Transurethral resection of prostate: a comparison of standard monopolar versus bipolar saline resection

Abstract

Introduction: Transurethral resection syndrome is an uncommon but potentially life threatening complication. Various irrigating solutions have been used, normal saline being the most physiological. The recent availability of bipolar cautery has permitted the use of normal saline irrigation. Material and Methods: In a randomized prospective study, we compared the safety and efficacy of bipolar cautery (using 0.9% normal saline irrigation) versus conventional monopolar cautery (using 1.5% glycine irrigation). Pre and postoperative hemoglobin (Hb) and hematocrit values were compared. Hemodynamics and arterial oxygen saturation were monitored throughout the study. Safety end points were changes in serum electrolytes, osmolarity and Hb/PCV (packed cell volume). Efficacy parameters were the International Prostate Symptom Score (IPSS) and Qmax (maximum flow rate in mL/sec) values. Results: Mean preoperative prostate size on ultrasound was 60 ± 20cc. Mean resected weight was 17.6 ± 10.8 g (glycine) and 18.66 ± 12.1 g (saline). Mean resection time was 56.76 ± 14.51 min (glycine) and 55.1 ± 13.3 min (saline). The monopolar glycine group showed a greater decline in serum sodium and osmolarity (4.12 meq/L and 5.14 mosmol/L) compared to the bipolar saline group (1.25 meq/L and 0.43 mosmol/L). However, this was not considered statistically significant. The monopolar glycine group showed a statistically significant decline in Hb and PCV (0.97 gm %, 2.83, p < 0.005) as compared to the bipolar saline group (0.55 gm % and 1.62, p < 0.05). Patient follow-up (1,3,6 and 12 months postoperatively) demonstrated an improvement in IPSS and Qmax in both the groups. Conclusion: We concluded that bipolar transurethral resection of prostate is clinically comparable to monopolar transurethral resection of prostate with an improved safety profile. However, larger number of patients with longer follow up is essential.

Bipolar Transurethral Resection Versus Monopolar Transurethral Resection for Benign Prostatic Hypertrophy: A Systematic Review and Meta-Analysis

“…8 In recent years (2009-2013), a number of new RCTs, including multicenter and international studies, have been published. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] Therefore, it is necessary to conduct a new systematic review and metaanalysis of RCTs that assesses the efficacy and safety (primary outcomes) of M-TURP and B-TURP in patients with BPO.…”

Bipolar Versus Monopolar Transurethral Resection of Prostate - A Prospective Randomised Study

“…He explained use of non-haemolytic hypoosmolar fluid like glycine has entirely reduced the incidence of TUR syndrome in monopolar TURP cases. Singhania et al (7) in his study had greater decline in serum sodium (4.12 mEq/L) compared to bipolar saline group (1.3 mEq/L); however, this is not statistically significant. He explained that osmolality of the absorbed irrigant is equally responsible for the development of TUR syndrome and not only serum sodium level.…”

“…Patankar et al (11) in his study found significant blood loss among patients undergoing monopolar TURP (282.67 mL) as compared to those undergoing bipolar TURP (140.6 mL). Singhania et al (7) in his study showed statistically significant haemoglobin drop (0.97 gm%, p value < 0.005) as compared to bipolar group which showed small drop in haemoglobin (0.55 gm%, p value = 0.014).…”

“…Singhania et al (7) in his study had 19.8 litre mean irrigation used in monopolar group and 18.6 litre in bipolar group. He explained a better coagulation and clearer operative field with bipolar resectoscope.…”

“…The mean age of the patients grouped in monopolar and bipolar are 69.08 and 68.92 years respectively (Table 2), which corresponds to the findings noted by various authors. (6,7,8,9,10) The mean prostate size of the patients in monopolar group is 52.12 gm and in bipolar group is 50.2 gm (Table 3a). Fagerstrom et al (9) and Singhania et al (7) in their study had mean prostate size of 58.2 gm and 55.86 gm respectively in monopolar group and 55.6 gm and 59.23 gm respectively in their bipolar group.…”