Monopolar Transurethral Resection Research Articles

Holmium laser enucleation of the prostate vs monopolar transurethral resection of the prostate in management of benign prostatic hyperplasia

Objective The aim was to compare the efficacy, safety, and cost-effectiveness of holmium laser enucleation of the prostate (HoLEP) vs monopolar transurethral resection of the prostate (TURP) in the management of benign prostatic hyperplasia. Materials and methods Between February 2018 and February 2020, 70 patients who underwent surgical treatment for benign prostatic hyperplasia were randomized into two equal groups, representing HoLEP and monopolar TURP. All the patients were assessed preoperatively and followed up for 12 months postoperatively. The primary preoperative and postoperative parameters were the international prostate symptom score (IPSS) and maximum urine flow rate (Qmax), whereas the secondary parameters were operative time, resected volume, postoperative drop in hemoglobin level, postoperative change in sodium level, postoperative catheterization time, duration of hospital stay, and postvoiding residual urine. All complications were recorded. Cost analysis was evaluated. Results A total of 60 patients (30 HoLEP and 30 TURP) of the initial 70 patients completed our study. Mean baseline prostate sizes were similar in both groups. HoLEP group had longer operative time of 80 min compared with 60 min in the TURP group. HoLEP was associated with shorter postoperative catheter time and hospital stay compared with those of TURP group. There were no statistically significant differences between both groups regarding perioperative parameters such as resected volume, hemoglobin drop, and sodium level drop. Moreover, postoperative international prostate symptom score, Qmax, postvoiding residual urine, prostatic specific antigen, and quality of life were comparable in both groups. There was no statistically significant difference between both groups regarding postoperative complications. Regarding cost analysis, HoLEP was more cost-effective than TURP. Conclusion Both HoLEP and monopolar TURP are safe and effective. However, HoLEP has shorter catheterization time and hospital stay and was more cost-effectiveness but had longer operative time than monopolar TURP.

Does finasteride affect blood loss during monopolar transurethral resection of the prostate?

Objectives To evaluate the effect of preoperative finasteride on the surgical blood loss during monopolar transurethral resection of the prostate (TURP). BackgroundBenign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms in elder men. Prophylactic measures have been employed to reduce perioperative bleeding, including preoperative 5α-reductase inhibitors administration. Finasteride and dutasteride can block the conversion of testosterone to dihydrotestosterone and have been used to treat BPH and BPH-related hematuria.Patients and methodsWe conducted a randomized controlled study at the Urology Department of Menoufia University Hospital, comparing the preoperative use of finasteride 5 mg over the intraoperative bleeding during TURP. A total of 90 patients with BPH with prostate size varying between 40 and 90 g assigned for a monopolar TURP surgery were randomly allocated into three groups: the first group as control, the second group used finasteride 5 mg for 2 weeks before surgery, and the third group used finasteride 5 mg for 4 weeks before surgery.ResultsThere was an insignificant difference between the three groups regarding age or associated comorbidities. Calculated blood loss was lower for the second and third groups in comparison with the control one (P = 0.046).ConclusionResults of our study elicit that treatment with finasteride for even 2 weeks before surgery significantly reduces surgical bleeding.

Systematic review and meta-analysis on bipolar versus monopolar transurethral resection of bladder tumors.

BackgroundTransurethral resection of bladder tumour (TURB) is the initial and crucial step in the management of non-muscle invasive bladder cancer (NMIBC), having both diagnostic and therapeutic role. For many years, the gold standard for TURB was monopolar TURB (mTURB), however, it is associated with several complications related to its technical details. To overcome limitations of mTURB, TURB using bipolar technology (bTURB) has been developed. So far, making unequivocal statement about definitive advantage of bTURB over mTURB was difficult. The aim of this study was to systematically evaluate and compare the efficacy and safety of bTURB with mTURB.MethodsA systematic search was conducted independently by two authors on the 4 electronic databases, including PubMed, Scopus, Embase and Cochrane Library, according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Nine comparative prospective studies with randomization (8 RCTs and 1 post-hoc analysis of RCT) were eligible to be included in this meta-analysisResultsAfter extraction, data were pooled to conduct the meta-analysis. The following outcomes were analysed: operation time, catheterization time, length of hospital stay, decrease in postoperative haemoglobin level, obturator nerve reflex rate, bladder perforation rate, transfusion rate, TUR syndrome rate, one year recurrence rate, failures of detrusor muscle detection. bTURB was associated with decreased operation and hospitalization time. There were no statistically significant differences between bTURB and mTURB in terms of catheterization time, decrease in haemoglobin level, postoperative complications rates, recurrence rates and pathologic outcomes.ConclusionsThis meta-analysis corroborates that bTURB shows significant advantage over mTURB in terms of operation and hospitalization time while other outcomes are comparable.

Актуальные аспекты применения тулиевого лазера как перспективного метода в лечении гиперплазии предстательной железы

Lower urinary tract symptoms caused by benign prostatic hyperplasia are the most widespread and frequent urological problem among men, affecting about a third of the male population of Russia over 50 years of age. Surgical intervention is the most effective method of treating benign prostatic hyperplasia, and about 75,000 surgical interventions are performed annually in Russia. Today, of all available surgical treatments, monopolar transurethral resection of the prostate (TURP), in which enlarged prostate tissue is resected with a monopolar electrode, has been the preferred surgical method since the 1970s. This method of therapy can significantly improve the maximum urinary flow rate (Qmax), reduce obstructive symptoms assessed on the basis of the international questionnaire on the severity (IPSS) and improve the quality of life of patients. However, monopolar TURP is a rather risky procedure due to the possibility of developing serious complications such as massive bleeding or TURP syndrome (water intoxication syndrome of the body). Consequently, practicing urologists all over the world are faced with the urgent task of developing minimally invasive surgical methods of treatment, the results of which would be at least similar to those after monopolar TURP, while with fewer intra- and postoperative complications, side effects and a shorter recovery period for the patient.

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.

Safety and Efficacy of Bipolar vs Monopolar Transurethral Resection of Bladder Tumor- A Randomized Controlled Trial

Monopolar Transurethral resection of bladder tumor (TURBT) has been a gold standard for bladder tumor. Initial studies of bipolar TURBT were promising, however, no high level evidence exists and its exact role remains undefined. We compared the safety and efficacy of bipolar and monopolar TURBT. Primary objective was to compare the incidence of obturator jerk. The secondary objectives included the comparison of decrease in hemoglobin, recoagulation and transfusion requirements, bladder perforation, decrease in sodium, resection syndrome and resection time, hospital stay, detrusor muscle identification and severe cautery artifact in resected specimen in two groups. A randomized control trial was conducted for one year. All patients undergoing TURBT for suspected bladder tumors were eligible. Patient’s refusal to participate, unfitness for spinal anesthesia and lack of tumor in lateral wall were excluded. Of the 118 TURBT done during study period, 48 were excluded and 70 patients, 36 in monopolar and 34 in bipolar arms, were analyzed. The incidence of obturator jerk was less in bipolar arm but not significantly different (26.4% vs. 47.2%, p=0.073). There was no significance difference in most of the secondary outcomes except lesser hemoglobin drop (0.49gm/dl vs. 0.98gm/dl, p=0.016) and lesser resection time in bipolar arm (33.0 mins vs. 46.8mins, p=0.008). Bipolar was not different to monopolar TURBT with respect obturator jerk and most of the secondary outcomes. However, with bipolar TURBT, there was significantly less resection time and although hemoglobin drop was less as well, it was not clinically significant.

Monopolar trans-urethral resection of prostate: our initial experience in a new African hospital with few resources

Background: Diseases of the prostate including benign prostate hyperplasia constitute a significant portion of cases that are routinely managed by urologists worldwide. Where there is need for surgical intervention of clinical BPH, monopolar trans-urethral resection of prostate is a gold standard surgical option. The objective of our study is to describe and share our initial experience of monopolar TURP in our new African hospital with few resources, a stepping stone for future comprehensive research on TURP and urology capacity building.Methods: Retrospective study of twelve patients who had M-TURP using sterile distilled water as irrigation fluid over one year period, at Yobe State University teaching hospital, a new hospital in North-Eastern Nigeria. Data related to the TURP were extracted from the patients’ folders and operation theatre register, and then analyzed.Results: The mean age of patients was 67.4 years, recurrent urine retention was the commonest indication for M-TURP (50.0%), preoperative mean volume of prostate was 45.8 ml , mean duration of surgery was 63.8 minutes and mean weight resected prostatic chips was 18.4 grams. There was low complication rate (16.7%).Conclusions: M-TURP using sterile water as irrigation fluid is efficacious, reliable and pocket-friendly surgical option for our patients that needed surgery for clinical BPH. Patient selection and minimizing the time spent on M-TURP are of paramount importance in avoiding or reducing the risk of complications as observed in our study.

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

Surgical treatment of benign prostatic obstruction (BPO) in patients under anticoagulation: areview of the bleeding risks of established techniques

HintergrundBei einer alternden Gesellschaft ist mit einer Zunahme der therapiebedürftigen benignen Prostataobstruktion (BPO) zu rechnen, auch der Anteil an Patienten mit kardiovaskulären Komorbiditäten unter Antikoagulation steigt an. Hier kann die operative Therapie der BPO problematisch sein. Die blutstillende Wirkung der Techniken ist von besonderer Bedeutung.FragestellungDie folgende Übersichtsarbeit diskutiert die Datenlage zum Blutungsrisiko etablierter operativer Techniken und die Stellungnahme der EAU-Leitlinie „EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract symptoms (LUTS) incl. Benign Prostatic Obstruction (BPO)“ zu diesem Thema.Material und MethodenEs wurde eine Datenanalyse aus PubMed erstellt.ErgebnisseDie EAU-Leitlinie gibt der transurethralen Vaporisation der Prostata mittels Greenlight‑, Thulium- oder Diodenlaser und der Enukleation mittels Holmium- oder Thuliumlaser bei diesem Patientengut den Vorzug. Die bipolare ist der monopolaren transurethralen Resektion der Prostata (TURP) bei der Blutstillung überlegen. Die bipolare Enukleation der Prostata (BipoLEP) kann bei guter Hämostase zukünftig eine Alternative darstellen. Neuere minimal-invasive Techniken wie Urolift® (NeoTract, Pleasanton, USA), I‑TIND© (MediTate, Or-Akiva, Israel) und Rezūm™ (Boston Scientific, Boston, USA) zeigen ein geringes Blutungsrisiko, dies gilt auch für die Prostataarterienembolisation. Nicht geeignet erscheint die Aquaablation/AquaBeam® bei häufigen Nachblutungen. Die chirurgische Adenomektomie kann mit hoher Blutungsgefahr verbunden sein.SchlussfolgerungTransurethrale Laservaporisation und -enukleation der Prostata sind die Therapie der Wahl beim antikoagulierten Patienten, jedoch haben auch andere transurethrale Techniken, wie die BipoLEP, ein akzeptables Blutungsrisiko und können je nach lokalen Ressourcen eine Alternative darstellen. Neuere minimal-invasive Ansätze können zukünftig mehr an Bedeutung gewinnen.

Efficacy and Safety of Monopolar Transurethral Resection of the Prostate on Bleeding Control in the Treatment of Benign Prostatic Obstruction: Is It Still a Good Option in Developing Countries?

Efficacy and Safety of Monopolar Transurethral Resection of the Prostate on Bleeding Control in the Treatment of Benign Prostatic Obstruction: Is It Still a Good Option in Developing Countries?

Monopolar versus bipolar transurethral resection of bladder tumors: An updated systematic review and meta-analysis of existing studies.

Background:To compare the efficacy and safety of bipolar and monopolar transurethral resection of bladder tumors (TURBT) in non-muscle invasive bladder cancer (NMIBC) treatment.Methods:This protocol established in this study has been reported following the preferred reporting items for systematic review and meta-analysis protocols. Web of Science, PubMed, EMBASE, and the Cochrane Library were searched for all randomized controlled trials comparing bipolar TURBT and monopolar TURBT in NMIBC treatment until 31st of June 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The odds ratio and 95% confidence intervals of were used as effect estimate. I-square (I2) test, substantial heterogeneity, sensitivity analysis, and publication bias assessment will be performed accordingly. Stata 15.0 and Review Manger 5.3 are used for meta-analysis and systematic review.Results:The results will be published in a peer-reviewed journal.Conclusion:The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide helpful evidence of the efficacy and safety of bipolar and monopolar transurethral resection of TURBT in NMIBC treatment.PROSPERO registration number:CRD42020151997

PT317 - Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction: A Cochrane systematic review and meta-analysis

PT317 - Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction: A Cochrane systematic review and meta-analysis

PT320 - A randomized trial comparing high power Thulium laser vaporization versus monopolar transurethral resection of the prostate for treatment of small to moderate sized benign prostatic obstruction: A preliminary report

PT320 - A randomized trial comparing high power Thulium laser vaporization versus monopolar transurethral resection of the prostate for treatment of small to moderate sized benign prostatic obstruction: A preliminary report

The Obturator Nerve Reflex after Thulium Laser vs. Monopolar Transurethral Resection of Bladder Tumors: A Randomized Clinical trial.

Obturator nerve reflex is the surgery treatment side effect in patients with bladder cancers. This study was run to determine the obturator nerve reflex by Thulium laser versus monopolar Transurethral Resection of Bladder Tumors (TURBT). After receiving the approval code IRCT20190624043991N4, one hundred and eightynine patients with bladder tumors from 2010 to 2016 were assessed, and among them, 35 patients were randomly assigned into two groups in a blinded manner; the first group (16 patients) received thulium laser and the second group (19 patients) were patients undergoing monopolar transurethral resection of bladder tumor after spinal analgesia. Clinical data, including different variables such as; age, tumor characteristics, gender, operation duration, types of leg jerking, and intraoperative complications, were recorded. The site of the obturator nerve was determined by nerve stimulation, anatomical landmarks, and ultrasonography. Leg jerking was compared in both groups. Of the 35 patients, 28 cases were male, and 7 points were female. The mean ± SD (range) of age was 62.0 ± 6.9 (40-75) years in the Thulium laser group and 64.0 ± 7.1 (41-77) years in the monopolar TURBT group. The mean operation time was not different between the two groups significantly (P > 0.05). Leg jerking was reported in 25% and 63.1% of the patients in Thulium laser and monopolar TURBT groups, respectively (P < 0.05). Thulium laser is a more feasible and effective method to prevent leg jerking in patients with bladder cancer; so, it is recommended more than monopolar Transurethral.

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.

Usefulness of non-invasive cardiac output monitoring in elderly patients undergoing monopolar transurethral resection of the prostate: a pilot study.

ObjectiveTo assess the impact of irrigating fluid on hemodynamic profiles using real-time non-invasive cardiac output monitoring (NICOM) in elderly patients undergoing monopolar transurethral resection of the prostate (TURP).MethodsTwenty patients between 65 and 80 years of age who were scheduled for monopolar TURP and received spinal anesthesia up to T10 were enrolled. Irrigating fluid (2.7% sorbitol with 0.5% mannitol solution) was used. Hemodynamic profiles including cardiac index, and stroke volume variation (SVV) using NICOM were obtained. Estimated irrigating fluid absorption was indirectly calculated.ResultsThe median amount of irrigating fluid used was 6000 mL. The median SVV was 11%, which increased to 12% at 10 minutes after initiating surgery. No significant changes in the cardiac index were observed. The estimated absorption of irrigating fluid was almost zero.ConclusionsAlthough the estimated amount of irrigating fluid that was absorbed was negligible, the increase in SVV may indicate intravascular volume depletion with diuresis resulting from mannitol in the irrigating fluid early during irrigation. Therefore, even during short irrigating times, intensive hemodynamic monitoring should be performed to monitor the possibility of intravascular volume depletion as well as volume overload, especially immediately after large amounts of irrigating fluid are used.

Comparison between Photoselective Vaporization of Prostate by Diode Laser and Monopolar Transurethral Resection of Prostate in Single Center Experience

Background: Transurethral resection of prostate has been regarded as the gold standard surgical management of benign prostatic hyperplasia (BPH).With the evolution of new technologies, laser prostatectomy emerged as an alternative. Aim of the study: To compare the rate of outcome of diode laser vaporization of prostate and Transurethral Resection of Prostate in Al Diwaniya governorate. Patients and methods: From October 2017 to October 2018, forty patients with surgical indications of prostatectomy were enrolled in this study. Their ages ranged from 60-75 years with a mean age 68.6 years and prostate size ranged from 40-80 ml with a mean size 62.175 ml. Twenty patients underwent diode laser vaporization of prostate and another 20 patients underwent Transurethral Resection of Prostate. The choice based on surgeon preference and patient ability. Preoperative evaluation was done for all patients by history, physical examination and investigations. International Prostate Symptoms Score, maximum flow rate, digital rectal examination, prostate specific antigen, abdominal ultrasound, urinalysis, blood urea, s.creatinine, complete blood count were all done preoperatively. One pint of compatible fresh blood prepared. Results: The rate of significant bleeding and transfusion in diode PVP and TURP was (zero vs. 35% respectively) , in PVP and TURP the mean irrigation amount perioperatively was (10.10 vs. 33.15 pints respectively) , mean operative time was (70.80 vs. 50.00 min respectively) ,mean hospital stay was (16.03 vs. 30.09 hours respectively), mean time to urethral catheter removal was (24 vs. 81.71 hours respectively), postoperative complication rate (mainly dysuria) was (75% vs. 65% respectively), mean postoperative IPSS was (14.40 vs. 14.20 respectively) , mean postoperative Qmax was (15.45 vs. 16.30 ml/sec respectively). There was no statistical difference between both groups in regard to lowering IPSS or increment in Qmax. The mean cost was (1500 vs. 500.42 dollars) in diode PVP and TURP respectively. Conclusion: Diode laser vaporization of prostate is a good alternative to TURP with comparable results in treatment of BPH especially in patients taking anticoagulant drugs who cannot stop their medication. However, the high cost of this procedure and dysuria as a complication may prevent the common use of this technique.

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.

Safety and efficacy of bipolar versus monopolar transurethral resection of bladder tumor: a systematic review and meta-analysis.

Transurethral resection of bladder tumor is the standard of care for the management of patients with bladder mass. Primary objective of this study was to compare safety and efficacy of the two energy modalities used for TURBT (monopolar and bipolar). Systematic literature search of various electronic databases was conducted to include all the randomized studies comparing two groups. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019139987). In the present review, eight RCTs including 1147 patients were included. Resection time, hospital stay and catheter duration were significantly shorter with bipolar group. There was no significant difference in incidence of obturator reflex (OR 0.65, CI [0.35, 1.2], p = 0.17), whereas incidence of bladder perforation was significantly higher in the monopolar group (6.4% versus 3.3%, p = 0.01. However, sensitivity analysis including 3 high quality studies revealed equal incidence of bladder perforations. Need for blood transfusion was similar in the two groups but fall in hemoglobin was significantly lower in bipolar group (MD - 0.45 CI [- 0.72, - 0.18], p = 0.0009). Bipolar group was found to have significantly lower incidence of tissue artifacts due to thermal energy on pathological examination (OR 0.27 CI [0.15, 0.47], p < 0.00001). Bipolar and monopolar devices are equally safe in terms of obturator jerk and bladder perforation. Bipolar group was significantly better as compared to monopolar for hospital stay, catheter duration and fall in hemoglobin; however, the clinical relevance of most of these parameters is little.