Bipolar versus Monopolar TURP: A Prospective Controlled Study at two Urology Centers

DS Engeler; C Schwab; M Neyer; T Grün; A Reissigl; H-P Schmid

Disclosures

Prostate Cancer Prostatic Dis. 2010;13(3):285–291 

In This Article

Abstract and Introduction

Abstract

We compared bipolar and monopolar TURP in a prospective controlled study at two urology centers. The objective of the study was to establish whether there were differences between the two methods with regard to frequency of the transurethral resection (TUR) syndrome, amount of fluid absorbed during surgery, risk of hemorrhage, duration of postoperative catheterization and duration of hospitalization. The duration of surgery, improvement in maximum flow rate (Q-max), residual urine volume, International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score were also compared. Overall, our study showed that there were no major differences between bipolar and monopolar TURP. During follow-up, the clinical efficacy of bipolar TURP has been maintained to the same degree as with the traditional method, with no significant differences for Q-max, IPSS and QoL scores after 1 year. Although the risk of developing TUR syndrome seemed to be smaller with bipolar resection (serum sodium change bipolar versus monopolar: +1.2 versus −0.1 mmol l−1), the bleeding tendency with both methods was the same (14.0 g l−1 hemoglobin loss after 1 day in both groups). On the basis of our findings, we think that the monopolar technique has still a place in TURP.

Introduction

As men get older, they frequently complain of lower urinary tract symptoms, usually caused by benign prostate syndrome. Monopolar TURP is still the standard surgical approach in benign prostate syndrome, and has excellent results with regard to subjective and objective symptoms.[1–3]

Advances in technology and methods over the years have considerably improved the safety profile of TURP, both in terms of surgery and anesthesia. Despite these, TURP is still associated with the risk of heavy intraoperative bleeding and disturbances in the electrolyte metabolism (transurethral resection (TUR) syndrome) from absorption of large amounts of irrigation fluid.[4] Various attempts have been made to reduce the morbidity related to surgery, with different degrees of success.

The present prospective, controlled study compared bipolar and monopolar TURP. The aim of the study was to establish whether the two methods differed with regard to frequency of TUR syndrome, absorption of irrigation fluid during surgery, risk of hemorrhage, duration of postoperative catheterization and duration of hospitalization. The duration of surgery, improvement in maximum flow rate (Q-max), residual urine volume, International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were also compared.

The Gyrus Plasmakinetic Superpulse System (Gyrus Medical, Tuttlingen, Germany) has already been reported on several times.[5,6] It consists of a 17 mm-long, gold-plated, crescent-shaped cutting tool, with no major differences from the standard monopolar instruments. The diameter of the bipolar resection loop is, however, a little smaller than that of the conventional monopolar instrument. The positive and negative poles are on the same axis and are isolated from each other by a ceramic connecting piece.[7] The Plasmakinetic Generator (Gyrus Medical) generates strong, pulsatile, bipolar energy, which generates the working temperature on the cutting tool, permitting maximum tissue dissection with minimum collateral damage. In addition to allowing effective cutting, it has been constructed to achieve optimum hemostasis and prevent adherence to the tissue. Only a small proportion of the energy applied leads to tissue vaporization, which means that the tissue remains for histological analysis, as with monopolar TURP. One principal advantage of the bipolar instrument is that it is possible to use normal saline solution (NaCl 0.9%) as irrigating fluid. The absence of reverse current is intended to decrease the risk of burns and subsequent stricture formation.[8,9]

Studies already published have described advantages of bipolar resection with regard to the frequency of the TUR syndrome,[1,2,10–13] intraoperative absorption of fluid, risk of hemorrhage,[14] duration of postoperative indwelling catheter irrigation, duration of catheterization and duration of hospitalization.[2,9,11,15] The duration of surgery, improvement in Q-max, residual urine volume, IPSS and QoL score have, however, been reported as similar to the monopolar approach.[12,14]

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