusions: We found that the histological depth of burn in animal tissue extended only 0.5 mm beyond the grossly visible edge of the evaporation defect unlikely contributing to sphincter injury.

COMPARISON OF THE OUTCOME OF MONOPOLAR VERSUS BIPOLAR DIATHERMY USE DURING TRANSURETHRAL RESECTION OF PROSTATE

Monopolar transurethral resection of the prostate (M-TURP) remains a widely used surgical modality for treating benign prostatic hyperplasia (BPH). However, bipolar TURP (B-TURP), which uses isotonic saline as an irrigant, may reduce the risk of dilutional hyponatremia and transurethral resection (TUR) syndrome associated with M-TURP. Objective: To compare the outcomes of bipolar versus monopolar diathermy during transurethral resection of the prostate. Methods: This randomized controlled trial was conducted at the Department of Urology &amp; Renal Transplantation, Bahawal Victoria Hospital, Bahawalpur, from March 1, 2022, to May 31, 2023. The study included 100 patients, aged 55 to 85 years, scheduled for transurethral resection of the prostate due to BPH. Exclusion criteria were prostatic carcinoma, previous prostate surgery, cirrhosis, chronic renal failure, and bleeding disorders. Patients were randomized into Group A (M-TURP with 5% dextrose water as irrigant) and Group B (B-TURP with normal saline as irrigant). Outcomes, including changes in serum sodium levels, hemoglobin levels, and incidence of TUR syndrome, were assessed 12 hours postoperatively. Statistical analysis was performed using appropriate methods to compare the two groups. Results: The mean drop in hemoglobin (g/dL) was significantly more significant in the bipolar group (51.71 ± 7.28) compared to the monopolar group (47.86 ± 8.26) (p = 0.0001). The mean decrease in serum sodium levels (mEq/L) was significantly less in the monopolar group (143.57 ± 13.85) compared to the bipolar group (75.51 ± 7.98) (p = 0.0001). TUR syndrome occurred in 2 (4.0%) patients in the M-TURP group, whereas no cases were reported in the B-TURP group (p = 0.153). Conclusion: Bipolar transurethral resection of the prostate is associated with a smaller drop in hemoglobin, a lesser decrease in serum sodium levels, and a lower incidence of TUR syndrome than monopolar transurethral resection.

Patient’s Satisfaction Post-Transurethral Resection of the Prostate with Monopolar and Bipolar for Benign Prostate Hyperplasia

Transurethral resection of the prostate (TURP), either bipolar or monopolar, is a surgical treatment for benign prostatic hyperplasia, which has similar effectiveness in reducing international prostate symptom score, increasing men peak flow rates, and reducing post-void residual volume. However, bipolar TURP (B-TURP) can reduce the incidence of bleeding and dilutional hyponatremia. This study aims to evaluate the effectiveness of the level of patient satisfaction between Monopolar-TURP (M-TURP) and B-TURP. 82 patients at three hospitals in Denpasar City were eligible as subjects based on inclusion criteria, consisting of 41 patients for each procedure. The recruitment method used consecutive sampling from March to August 2019. The patient’s demographics as baseline data were recorded. The level of patient satisfaction was recorded for one month after surgery through the SF-36 questionnaire. The baseline sample’s characteristics before surgery in both groups were statistically identical. In evaluating patient satisfaction levels, there are significant differences where TURP (B-TURP) is better in the domain of vitality (p=0.001), social function (p=0.005), pain (p=0.002), and general health (p=0.001). B-TURP resulted in an increasing level of patient satisfaction better than M-TURP.

Patient’s Satisfaction Post-Transurethral Resection of the Prostate with Monopolar and Bipolar for Benign Prostate Hyperplasia

Transurethral resection of the prostate (TURP), either bipolar or monopolar, is a surgical treatment for benign prostatic hyperplasia, which has similar effectiveness in reducing international prostate symptom score, increasing men peak flow rates, and reducing post-void residual volume. However, bipolar TURP (B-TURP) can reduce the incidence of bleeding and dilutional hyponatremia. This study aims to evaluate the effectiveness of the level of patient satisfaction between Monopolar-TURP (M-TURP) and B-TURP. 82 patients at three hospitals in Denpasar City were eligible as subjects based on inclusion criteria, consisting of 41 patients for each procedure. The recruitment method used consecutive sampling from March to August 2019. The patient’s demographics as baseline data were recorded. The level of patient satisfaction was recorded for one month after surgery through the SF-36 questionnaire. The baseline sample’s characteristics before surgery in both groups were statistically identical. In evaluating patient satisfaction levels, there are significant differences where TURP (B-TURP) is better in the domain of vitality (p=0.001), social function (p=0.005), pain (p=0.002), and general health (p=0.001). B-TURP resulted in an increasing level of patient satisfaction better than M-TURP.

Application of Urethral Contrast Computed Tomography Three-Dimensional Imaging in the Postoperative Assessment of Prostate Hyperplasia.

This study assesses the morphological effectiveness of benign prostatic hyperplasia (BPH) surgery using multislice spiral computed tomography three-dimensional imaging (CT3D) with urethral contrast. Twenty-five male patients with BPH and bladder outlet obstruction (BOO) who underwent bipolar transurethral resection of the prostate were selected. Preoperative and postoperative CT3D indicators of retrograde and voiding cystourethrography, including bladder neck diameter, length of the posterior urethra, and degree of prostate protrusion into the bladder and upper and lower diameter of the prostate were used to assess bladder neck and posterior urethra morphology and BOO severity. In addition, preoperative and postoperative International Prostate Symptom Scores and maximum urine flow rates were compared. Postoperative CT3D was used to evaluate changes following obstruction relief postsurgery. Preoperative CT3D indicated significant BOO, whereas postoperative imaging showed improved patency but with irregular posterior urethral lumens and varying degrees of residual glandular tissue. Comparative analysis of preoperative and postoperative bladder outlet metrics revealed significant changes (p < .05). Urethral contrast CT3D effectively visualizes the prostate, bladder neck, and prostatic urethra. It quantifies changes in the urethral lumen postsurgery, correlating the extent of posterior urethral lumen spaciousness with urinary flow rates.

One-Year Outcomes of Transurethral Treatment of Bladder Neck Stenosis Following Transurethral Resection of the Prostate. Results from a Large, Multicenter Series.

To assess management and outcomes of bladder neck stenosis (BNS) post-transurethral resection of the prostate (TURP) in 12 centers. A retrospective analysis of patients who underwent transurethral BN incision for stenosis following TURP from January 2015 and January 2023 was performed. Inclusion criteria included endoscopic diagnosis of BNS associated with obstruction and/or lower urinary tract symptoms. Data are presented as median and interquartile range. Two distinct univariable logistic regression analyses were performed to identify factors associated with overall urinary incontinence and recurrent stenosis. Three hundred and seventy-two men were included. 95.2% of patients developed BNS following bipolar TURP. 21.0% of patients were on an indwelling catheter before BNS incision. Bipolar electrocautery was the most commonly employed energy for incision (66.5%). Collings knife was the most commonly employed (61.2%) instrument for incision, followed by end-firing holmium lasering (35.3%). Median operation time was 30 (25-45) minutes. The overall complication rate was 12.4%, with 19 (5.1%) patients suffering from acute urinary retention, 6 (1.6%) patients requiring prolonged irrigation due to persistent hematuria, and a surgical hemostasis was necessary in 8 cases (2.2%). Overall postoperative incontinence rate was 17.2%, with urge incontinence accounting for the most common type (45.3%). Incontinence lasted more than 3 months in 9/46 (14.3%) patients. Recurrent BNS occurred in 29 (7.8%) patients and was managed by re-endoscopic incision in 21 (5.6%) patients and dilatation only in 6 (1.6%) patients. Two (0.5%) patients underwent urethroplasty for recalcitrant stenosis. Logistic regression analysis showed that Collings knife was associated with higher odds of having postoperative incontinence (OR 3.93 95% CI 1.45-11.13, p=0.008) and BN recurrence (OR 3.589 95% CI 1.157-15.7, p=0.047). Transurethral BN incision provides satisfactory short-term results with an acceptable rate of complications.

Beware of Bipolar Transurethral Resection of Prostate in Patients with Previously Inserted Metallic Prostate Stapling Devices

Metallic prostate stapling (e.g., UroLift) is a minimally invasive treatment option for men with bladder outlet obstruction from benign prostatic hyperplasia (BPH). While it provides rapid relief and preserves sexual function, unexpected interactions with other medical devices can compromise surgical procedures. In this letter, we highlight five cases where stapled metallic implants resulted in damage to bipolar energy device during transurethral resection of the prostate (TURP) and stimulation of obturator nerve. Laser may also reflect off metallic prostate implants which can result in laser equipment malfunction. Monopolar TURP should be considered in patients with existing metallic prostate implants who need further transurethral surgery for obstructive BPH to prevent bipolar instrument damage and obturator kick.

PSA density as a predictor of long-term infectious complications during transurethral resection of the prostate: determining an optimal cut-off value

Introduction. Infectious complications (ICs) after transurethral resection of the prostate (TURP) are significant and potentially life-threatening conditions with an incidence 0.5% – 20.0%. Most publications provide data regarding early infectious complications. At the same time, there are currently no studies aimed at a comprehensive assessment of long-term infectious complications after TURP. The problem of prevention and treatment of ICs is also accompanied by insufficient understanding of the role of undiagnosed inflammation in prostate tissues and the lack of representative laboratory markers.Objective. To assess the prostate-specific antigen density (PSAd) as a predictor of long-term infectious complications after transurethral resection of the prostate and to determine the optimal cut-off value.Materials &amp; methods. This single-center study included 162 patients who underwent mono- and bipolar TURP between 2016 – 2023. Inclusion criteria for the study: prostate volume 30–80 cm3, no history of urinary tract infections (UTIs) at the time of hospitalization and antibiotic treatment at least one month before surgery, possible presence of latent UTIs before surgery, no prostate cancer. Exclusion criteria were failure to meet inclusion criteria. Infectious complications assessed included upper and lower UTIs, as well as epididymitis, orchitis and prostatitis, confirmed by clinical and laboratory data. Prostate-specific antigen (PSA) assessment was performed &lt; 2 days before surgery.Results. The median PSAd value was 0.04 [0.03; 0.08] ng/ml2, the variable was significantly different in non-infection and infection groups (0.04 and 0.08 ng/ml2, respectively, p = 0.009). The area under the curve (AUC) was 0.67 (95% CI [0.546 – 0.791]). The optimal cut-off value of the PSAd in prediction of long-term ICs was &gt; 0.07 ng/ml2, sensitivity / specificity: 58.3% and 76.1%, respectively. The analysis showed more than 4 times higher odds of developing an infectious complication in PSAd &gt; 0.07 ng/ml2 patients: OR 4.3 (95% CI [1.7 – 10.5], p = 0.001).Conclusion. This study demonstrates data that defines a new clinical non-oncological significance of PSAd as a predictor of the development of long-term infectious complications after TURP.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

ObjectiveTo investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study. MethodsOne hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. ResultsA total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. ConclusionIntra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

Comparison of Bipolar and Monopolar Transurethral Resection of the Prostate, Functional Outcomes and Analysis of Factors Predictive of Complications: A Prospective Study

Introduction: In Morocco, RTUP-m is considered the gold standard for the surgical treatment of prostate adenomas, recommended for prostates with a volume suitable for resection in less than 60 minutes. Additionally, the challenge arises when dealing with patients on antiplatelet or anticoagulant medications due to the associated risk of bleeding, hence the significance of RTUP-b. The objective of our study is to compare the functional outcomes and immediate postoperative complications between these two techniques and to identify predictive factors for complications. Methods: This is a prospective randomized study conducted between January 2022 and September 2022. The variables age, BMI, surgical indication, transrectal prostate volume, ASA classification (American Society of Anesthesiologists), previous pharmacological treatments, IPSS score, quality of life index (QLI), maximum flow rate (Qmax) and postoperative complications were collected. The Chi2 test and Student's t-test were used for statistical analysis. Results: Sixty-nine consecutive patients were included, 38 patients in the monopolar TURP group and 31 in the bipolar TURP group. Both groups were homogeneous in their baseline characteristics. The overall pre-surgical IPSS/QLI/Qmax score was 24,03/4,73/9,47. Functional results at 1st and 3rd month are shown in Table 1. For complications, see Table 2 and 3. These differences were not statistically significant (p = 0,427): the most frequent were hematuria (9,4%) and febrile urinary tract infections (9,4%). Only one patient presented hyponatremia due to glycocol reabsorption in the monopolar group. All complications were Clavien 1 or 2. We found no significant differences between the two groups with regard to complications or their predictive factors. Conclusion: Analysis of our data over the first three months reveals no differences between the two techniques in terms of functional results and postoperative complications, and there are no predictive .........

Outcome of Monopolar versus Bipolar Transurethral Resection of Prostate

Introduction: Transurethral resection of the prostate is the gold standard surgical treatment for benign prostatic hyperplasia with the lower urinary tract symptoms. Bipolar system is a new in technology to lower the adverse effects of monopolar system. This study was designed to find out clinic-demographic data and peri-operative outcomes of the monopolar versus bipolar transurethral resection of prostate. Methods: This prospective comparative study was conducted from June 2022 to March 2023, in the Department of Urology of Bir Hospital, National Academy of Medical Sciences, Nepal. Ethical approval of research was taken from Institutional Review Board, NAMS: Ref No. 735/2079/80. Microsoft Excel was used for descriptive analysis for clinic-demographic and outcome variable data, were presented in frequencies and percentages and their relation were analyzed by chi-square test/fisher’s exact test. A p-value of &lt;0.05 statistically significant. Result: A total 80 patients were compared, bipolar(40 cases) and monopolar(40 cases). There were no differences in the incidence of hyponatremia, clot retention and evacuation rate, re-catheterization rate, mean hemoglobin loss, and mean length of hospital stay. The longer duration of operation time (&gt;60 min) was observed in bipolar transurethral resection ( p=0.001). The transurethral resection syndrome was found only in M-TURP. Conclusion: Both monopolar and bipolar transurethral resection of prostate showed no statistical differences in the amount of resected prostatic tissue, the incidence of hyponatremia, length of hospital stays, blood transfusion rate, re-catheterization rate, clot retention and evacuation rate. The shorter duration of surgery and the trans-urethral resection syndrome was observed in M-TURP.