Five-Year Follow-Up Results of a Randomized Controlled Trial Comparing Bipolar Plasmakinetic and Monopolar Transurethral Resection of the Prostate

Abstract

PurposeTo report the 5-year follow-up results of a randomized controlled trial comparing bipolar transurethral resection of the prostate (TURP) with standard monopolar TURP for the treatment of benign prostatic obstruction (BPO).Materials and MethodsA total of 220 patients were randomized to bipolar plasmakinetic TURP (PK-TURP) or monopolar TURP (M-TURP). Catheterization time was the primary endpoint of this study. Secondary outcomes included operation time, hospital stay, as well as decline in postoperative serum sodium and hemoglobin levels. All patients were assessed preoperatively and followed-up at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Parameters assessed included quality of life, transrectal ultrasound, serum prostate-specific antigen level, postvoid residual urine volume, maximum urinary flow rates (Qmax), and International Prostate Symptom Score. Patient baseline characteristics, perioperative data including complications, and postoperative outcomes were compared. Complication occurrence was graded according to the modified Clavien classification system.ResultsPK-TURP was significantly superior to M-TURP in terms of operation time, intraoperative irrigation volume, resected tissue weight, decreases in hemoglobin and sodium, postoperative irrigation volume and time, catheterization time, and hospital stay. At 5 years postoperatively, efficacy was comparable between arms. No differences were detected in safety outcomes except that the clot retention rate was significantly greater after M-TURP.ConclusionOur results indicate that PK-TURP is equally as effective in the treatment of BPO, but has a more favorable safety profile in comparison to M-TURP. The clinical efficacy of PK-TURP is long-lasting and comparable with M-TURP.

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

“…The combined search strategies identified 31 trials [9][10][11][12][13][14][15][16][17][18][19][20][21][22][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] that included 3,669 patients who met the inclusion criteria. All the studies were RCTs, and almost all were reported in English, except for one in Korean 32 and one in Chinese.…”

“…This is an important advantage because all issues relating to hypotonic/ hyposmolar fluid irrigation (dilutional hyponatremia, TUR syndrome) have been eliminated. 42 Twenty-four studies 9,10,[13][14][15][16]18,19,21,22,[25][26][27][29][30][31][32][33][34][36][37][38][39][40] investigated transurethral resection for TUR syndrome ( Fig. 2; risk difference 0.02; 95% CI, 0.01-0.03; P = 0.0004).…”

“…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.…”

Outcome analysis of transurethral resection versus potassium titanyl phosphate-photo selective vaporization of the prostate for the treatment of benign prostatic hyperplasia; a randomized controlled trial with 4 years follow up

“…The International Prostate Symptoms Score (IPSS) and Q max were not available in patients (11 in TURP and 8 in KTP groups) who initially presented with urinary retention. According to American Urological Association (AUA) guidelines, BPH symptom score have been divided into three groups, ie mild (1-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)) and severe (20-35). IPSS scoring system includes AUA symptom, and Quality of life scores.…”

Surgical management of benign prostatic hyperplasia

“…Zbog ovog se može koristiti fiziološka otopina, a time se izbjegava nastanak TUR sindroma. Istraži-vanja koja su uspoređivala dugoročne rezultate i efikasnost oba zahvata pokazale su da su jednako uspješni 15,16 . Što se tiče perioperacijskih komplikacija, bipolarni TURP se po tome pokazao nešto sigurnijim jer uzrokuje manje TUR sindroma i tamponada mokraćnog mjehura uz kraću kateterizaciju 17 .…”