Monopolar Transurethral Resection Research Articles

Comparing the incidence of Bladder Neck Stenosis post monopolar Transurethral Resection of the Prostate; small prostates versus larger prostates in the black African population

Monopolar Transurethral Resection of the Prostate (TURP) is the commonly done procedure for surgical removal of the prostate after open prostatectomy in our subregion. It is still a novel procedure in our subregion, as very few centers offer this procedure. It is generally believed that the size of the prostate may influence the development of complications of bladder neck stenosis. This is a dreaded complication, which requires further surgical procedure to correct in a resource-poor environment. We decided to compare the incidence of Bladder Neck Stenosis (BNS) in small vs larger prostates following monopolar TURP in our black African subregion. We prospectively studied 194 patients who underwent TURP in our facility from 2015 to 2022 that satisfied the inclusion criteria. Eighty-five participants (43.81%) had a small prostate (Transrectal Ultrasound, TRUS, weight <30 g), and 109 participants (56.19%) had a large prostate (TRUS weight >30 g). Overall, ten participants (5.15%) had postoperative BNS. Participants with smaller prostates had more incidence of bladder neck contracture than those with larger prostates, although this did not reach statistical significance, Fisher’s Exact test p=0.338. Multifactorial reasons and not prostate size alone may be responsible for BNS. There may be a need for larger-scale standardized studies on prostate size effect on BNS.

Intraprostatic Injection of Tranexamic Acid Decrease Blood Loss During Monopolar Transurethral Resection of the Prostate: A Randomized Controlled Clinical Trial

ObjectiveTo assess the role of intraprostatic injection of tranexamic acid (TXA) in reducing blood loss during transurethral resection of the prostate (TURP). MethodsWe conducted a randomized, controlled, double-blind trial involving 60 patients with benign prostatic hyperplasia (BPH) aged 50–85 years, undergoing monopolar TURP. Patients' prostatic weights ranged from 50 to 80 grams. They were divided equally into two groups: Group I received an intraprostatic injection of 1 gram of TXA (Cyklokapron) dissolved in 50 ml of 0.9% saline at multiple sites, while Group II (control) received a 60 ml saline injection. Comprehensive clinical assessments and standard laboratory tests, including screenings for TXA hypersensitivity, were performed for all patients. ResultsGroup I exhibited significantly lower intraoperative blood loss and hemoglobin concentration in irrigation fluid immediately post-surgery and at the 6-hour postoperative mark compared to Group II (P < 0.05). Coagulation parameters—activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen level (FB), and thrombin clotting time (TT)—showed no significant differences between the groups preoperatively or at 6 and 24 hours postoperatively. No thromboembolic events or other complications were reported in either group. ConclusionThe intraprostatic injection of TXA during monopolar TURP is safe, with minimal adverse effects, and effectively reduces blood loss.

Assessing safety and feasibility of monopolar transurethral resection of the prostate without post-operative catheter traction: A randomized controlled trial.

Traction on the per-urethral catheter is commonly employed after monopolar transurethral resection of the prostate (mTURP) to reduce bleeding. However, its efficacy and impact on postoperative pain remain uncertain. Further, there is limited evidence to suggest any benefit regarding post-operative blood loss. In a randomized controlled trial, 62 patients undergoing mTURP were assigned to either a traction (n = 30) or non-traction (n = 32) group. Blood loss, postoperative pain, and analgesic requirements were assessed between January 2022 and April 2023. {(IHEC-PGR/2021/DM/M.Ch/Jan/02), CTRI Registration: CTRI/2022/01/039199.}. No significant differences were observed between the traction and non-traction groups regarding postoperative blood loss (p-value- 0.632), fall in hemoglobin (p-value- 0.719) and hematocrit (p-value- 0.937) levels, and length of postoperative hospital stay (p-value- 0.797). However, the traction group reported significantly higher postoperative pain scores (p-value < 0.001) and increased analgesic requirements (p-value < 0.001). The study suggests that 12-hours catheter traction after mTURP does not reduce blood loss and is associated with increased postoperative pain.

Emergency department visits following transurethral resection of prostate in the elderly: Does duration of postoperative catheterization count?

Elderly patients with benign prostatic hyperplasia are increasingly having minimally invasive surgeries due to their safety. There is also a drive to minimize the duration of postoperative catheterization following transurethral resection of the prostate to reduce hospital stay and encourage early ambulation. These are desirable in the elderly to improve outcomes. Can early catheter removal be done safely in the geriatrics without an increase in presentation to the emergency department with complications? We compare the emergency presentation of elderly patients who had early and delayed catheter removal following transurethral resection of the prostate. This was a retrospective review of transurethral resection of the prostate in the elderly (≥70 years) within 2 years in a single hospital. All the patients had monopolar transurethral resection of the prostate and were categorized based on the duration of postoperative catheterization as either early (third postoperative day) or delayed (> third postoperative day). The duration of catheterization was based on surgeon preference. Patients with intraoperative complications were excluded. Data on clinical presentation, comorbidities, and presentation at the emergency department were retrieved and analysed. Forty-one patients were studied with the mean age of patients being 76 ± 4 years. Twenty patients had early catheter removal and 21 had delayed catheter removal. A total of nine patients presented to the emergency department within the 30-day postoperative period with either bleeding urinary retention or incontinence requiring re-catheterization, six had early catheter removal, and three had delayed catheter removal. The catheter duration, preoperative ASA status prostate volume, and preoperative indwelling catheter were not statistically significant determinants of presentation to the emergency department in these elderly men. The presence of comorbidities assessed using the Charlson Comorbidity Index was a statistically significant variable to presentation at the emergency department after surgery P = 0.006. Early catheter removal is safe in elderly patients following transurethral resection of the prostate, however, there is a risk of presentation to the emergency department with complications, especially in patients with comorbidities.

Incidence and Determinants of Catheter-Related Bladder Spasms Following Transurethral Resection of the Prostate; A Prospective Review of 80 Cases.

Bladder spasms due to involuntary contraction of the bladder occur frequently following Transurethral resection of the prostate (TURP). They may be aggravated by the presence of a catheter, blood clots, preoperative overactive bladder, or preoperative ingestion of bladder stimulants like caffeine. These bladder spams are painful, associated with peri-catheter leakage of urine, increased post-operative bleeding, and often refractory to postoperative analgesia. The incidence and risk factors for the occurrence of bladder spasms following TURP need to be reviewed and validated to ensure adequate patient counseling and possible lifestyle modification before surgery. We conducted a prospective review of the determinants of bladder spasms in our patients following TURP. The study population was patients with benign prostatic obstruction scheduled for TURP between March 2022 and April 2023. Monopolar transurethral resection of the prostate was done using a continuous flow resectoscope. The primary endpoint of the study was occurrences of bladder spasms postoperatively before the trial without a catheter. Pain perception during the spasms was assessed using a visual analog scale. Clinical data were collected and analyzed to determine their association with the occurrence of bladder spasms postoperatively using regression analysis. Sub-group analysis was also done to correlate significant variables with the severity of pain in patients with spasms. The mean age of the 80 patients reviewed was 66.9 ±8 years. Bladder spasms were seen in 41(51.2%) of the patients. The presence of overactive bladder (OAB) symptoms and the use of bladder stimulants were statistically significant determinants with a p-value of 0.003 and 0.026 respectively. The age of the patient, preoperative indwelling catheter, prostate volume, and resection time were not statistically determinant variables in the occurrence of bladder spasms post-operatively. 61% had severe pains and 39% had mild pains. There was no significant correlation between the presence of OAB or the use of bladder stimulants with the severity of pains in patients with bladder spasms after TURP. Half of the patients are likely to have bladder spasms after TURP. The risk of having these spasms is higher in patients with preoperative OAB or patients who are exposed to bladder stimulants. The severity of spasms is however independent of these risk factors.

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 .........

Comparison of holmium laser, bipolar and conventional monopolar transurethral resection of bladder tumour in primary non-muscle invasive bladder cancer.

To compare the efficiency and safety profile of conventional monopolar, bipolar plasmakinetic and holmium laser techniques for transurethral resection of bladder tumour. The prospective comparative study was conducted from July 2019 to May 2021 after approval from the ethicsreview committee of Kafrelsheikh University, Egypt, and comprised patients of either gender with primary non muscle invasive bladder cancer who qualified for transurethral resection of bladder tumour. The patients were stratified into low-risk group A, intermediate risk group B and high-risk group C in accordance with the guidelines of the European Association of Urology. Comprehensive cystoscopy and panendoscopy were done in all cases. Once panendoscopy was done, tumour resection was performed with monopolar resectoscope in group A, plasmakinetic resectoscope in group B and holmium laser in group C). Data was collected at preoperative, peroperative, postoperative and follow-up stages. Data was analysed using SPSS 21. Of the 84 patients, 67(79.76%) were males and 17(20.23%) were females. There were 27(32.14%) patients in group A; 21(77.8%) males and 6(22.2%) females withy mean age 60.63±11.76 years. Group B had 32(38%) patients; 26(81.2%) males and 6(18.8%) females with mean age 65.34±7.55 years. Group C had 25(29.76%) patients; 20(80%) males and 5(20%) females with mean age 59.48±12.6 years. The mean follow-up period was 12.97±2.70 months in group A, 12.81±2.75 monthsin group B and 13.48±3.3 monthsin group C. Visualised complete resection was done in 23(85.8%) group A patients, 29(90.6%) group B patients and 24(96%) group C patients(p=0.018). Visualised complete resection, tumour multiplicity, tumour size, catheter duration, and hospital stay were significant predictors (p<0.05). Survival analysis showed 26(96.3%), 30(93.75%) and 25(100%) cases in groups A, B and C, respectively. Bipolar plasmakinetic and holmium laser techniques were found to be more effective and safer than the conventional monopolar technique for transurethral resection of bladder tumour in patients with primary non-muscle invasive bladder cancer.

Incidence and outcome of transurethral resection of prostate syndrome at a tertiary care hospital

Introduction: Monopolar transurethral resection of prostate (M-TURP) is rarely complicated with the dreaded syndrome the TURP syndrome due to absorption of larger amount of non-electrolyte hypo-osmolar irrigation fluid (1.5% glycine), longer duration of surgery and larger amount of tissue resection. This study aims to find out the incidence and perioperative outcome of TURP syndrome after monopolar TURP. Method: This was a cross sectional study of retrospectively collected data during the period of 4 years from June 1st 2018 to 30th May 2022, in Department of Urology of Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal. Ethical approval was obtained from NAMS ethical committee. Microsoft Excel was used for descriptive analysis of the incidence of TURP syndrome, its relation with amount of resected tissue, duration of resection time, and the outcome (need of blood transfusion, length of hospital stay, mortality). Result: Out of 208 cases of monopolar TURP, 8/208(3.8%) had TURP syndrome. Patients with TURP syndrome were age group 70-85 y. Duration of surgery was &gt;60 min was in 5/8(62.5%), resection weight &gt;20 gm 6/8(75%), blood transfusion 1/8(12.5%), and hospital stay &gt;3 days in all 8/8(100%) cases. Mortality was nil in patients with TURP syndrome. Conclusion: The TURP syndrome was observed in 8/208(3.8%) and it was more common in older (&gt;60y) with longer duration (&gt;60 min) of surgery, and larger amount of prostatic tissue (&gt;20gm) resection.

Bipolar vs Monopolar Transurethral Resection of the Prostate in Iraqi Patients: A Prospective Study

Bipolar vs Monopolar Transurethral Resection of the Prostate in Iraqi Patients: A Prospective Study

Evaluation of sexual function following bipolar vaporization versus monopolar transurethral resection of the prostate

Evaluation of sexual function following bipolar vaporization versus monopolar transurethral resection of the prostate

Comparison of Bipolar and Monopolar Transurethral Resection of Bladder Tumours: A Randomised Clinical Study

Introduction: The standard treatment of Urinary Bladder Cancer (UBC) is Transurethral Resection of Bladder Tumours (TURBT) commonly using a monopolar resection system. Bipolar-TURBT (B-TURBT) is associated with better haemostasis than MonopolarTURBT (M-TURBT). Despite this, there exists controversy whether B-TURBT can completely replace M-TURBT. Aim: To assess the perioperative outcomes of B-TURBT and compare it with the conventional monopolar system (M-TURBT). Materials and Methods: The present randomised clinical study was conducted at the Department of Urology of SCB Medical College, Cuttack between January 2018 and January 2020. Fifty patients of either sex, aged &gt;18 years with urinary bladder tumour size of ≤4 cm were included in the study. Patients were randomly assigned into B-TURBT and M-TURBT treatment groups. Demographic data (age and sex), morphology, location, shape, grade, stages of transitional cell carcinoma, degree of artifact were analysed and compared. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. The qualitative and quantitative variables between the groups were compared using independent sample t-test and chi-square test, respectively. A p-value&lt;0.05 was considered statistically significant. Results: A total of 50 patients with UBC were evaluated in this study where the majority of patients were male 45 (90.0%) with mean age 60.9 years. The most common morphologies were papillary tumour (28.0%), broad solid mass (22.0%), and papillary solitary (22.0%). Total 25 patients underwent M-TURBT and 25 patients underwent B-TURBT. Older patients (&gt;55 years) had a higher rate of severe artifact compared to younger patients (&lt;55 years). The B-TURBT had a significantly lower rate of artifact compared to M-TURBT (p-value &lt;0.001). The need for secondary procedure was comparatively higher in M-TURBT than in bipolar resection (p-value=0.253). The obturator jerk and bladder perforation were not observed in this study. Conclusion: The B-TURBT had a lower incidence of severe artifact and restaged TURBT as compared to M-TURBT. Thus, B-TURBT is a safer and more effective treatment for patients with UBC.

Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study.

Background: The postoperative bleeding complications associated with laser surgery of the prostate and transurethral resection of the prostate (TURP) were compared. Methods: We used the Taiwan National Health Insurance Research Database to conduct an observational population-based cohort study. All eligible patients who received transurethral procedures between January 2015 and September 2018 were enrolled. Patients who received laser surgery or TURP were matched at a ratio of 1:1 by using propensity score matching, and the association of these procedures with bleeding events was evaluated. Results: A total of 3302 patients who underwent elective transurethral procedures were included. The multivariable Cox regression analysis revealed that diode laser enucleation of the prostate (DiLEP) resulted in significantly higher emergency room risks within 90 days after surgery due to clot retention than the Monopolar transurethral resection of the prostate (M-TURP) (Hazard Ratio: 1.52; 95% Confidence Interval [CI], 1.06–2.16, p = 0.022). Moreover, GreenLight photovaporization of the prostate (PVP) (0.61; 95% CI, 0.38–1.00 p = 0.050) and thulium laser vaporesection of the prostate (ThuVARP) (0.67; 95% CI, 0.47–0.95, p = 0.024) resulted in significantly fewer rehospitalization due to clot retention than did M-TURP. No significant increase in blood clots were observed in patients using comedications and those with different demographic characteristics and comorbidities. Conclusions: Among the investigated six transurethral procedures for Benign prostatic hyperplasia, PVP and ThuVARP were safer than M-TURP because bleeding events and clot retention were less likely to occur, even in patients receiving anticoagulant or antiplatelet therapy. However, DiLEP and holmium laser enucleation of the prostate (HoLEP) did not result in fewer bleeding events than M-TURP.

SAFETY AND EFFICACY OF MONOPOLAR TRANSURETHRAL RESECTION OF PROSTATE IN LABORATORY PARAMETERS

Objective: This study aims to assess the safety and effectiveness of transurethral resection of prostate using preoperative and postoperative laboratory parameters. Material &amp; Methods: This was a retrospective study of all patients treated with transurethral resection of prostate at Karawang Hospital from January – August 2018. The laboratory parameters are measured in the preoperative and postoperative period, including haemoglobin, leucocyte, and electrolyte. The outcomes of the study were the comparison of laboratory parameters before and after monopolar transurethral resection of prostate. Results: A total of 142 patients were enrolled in this retrospective study. The mean age was 68 years. Transurethral resection of prostate was performed in all patients. The mean of preoperative level of haemoglobin was higher compared to postoperative level (13.21 gr/dL vs 12.79 gr/dL; p = 0.000). The mean preoperative level of leucocyte was higher during postoperative time compared to preoperative time (13.450 vs 7503.52 p = 0.000). The sodium level was lower postoperative than preoperative ( 137.76 vs 139.39; p = 0.000 ). The potassium level was higher preoperative than in postoperative (4.12 vs 4.02, p = 0.000 ). The logistic regression was performed and shows no significant association between prostate resected weight and length of surgery compared to laboratory parameters. There was no patient who needed blood transfusion or having electrolyte derangement. Conclusion: Based on laboratory parameters, monopolar transurethral resection of prostate is safe and effective in the treatment of benign prostate hyperplasia.

A systematic review of recorded technical settings used in bipolar and monopolar transurethral resection of bladder tumors

Abstract High-frequency (HF) surgery has been established in medicine for decades and is very popular in transurethral (minimally invasive) surgery. However, the technical settings of generators are almost exclusively based on empirical data. So far, making a well-founded statement about a possible impact of technical parameters in HF surgery is nearly impossible. Therefore, the aim of this research was to systematically review the published data for transurethral resection of bladder tumor (TURBT) to find out, whether the publications consider both sufficiently, technical parameters and physical parameters. It is shown that although technical parameters are reported, they have been insufficiently considered in analyses so far. Further analyses must be performed.

Cluster Analysis Assessment in Proposing a Surgical Technique for Benign Prostatic Enlargement.

Benign prostatic enlargement (BPE) is a common disease in men over 50 years old. The phenotype of patients with BPE is heterogenous, regarding both baseline patient characteristics and disease-related parameters. Treatment can be either medical-conservative or surgical. A great variety of surgical techniques are available for surgical management, with three of the most common being monopolar transurethral resection of the prostate (mTUR-P), bipolar transurethral resection of the prostate (bTUR-P), and bipolar transurethral vaporization of the prostate (bTUVis). The selection of each one of these depends on surgeon reasoning, equipment availability, patient characteristics, and preferences. Since all of these techniques are available in our Urology Department, and surgeons are skilled to perform each one of them, we performed a clustering analysis according to patient pre-operative characteristics, using the k-means algorithm, to compare clustering-related technique assignment with the real-life technique used.

Assessing the Complications of Monopolar Transurethral Resection of the Prostate (M-TURP) Using Clavien-Dindo Complications Grading System.

Benign prostatic hyperplasia (BPH) is one of the most common diseases of ageing men, which increase starting from age 40. Monopolar transurethral resection of the prostate (M-TURP) is the gold standard surgical treatment for BPH between 30 to 80cc. This study is designed to assess complications of TURP based on the Clavien-Dindo post-op complication grading system. A descriptive prospective study of prevalence of complications of M-TURP from May1, 2019 to April 30, 2021 in Tikur Anbessa Specialized Hospital. In this study, 174 patients were assessed pre-operatively, intra-operatively and post-operatively. All BPH patients with bothersome LUTS, bladder stone, recurrent UTI, recurrent acute urinary retention (AUR), renal insufficiency, or failed medical therapy had undergone TURP. We collected it by revising patient's icare/charts and cell phone call. About 174 patients were studied with mean age were 63 years. Intra op complications were noticed in seventeen (9.8%) patients, the most common one was prostate capsule perforation seen in 9 (5.2%) cases followed by severe bleeding in 3(1.7%) patients which needs transfusion and urethral injury. Urinary tract infections developed in eleven (7.8%) of patients. Bulbar urethral stricture and bladder neck contracture developed in 9 (5.2%) and 3 (1.7%) patients each, respectively. Re TURP was done for 7 (4%) of patients. In this study, the overall complication rate of TURP with Clavien-Dindo grading system was 29.3%. Around 96% of the complications were Clavien-Dindo grade I, II and III; managed conservatively or with minimally invasive surgery. This shows M-TURP is a relatively safe procedure.

Transurethral Resection of Prostate Without Traction: A Retrospective Observational Study

Introduction: Application of traction after monopolar transurethral resection of prostate (TURP) is a common practice that causes significant discomfort to the patients. So can we avoid the morbidity of traction in a selected group of the patient where there is no significant hematuria after TURP? Hence we did a retrospective observational study to look for feasibility and safety of traction less TURP.&#x0D; Methods: It is a retrospective observational study conducted in the Department of Urology, Manipal Teaching Hospital from August 2018 to August 2020 in patients who underwent traction less TURP. There was a total of 64 patients who fulfilled the inclusion criteria. All the demographic profiles, preoperative investigations, and perioperative parameters were noted. Postoperatively requirement of reapplication of traction, bladder washes, and application of tranexamic acid for hematuria, clot retention, and blood transfusion were noted. Statistical analysis was done by SPSS version 25.&#x0D; Result: Mean age and prostate size were 71 yrs. and 52 g. Sixteen(25%) patients were on antiplatelet therapy, fourteen(21%) patients had a catheter in situ and 34(53%) patients were on anti-BPH (Benign Prostatic Hyperplasia) medication. There were no patients who require re- traction, bladder washes, or application of intravenous tranexamic acid. There was one (1.56%) patient who had clot retention requiring evacuation and blood transfusion. VAS score after 8 hrs. and 12hrs. was 3.22 and 1.73. Mean hemoglobin fall was 0.81 g%.&#x0D; Conclusion: Traction after monopolar TURP can be safely omitted in carefully operated patients but traction should be reserved for those patients with continuous hematuria.&#x0D;

Can tranexamic acid in irrigation fluid reduce blood loss during monopolar transurethral resection of the prostate? A randomised controlled trial

ABSTRACT Objective To assess the efficacity and safety of using tranexamic acid (TXA) in the irrigation solution during transurethral resection of the prostate (TURP). Patients and Methods A total of 50 patients undergoing TURP for benign prostatic hyperplasia were prospectively randomised in a controlled clinical trial and distributed into two groups. Group A received 0.1% TXA 1000 mg (10 mL) in 1 L of irrigation solution of sterile wash (glycine) during surgery, while Group B received 10 mL distilled water (placebo) in 1 L of irrigation solution of sterile wash (glycine) during surgery. At the end of surgery, a three-way catheter was inserted in the bladder. Group A received local 500 mg of TXA (5 mL), which was dissolved in 100 mL of normal saline solution, while Group B received distilled water (5 mL) dissolved in 100 mL of normal saline solution after which the catheter was clamped. The serum haemoglobin (Hb) concentration, haematocrit (HCT), blood loss volume, Hb concentration in the irrigation fluid, and bladder irrigation volumes were compared between the two groups at three time-points: preoperatively and at 4- and 24-h postoperatively. Coagulation function, complications, thromboembolic events, quality of endoscopic view, surgery duration, and hospital stay were also noted. Results Group A had significantly lower blood loss intraoperatively, and at 4- and 24-h postoperatively compared to the control group (P < 0.05). The serum Hb concentration, HCT, Hb concentration in the irrigation fluid, and bladder irrigation volumes were significantly lower in the TXA group vs the control group (P < 0.001). The shortening of the surgery duration and improvement in the quality of the endoscopic view were significantly noted in the TXA group (P = 0.001). However, no thromboembolic events occurred in either group. Conclusion The use of TXA in the irrigation fluid during TURP and injection into the bladder postoperatively can reduce blood loss and the need for blood transfusion without increasing the risk of thrombosis.

Is bipolar superior to monopolar energy for transurethral resection of bladder tumors?

ObjectivesTo compare bipolar transurethral resection of bladder tumor (B-TURBT) and monopolar transurethral resection of bladder tumor (M-TURBT) in terms of its perioperative clinical and pathological outcomes.BackgroundBladder cancer is the seventh most diagnosed cancer in the male population worldwide. TURBT is considered the initial treatment and the only method to provide specimens for tumor staging and grading.Patients and methodsThis study was conducted at the Urology Department at Menoufia University Hospital during the period of study from April 2018 and April 2020. After consent, newly diagnosed bladder tumor patients who were planned for TURBT at Menoufia University were randomized into two equal groups: B-TURBT and M-TURBT. All patients were evaluated through careful history, physical examination, routine laboratory investigations, ultrasonography, and contrast-enhanced computed tomography. All specimens were examined by a uropathologist who was blinded to the type of energy used.ResultsThere were no statistically significant differences between both groups regarding patients' characteristics, obturator jerk, bladder perforation, completed resection of the tumor, and serum sodium drop. Bipolar resection group showed significantly shorter resection time (P = 0.009), less hemoglobin drop (P = 0.001), less catheterization time (P = 0.044), and less hospitalization time (P = 0.012). Grade 3 tissue artifact on histopathological examination was 16.6 and 23.5% in bipolar and monopolar groups, respectively, with no statistically significant difference.ConclusionBipolar energy in TURBT is a safe and effective modality as the monopolar one. Bipolar resection is superior to the monopolar one in shortening the resection time, hospital stay and catheterization time and less hemoglobin drop. Both techniques have comparable effects on tissue biopsy, other operative data, and perioperative complications.

Monopolar Transurethral Resection of the Prostate Versus Holmium Laser Enucleation in Men with Prostate Volume Greater than 100 mL

Purpose: The surgical treatment for severe benign prostatic hyperplasia is challenging. The aim of our study was to compare the safety and efficacy of monopolar transurethral resection of the prostate (M-TURP) and holmium laser enucleation of the prostate (HOLEP) for prostate size &gt;100 ml. Materials and Methods: We retrospectively evaluated our database of two groups of patients. Thirteen patients underwent M-TURP (group 1), and 27 underwent HOLEP (group 2). Results: The mean prostate size was 163.1 ± 49.0 ml in group 1 and 143.4 ± 40.9 ml in group 2 (P = 0.19). There was no significant difference in resected tissue volume, days of catheter removal, admission days, and postoperative serum hemoglobin between treatment groups. However, in group 1, mean postoperative serum sodium dropped from 137.1 mmol/L to 131.4 mmol/L, which was significantly lower than postoperative serum sodium in group 2 (P &lt; 0.0001). There were more complications in group 1 than group 2, especially for patients undergoing transfusion (76.9% in group 1 and 22.2% in group 2) and with hyponatremia (15.4% in group 1 and 0% in group 2). At 3-month follow-up, the international prostate symptom score, quality of life score, and residual urine volume revealed no significant differences between groups. Conclusion: M-TURP and HOLEP in men with prostate volume greater 100 ml had similar operative time, admission days and postoperative functional outcomes. However, higher transfusion rates and postoperative hyponatremia were noted in the M-TURP group comparing to the HOLEP group.