A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications

Abstract

Objective: To generate high-quality data comparing the clinical effi cacy and safety profi le between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment effi cacy evaluated at 1, 3, 6 and 12 months. Effi cacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary fl ow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualifi ed for the analysis (45 M-TURP/39 PK-TURP). No signifi cant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadadscale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not signifi cant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.

Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis

“…However, other potential risk factors such as PSA density, PSA velocity, or underlying diseases could not be investigated due to the limited data obtained from the included studies. Nevertheless, one previous research indicated that higher preoperative PSA density and velocity, preoperative treatment with 5-alpha reductase inhibitors, and diabetes was identified to have a significant correlation with the diagnosis of IPC after surgery for BPH (41)(42)(43)(44). Future study regarding more important risk factors of IPC with sufficient data are still needed for early screening and identification of IPC patients.…”

Bipolar transurethral resection of large prostate >100 gm: single center experience

“…16 Furthermore, urinary tract infection is a common perioperative complication following TURP that may occur in 1.7-8.2% of patients; however, two patients (25%) in this case series reported UTI. [17][18][19] Moreover, urethral stricture may occur following TURP because of the large resectoscope sheath, which may cause urethral ischemia and/or trauma. 17 In this setting, one patient developed urethral stenosis 12 months after the surgery that was managed by optical urethrotomy.…”

Proper Use of the International Index of Erectile Function 5 (IIEF-5) Questionnaire in Patients Undergoing Transurethral Resection of the Prostate (TURP)

“…The study population was retrieved from NCT03936244 randomized clinical trial (RCT), which included men diagnosed with lower urinary tract symptoms (LUTS) in a tertiary-care public institution who required surgical treatment and were randomly allocated to monopolar or plasmakinetic TURP. Additional details on the trial are available in the original publication [7,8].…”

“…IIEF-5 questionnaire scores (Supplementary Table 1) were recorded for all patients at baseline and 1, 3, 6, and 12 months postoperatively [7]. Two additional questions were included at every period: one to capture sexual activity as self-reported by patients (a yes/no question); and another one to capture the reason for sexual inactivity as reported by the patients [possible answers were either "Inability to penetrate (enter) the partner due to penile flaccidity" or "Other causes (e.g., lack of sexual desire, lack of a sexual partner, etc.)"].…”