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Porto JG, Bhatia AM, Bhat A, Suarez Arbelaez MC, Blachman-Braun R, Shah K, Malpani A, Lopategui D, Herrmann TRW, Marcovich R, Shah HN. Transurethral resection of the prostate across continents: a meta-analysis evaluating quality of gold standard in the twenty-first century. World J Urol 2025; 43:85. [PMID: 39856398 PMCID: PMC11761131 DOI: 10.1007/s00345-024-05439-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 12/31/2024] [Indexed: 01/27/2025] Open
Abstract
PURPOSE To compare outcomes of transurethral resection of the prostate (TURP) across different regions worldwide over the past two decades. METHODS A systematic review and meta-analysis of randomized clinical trials indexed to PubMed that assessed TURP. A total of 102 studies with 8,454 patients were included and grouped by continents: Europe, Asia, Africa, and Others (North America, South America, and Australia). International Prostate Symptom Score (IPSS), peak flow (Qmax), postvoid residual urine (PVR), PSA levels, prostate volume, and Sexual Health Inventory for Men scores (at 3, 12, and 36 months) were assessed, along with postoperative complications. Heterogeneity across studies was classified as low (I2 < 25%), moderate (I2 = 25-75%), or high (I2 > 75%). RESULTS TURP consistently exhibited significant enhancements in IPSS, Qmax, and PVR across various regions. Notably, PVR demonstrated high heterogeneity (I²=100%). TURP presented low complication rates with TURP syndrome (2%), bleeding (8%), and blood transfusion (6%). However, significant heterogeneity was observed, particularly for clot evacuation (I2 = 87%), irritative symptoms (I2 = 96%), and incontinence (I2 = 84%). The retreatment rates at 1 and 3 years were 5% and 7%, respectively, with significant differences across regions. CONCLUSION Global outcomes of TURP lack a discernible trend. The substantial heterogeneity observed among continents suggests a lack of standardization. Nevertheless, uniform symptomatic improvements among patients still support TURP as the gold-standard surgical treatment for benign prostatic hyperplasia, despite variations in its results worldwide.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA
| | - Ansh M Bhatia
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Abhishek Bhat
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA
| | - Maria Camila Suarez Arbelaez
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA
| | - Khushi Shah
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA
| | - Ankur Malpani
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA
| | - Diana Lopategui
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA
| | | | - Robert Marcovich
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA.
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Porto JG, Bhatia AM, Bhat A, Suarez Arbelaez MC, Blachman-Braun R, Shah K, Malpani A, Lopategui D, Herrmann TRW, Marcovich R, Shah HN. Evaluating transurethral resection of the prostate over twenty years: a systematic review and meta-analysis of randomized clinical trials. World J Urol 2024; 42:639. [PMID: 39547977 PMCID: PMC11568034 DOI: 10.1007/s00345-024-05332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 10/20/2024] [Indexed: 11/17/2024] Open
Abstract
PURPOSE The goal of this systematic review is to assess the temporal changes in outcomes and complications of transurethral resection of the prostate (TURP) from 2000 to 2022. METHODS We conducted a systematic review and meta-analysis of 103 randomized clinical trials from PubMed on TURP, involving 8521 patients. Studies were grouped by years: 2000-2004, 2005-2009, 2010-2014, and 2015-2022. We assessed International Prostate Symptom Score (IPSS), Peak Flow (Qmax), Post-void residue of urine (PVR), and post-operative complications. Heterogeneity was ranked as low (I2 < 25%), moderate (I2 = 25-75%), or high (I2 > 75%). RESULTS TURP significantly improved IPSS, Qmax, and PVR, with the most recent studies showing superior results in IPSS and Qmax after 3 years compared to 2000-2004 studies. Heterogeneity in PVR was high (I2 = 100%). No negative impact on erectile function was observed. Complication rates included TURP syndrome (2%), bleeding (8%), and blood transfusion (6%), but elevated heterogeneity with difference between the groups was seen in clot evacuation (I2 = 83%) and urinary tract infections (I2 = 82%). Other complications were urinary retention (4%), incontinence (8%), urethral stricture (3%), bladder neck stenosis (2%). CONCLUSION In the last 20 years there has not been a clear trend in the results of TURP. The found heterogeneity may indicate a lack of standardization in TURP procedures. However, symptomatic improvement among patients is uniform, which supports this procedure as a historical benchmark surgical treatment for BPH.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, USA
| | - Ansh M Bhatia
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, USA
| | - Abhishek Bhat
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, USA
| | | | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, USA
| | - Khushi Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, USA
| | - Ankur Malpani
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, USA
| | - Diana Lopategui
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, USA
| | | | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, USA.
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Akpala A, Warda A, Batson-Patel S, Bhattacharyya S, Damola A, Farag A, Manandhar A. Comparing Urethral Stricture Rates Following Bipolar and Monopolar Transurethral Resection of the Prostate: A Retrospective Study. Cureus 2024; 16:e73548. [PMID: 39669803 PMCID: PMC11637457 DOI: 10.7759/cureus.73548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2024] [Indexed: 12/14/2024] Open
Abstract
Aim The aim is to compare the incidence of urethral strictures and other complications following monopolar and bipolar transurethral resection of the prostate (TURP). Method We conducted a retrospective study to compare patients who underwent bipolar TURP with those who underwent monopolar TURP between 2017 and 2023. The collected data included demographics, age, history of urethral stricture, prostate size, operation duration, and postoperative complications, such as blood transfusion, transurethral resection (TUR) syndrome, and other relevant data points. Results The COVID-19 pandemic significantly affected the number of surgeries performed. A total of 572 patients who underwent TURP at our center during this period were identified, 302 of whom underwent monopolar TURP, and 270 underwent bipolar TURP. Bladder neck stenosis was more frequently identified in the monopolar group compared to the bipolar group (1.99% (6) vs. 0.7% (2)). In the monopolar group, 6.62% (20) of the patients had strictures compared to 4.07% (11) in the bipolar group; however, this difference is not statistically significant. The bipolar group had a higher incidence of urinary incontinence (5.6% (15) vs. 3.3% (10)), whereas the monopolar group had higher readmission rates (18.8% (57) vs. 13.7% (37)) and a higher frequency of delayed trial without catheter (TWOC) (84% (254) vs. 75.9% (205)). Conclusion We believe that our findings contribute towards resolving the debate between stricture complication rates in monopolar versus bipolar TURP. Our analysis revealed no statistically significant differences in stricture rates between the two groups. However, we noted differences in other complications, such as higher rates of urinary incontinence in the bipolar group, whereas the monopolar group had increased rates of readmission and bladder neck stenosis.
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Affiliation(s)
- Anna Akpala
- Urology, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| | - Ahmed Warda
- Urology, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| | | | | | | | - Ahmed Farag
- Urology, Kettering General Hospital, Kettering, GBR
| | - Amar Manandhar
- Urology, University Hospitals of Birmingham, Birmingham, GBR
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Hahn RG. Isotonic saline causes greater volume overload than electrolyte-free irrigating fluids. J Basic Clin Physiol Pharmacol 2023; 34:717-723. [PMID: 34563101 DOI: 10.1515/jbcpp-2021-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/11/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Systemic absorption of the irrigating fluid used to flush the operating site is a potentially serious complication in several types of endoscopic operations. To increase safety, many surgeons have changed from a monopolar to a bipolar resection technique because 0.9% saline can then be used instead of electrolyte-free fluid for irrigation. The present study examines whether the tendency for excessive plasma volume expansion is greater with saline than with electrolyte-free fluid. METHODS Pooled data were analyzed from four studies in which a mean of 1.25 L of either 0.9% saline or an electrolyte-free irrigating fluid containing glycine, mannitol, and sorbitol was given by intravenous infusion on 80 occasions to male volunteers and patients scheduled for transurethral prostatic surgery. The distribution of the infused fluid was analyzed with a population volume kinetic model based on frequently measured hemodilution and the urinary excretion. RESULTS Electrolyte-free fluid distributed almost twice as fast and was excreted four times faster than 0.9% saline. The distribution half-life was 6.5 and 10.6 min for the electrolyte-free fluid and saline, respectively, and the elimination half-lives (by urinary excretion) from the plasma volume were 21 and 87 min. Simulation showed that the plasma volume expansion was twice as great from 0.9% saline than from electrolyte-free fluid. CONCLUSIONS Isotonic (0.9%) saline expands the plasma volume by twice as much as occurs with electrolyte-free irrigating fluids. This difference might explain why signs of cardiovascular overload are the most commonly observed adverse effects when saline is absorbed during endoscopic surgery.
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Affiliation(s)
- Robert G Hahn
- Research Unit, Södertälje Hospital, Södertälje, Sweden
- Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden
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Geremew LM, Gelaw SA, Beyene AD. Assessing the Complications of Monopolar Transurethral Resection of the Prostate (M-TURP) Using Clavien-Dindo Complications Grading System. Ethiop J Health Sci 2022; 32:605-612. [PMID: 35813687 PMCID: PMC9214742 DOI: 10.4314/ejhs.v32i3.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is one of the most common diseases of ageing men, which increase starting from age 40. Monopolar transurethral resection of the prostate (M-TURP) is the gold standard surgical treatment for BPH between 30 to 80cc. This study is designed to assess complications of TURP based on the Clavien-Dindo post-op complication grading system. METHODS A descriptive prospective study of prevalence of complications of M-TURP from May1, 2019 to April 30, 2021 in Tikur Anbessa Specialized Hospital. In this study, 174 patients were assessed pre-operatively, intra-operatively and post-operatively. All BPH patients with bothersome LUTS, bladder stone, recurrent UTI, recurrent acute urinary retention (AUR), renal insufficiency, or failed medical therapy had undergone TURP. We collected it by revising patient's icare/charts and cell phone call. RESULTS About 174 patients were studied with mean age were 63 years. Intra op complications were noticed in seventeen (9.8%) patients, the most common one was prostate capsule perforation seen in 9 (5.2%) cases followed by severe bleeding in 3(1.7%) patients which needs transfusion and urethral injury. Urinary tract infections developed in eleven (7.8%) of patients. Bulbar urethral stricture and bladder neck contracture developed in 9 (5.2%) and 3 (1.7%) patients each, respectively. Re TURP was done for 7 (4%) of patients. CONCLUSION In this study, the overall complication rate of TURP with Clavien-Dindo grading system was 29.3%. Around 96% of the complications were Clavien-Dindo grade I, II and III; managed conservatively or with minimally invasive surgery. This shows M-TURP is a relatively safe procedure.
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Affiliation(s)
| | - Samuel Amare Gelaw
- Urology Unit, School of Medicine, College of Health Sciences, Addis Ababa University
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Kretzmer L, Damola A, Sandher MJS, Martin W, Ehsanullah SA, Jones A, Manirajan S, Cakir S, Gao J, Ginepri A, Singh S, Apakama I. A ten-year observational study of the use of two-way catheters post-transurethral resection of the prostate without the use of post-op irrigation. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221081815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Over 15,000 transurethral resections of the prostate (TURP) are performed annually in the United Kingdom. It is therefore vital that every aspect of peri-operative care be optimised. Our centre favours the use of two-way catheters post-operatively without the use of continuous bladder irrigation (CBI). Objectives: To evaluate our practice of using two-way catheters without irrigation post-TURP and to determine impact on patient care compared with standard three-way catheterisation. Our primary outcome was duration of admission, but multiple secondary outcomes were also analysed. Design, setting, and participants: This was a prospective observational study. Every patient undergoing TURP at our centre from 2009 to 2019 was included. Following TURP patients were catheterised with two-way catheters. Prospective patient data were collected pertaining to peri-operative factors. These data were then compared with the data published in the literature. Results: 687 patients underwent TURP at our centre between 2009 and 2019. The average age of patients was 71.42 (±7.89). 87.17% ( n = 598) had two-way catheters placed post-operatively. Average duration of admission was 1.61 (±1.35) days, increasing to 2.20 days if patients required three-way catheters or 2.53 days if requiring CBI. TWOC was successful in 97.71% of patients. Complication rate was 8.73% ( n = 60). When compared with other centres, our method reduced lengths of admission and transfusion rates (1.6 days versus 3.1 days and 0.87% versus 2.83%, respectively). Conclusion: Our method is safe and is associated with a reduced length of admission. We recommend this practice to the wider urological community. Patient summary: This study looked at whether there was any impact on patients if two-way catheters were used following TURP. We found that use of two-way catheters reduced length of admission and duration of catheterisation. We also found that it did not increase likelihood of peri-operative complications in comparison with other centres.
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Affiliation(s)
| | | | | | - Wiliam Martin
- Warwick Medical School, The University of Warwick, UK
| | | | - Adam Jones
- Heart of England NHS Foundation Trust, UK
| | | | - Serkan Cakir
- Warwick Medical School, The University of Warwick, UK
| | - Jo Gao
- Warwick Medical School, The University of Warwick, UK
| | | | - Sid Singh
- The George Eliot Hospital NHS Trust, UK
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Knight L, Peirce S, Morris R. The PLASMA System for Transurethral Resection of the Prostate: A NICE Medical Technologies Guidance Update. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:665-672. [PMID: 33900568 DOI: 10.1007/s40258-021-00651-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
Lower urinary tract symptoms (LUTS) in men commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP). This can be performed using either monopolar or bipolar electrosurgery. Bipolar TURP uses saline for irrigation rather than glycine, which drastically reduces the risk of TUR syndrome complications, thus allowing for increased procedure time if needed. The PLASMA system (formally known as TURis) is a bipolar TURP electrosurgery system used to treat LUTS secondary to BPH. National guidance recommending the use of TURis in the UK NHS was issued in 2014 by NICE and we now report the updated contribution from Cedar that was included in the update of that guidance for 2021. The evidence in this review suggests that the PLASMA system could be beneficial to patients in relation to hospitalisation and catheterisation time compared with monopolar TURP (mTURP). However, it appears to be comparable to mTURP for urological outcomes and worse for post-operative haematology outcomes such as decline in sodium and haemoglobin levels. Adverse events, however, occurred much less with PLASMA use.
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Affiliation(s)
- Laura Knight
- Cedar, Cardiff & Vale University Health Board, Cardiff, UK.
| | | | - Rhys Morris
- Cedar, Cardiff & Vale University Health Board, Cardiff, UK
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Lebdai S, Chevrot A, Doizi S, Pradère B, Barry Delongchamps N, Baumert H, Benchikh A, Della Negra E, Fourmarier M, Gas J, Misraï V, Rouscoff Y, Theveniaud PE, Vincendeau S, Wilisch J, Descazeaud A, Robert G. [Surgical and interventional management of benign prostatic obstruction: Guidelines from the Committee for Male Voiding Disorders of the French Urology Association]. Prog Urol 2021; 31:249-265. [PMID: 33478868 DOI: 10.1016/j.purol.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO). METHODS All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions. RESULTS/GUIDELINES Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm3, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm3. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm3. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm3 without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols. CONCLUSION Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.
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Affiliation(s)
- S Lebdai
- Service d'urologie, CHU d'Angers, Angers, France.
| | - A Chevrot
- Service d'urologie, CHU de Nîmes, Nîmes, France
| | - S Doizi
- Service d'urologie, hôpital européen Georges-Pompidou, Paris, France
| | - B Pradère
- Service d'urologie, CHU de Tours, Tours, France
| | | | - H Baumert
- Service d'urologie, hôpital Ambroise-Paré, Paris, France
| | - A Benchikh
- Service d'urologie, Clinique les Martinets, Versailles, France
| | - E Della Negra
- Service d'urologie, hôpital des Côtes d'Armor, Saint-Brieuc, France
| | - M Fourmarier
- Service d'urologie, hôpital Aix-en-Provence, Aix-en-Provence, France
| | - J Gas
- Service d'urologie, CHU de Toulouse, Toulouse, France
| | - V Misraï
- Service d'urologie, clinique Pasteur, Toulouse, France
| | - Y Rouscoff
- Service d'urologie, polyclinique Saint-Georges, Nice, France
| | - P E Theveniaud
- Service d'urologie, CHR de Metz Thionville, Metz, France
| | - S Vincendeau
- Service d'urologie, CHU de Rennes, Rennes, France
| | - J Wilisch
- Service d'urologie, hôpital privé Natecia, Lyon, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, Limoges, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux, Bordeaux, France
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Alexander CE, Scullion MMF, Omar MI, Yuan Y, Mamoulakis C, N'Dow JMO, Chen C, Lam TBL. Reprint - Bipolar vs. monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction: A Cochrane review. Can Urol Assoc J 2020; 14:423-430. [PMID: 32569563 DOI: 10.5489/cuaj.6464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION 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). METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
| | - Malo M F Scullion
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
| | | | - Yuhong Yuan
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, ON, Canada
| | - Charalampos Mamoulakis
- Department of Urology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - James M O N'Dow
- Urology Department, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Changhao Chen
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
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Alexander CE, Scullion MMF, Omar MI, Yuan Y, Mamoulakis C, N'Dow JMO, Chen C, Lam TBL, Cochrane Urology Group. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev 2019; 12:CD009629. [PMID: 31792928 PMCID: PMC6953316 DOI: 10.1002/14651858.cd009629.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is a well-established surgical method for treatment of men with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). This has traditionally been provided as monopolar TURP (MTURP), but morbidity associated with MTURP has led to the introduction of other surgical techniques. In bipolar TURP (BTURP), energy is confined between electrodes at the site of the resectoscope, allowing the use of physiological irrigation medium. There remains uncertainty regarding differences between these surgical methods in terms of patient outcomes. OBJECTIVES To compare the effects of bipolar and monopolar TURP. SEARCH METHODS A comprehensive systematic electronic literature search was carried out up to 19 March 2019 via CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, PubMed, and WHO ICTRP. Handsearching of abstract proceedings of major urological conferences and of reference lists of included trials, systematic reviews, and health technology assessment reports was undertaken to identify other potentially eligible studies. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared monopolar and bipolar TURP in men (> 18 years) for management of LUTS secondary to BPO. DATA COLLECTION AND ANALYSIS Two independent review authors screened the literature, extracted data, and assessed eligible RCTs for risk of bias. Statistical analyses were undertaken according to the statistical guidelines presented in the Cochrane Handbook for Systematic Reviews of Interventions. The quality of evidence (QoE) was rated according to the GRADE approach. MAIN RESULTS A total of 59 RCTs with 8924 participants were included. The mean age of included participants ranged from 59.0 to 74.1 years. Mean prostate volume ranged from 39 mL to 82.6 mL. Primary outcomes BTURP probably results in little to no difference in urological symptoms, as measured by the International Prostate Symptom Score (IPSS) at 12 months on a scale of 0 to 35, with higher scores reflecting worse symptoms (mean difference (MD) -0.24, 95% confidence interval (CI) -0.39 to -0.09; participants = 2531; RCTs = 16; I² = 0%; moderate certainty of evidence (CoE), downgraded for study limitations), compared to MTURP. BTURP probably results in little to no difference in bother, as measured by health-related quality of life (HRQoL) score at 12 months on a scale of 0 to 6, with higher scores reflecting greater bother (MD -0.12, 95% CI -0.25 to 0.02; participants = 2004; RCTs = 11; I² = 53%; moderate CoE, downgraded for study limitations), compared to MTURP. BTURP probably reduces transurethral resection (TUR) syndrome events slightly (risk ratio (RR) 0.17, 95% CI 0.09 to 0.30; participants = 6745; RCTs = 44; I² = 0%; moderate CoE, downgraded for study limitations), compared to MTURP. This corresponds to 20 fewer TUR syndrome events per 1000 participants (95% CI 22 fewer to 17 fewer). Secondary outcomes BTURP may carry a similar risk of urinary incontinence at 12 months (RR 0.20, 95% CI 0.01 to 4.06; participants = 751; RCTs = 4; I² = 0%; low CoE, downgraded for study limitations and imprecision), compared to MTURP. This corresponds to four fewer events of urinary incontinence per 1000 participants (95% CI five fewer to 16 more). BTURP probably slightly reduces blood transfusions (RR 0.42, 95% CI 0.30 to 0.59; participants = 5727; RCTs = 38; I² = 0%; moderate CoE, downgraded for study limitations), compared to MTURP. This corresponds to 28 fewer events of blood transfusion per 1000 participants (95% CI 34 fewer to 20 fewer). BTURP may result in similar rates of re-TURP (RR 1.02, 95% CI 0.44 to 2.40; participants = 652; RCTs = 6; I² = 0%; low CoE, downgraded for study limitations and imprecision). This corresponds to one more re-TURP per 1000 participants (95% CI 19 fewer to 48 more). Erectile function as measured by the International Index of Erectile Function score (IIEF-5) at 12 months on a scale from 5 to 25, with higher scores reflecting better erectile function, appears to be similar (MD 0.88, 95% CI -0.56 to 2.32; RCTs = 3; I² = 68%; moderate CoE, downgraded for study limitations) for the two approaches. AUTHORS' CONCLUSIONS BTURP and MTURP probably improve urological symptoms, both to a similar degree. BTURP probably reduces both TUR syndrome and postoperative blood transfusion slightly compared to MTURP. The impact of both procedures on erectile function is probably similar. The moderate certainty of evidence available for the primary outcomes of this review suggests that there is no need for further RCTs comparing BTURP and MTURP.
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Affiliation(s)
- Cameron Edwin Alexander
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Malo MF Scullion
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
- European Association of UrologyArnhemNetherlands
| | - Yuhong Yuan
- McMaster UniversityDepartment of Medicine, Division of Gastroenterology1280 Main Street WestRoom HSC 3N51HamiltonONCanadaL8S 4K1
| | - Charalampos Mamoulakis
- University General Hospital of Heraklion, University of Crete Medical SchoolDepartment of UrologyHeraklion, CreteGreece
| | - James MO N'Dow
- NHS Grampian, Aberdeen Royal InfirmaryUrology DepartmentForesterhillAberdeenScotlandUKAB25 2ZN
| | - Changhao Chen
- Sun Yat‐Sen Memorial Hospital, Sun Yat‐Sen UniversityDepartment of Urology107 Yan‐Jiang RoadGuangzhouChina
| | - Thomas BL Lam
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
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11
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Bipolar vaporization of the prostate may cause higher complication rates compared to bipolar loop resection: a randomized prospective trial. Int Urol Nephrol 2019; 51:2143-2148. [PMID: 31522378 DOI: 10.1007/s11255-019-02280-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/09/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Transurethral resection of the prostate (TURP) by resection loop or vaporization button is becoming a standard of care due to its better safety profile (less bleeding and less incidence of TUR syndrome). However, there are published data showing bipolar vaporization may be associated with increased late complications. In this study, we compared results of bipolar TURP using the resection loop versus vaporization button for treatment of benign prostatic hyperplasia (BPH) to determine the relative safety profile. PATIENTS AND METHODS Between January 2013 and March 2014, 89 patients with BPH were randomized to surgical intervention either by Olympus (Gyrus) Bipolar loop TURP or Olympus (Gyrus) Bipolar button vaporization. Inclusion criteria were; BPH with Q-max < 10 ml/s, IPSS > 18 and prostate volume > 40 g. All patients were evaluated preoperatively and at 1, 3 and 9 months. Evaluation included IPSS, uroflowmetry, prostate volume by ultrasound. Clavien complications and operative time were recorded. Statistical analysis was done using Statistical Package of Social Science (SPSS) version 17 software. RESULTS 44 patients were included in bipolar TURP and 45 patients in vaporization arm. Preoperative mean prostate volume (59 g versus 58 g, p = 0.52) and mean IPSS (19 versus 20, p = 0.38) were equivalent in both groups. Vaporization was associated with a significant increase in operative time (mean of 81 ± 15 min range 40-110 versus 55 ± 10 min range 30-70 min, p < 0.001), less blood loss (0.8% versus 2.0% drop in hemoglobin, p < 0.001) but increased postoperative urinary frequency (80% versus 50%, p < 0.001), hematuria with clots up to 4 weeks post surgery (20% versus 2%, p < 0.001) and postoperative urethral stricture (11% versus 0%, p < 0.001). Both techniques improved urine flow with Q-max (17 ml/s versus 18 ml/s p = 0.22). Prostate volume (32 g versus 31 g, p = 0.31) and IPSS (6 versus 5, p = 0.22), were comparable in both treatment arms. CONCLUSIONS Bipolar vaporization of the prostate, despite being a technically robust, speedy and with less intraoperative bleeding, appears to be associated with increased postoperative irritative symptoms, increased late-onset postoperative bleeding and high urethral stricture rates.
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12
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Robert G, de la Taille A, Descazeaud A. [Surgical treatment of BPO: Standard and innovations]. Prog Urol 2018; 28:856-867. [PMID: 30297185 DOI: 10.1016/j.purol.2018.07.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVE Surgical management of benign prostatic hyperplasia has dramatically changed in the recent years towards higher proportion of endoscopic treatment and fewer perioperative complications. Nevertheless the question of urinary and sexual quality of life after surgical treatment remains partially unresolved with a high proportion of retrograde ejaculation after conventional surgical treatments. Therefore mini-invasive alternatives to conventional surgery have been proposed. The objective of this literature review was to provide an overview of the alternatives to monopolar TURP currently available in France. MATERIAL AND METHOD A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review. A synthesis is proposed for each alternative technique mentioning its level of clinical development, but also its potential advantages and disadvantages compared to conventional surgical techniques. RESULTS The quality of life of patients after surgical or interventional management has become the main priority of urologists since the risks of perioperative complication have been reduced by the use of laser or bipolar endoscopic techniques. Thanks to the development of minimally invasive alternatives that are better and better evaluated by randomized trials versus interventional simulation and conventional surgical treatment, more personalized care is possible. Patients' expectations and their individual risk factors can thus be placed at the center of the therapeutic decision and the preoperative information. CONCLUSION The surgical and interventional management of LUTS due to BPH has evolved to lower perioperative morbidity with the help of numerous technological developments. Mini-invasive alternatives to standard treatment have also been proposed in order to improve the quality of postoperative sexual life. These alternatives provide significant improvement in LUTS that remains lower than after conventional treatments. Somme of these alternative are also not fully supported by clinical trials, which should urge urologists to act with caution when proposing these alternatives in daily clinical practice.
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Affiliation(s)
- G Robert
- Service d'urologie, CHU de Bordeaux, 33000 Bordeaux, France.
| | - A de la Taille
- Service d'urologique, CHU Henri Mondor, AP-HP, 94000 Créteil, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, 87042 Limoges, France
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13
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Aboutaleb H, Ali TA, Zaghloul A, Amin MM. Efficacy of bipolar ‘button’ plasma vaporisation of the prostate compared to green laser vaporisation for benign prostatic obstruction. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817752855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Our objectives were to evaluate the efficiency of transurethral bipolar plasma vaporisation of the prostate (BPVP) using the button electrode and compare it to green laser vaporisation of the prostate (GLVP). Patients and methods: During the period March 2012 to January 2017, 155 patients with benign prostatic obstruction (BPO) were enrolled in our study. Overall, 80 patients underwent BPVP and 75 GLVP. All International Prostate Symptom Scores (IPSS), quality of life (QOL), uroflow Qmax, Qave and post-void residual (PVR) urine samples were evaluated 24 hours preoperatively and at three months postoperatively. Operative time, hospital stay, catheterisation time, and complications were reported. Mean serum haemoglobin, haematocrit and serum sodium changes were reported preoperatively and within 24 hours postoperatively in both groups. Statistical analysis was performed using the SPSS program version 20 for Windows. Results: Mean age at surgery was 62.8 ± 4 (53–82) years and 63 ± 6.6 (54–86) years for the BPVP and GLVP groups respectively. Mean prostatic volume was 45 ± 10 (36–90) and 43 ± 9 (32–85) in each group, respectively. Patients from both series had similar preoperative characteristics. The mean operative duration was 58 ± 21 (range: 20–70) minutes and 57 ± 13 (range: 24–75) minutes, hospital stay was 12.2 ± 6.4 (12–60) hours vs 7 ± 3.3 (6–48) hours ( p = 0.01), and catheterisation period was 48 ± 1.28 (24–72) hours vs 6 ± 6.2 (6–7) hours ( p = 0.001). Conclusions: Both BPVP and GLVP offer good options for management of BPO with less bleeding, one-day surgery, less catheterisation time with significant improvement of IPSS, QOL score and uroflow postoperatively. However, more studies comparing the cost of both techniques are needed for a solid conclusion. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - Tamer A Ali
- Urology Department Al-Azhar University Hospitals, Cairo, Egypt; Gulf Medical University, United Arab Emirates
| | - Ahmed Zaghloul
- Department of Urology, NMC Hospital, Dubai, United Arab Emirates
| | - Moamen M Amin
- Department of Urology, NMC Hospital, Dubai, United Arab Emirates
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14
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Davis NF, Jack GS, Witjes WP, Bjartell A, Caris C, Patel A, de la Taille A, Lawrentschuk N, Bolton DM, Tubaro A. Medical therapy versus transurethral resection of the prostate (TURP) for the treatment of symptomatic benign prostatic enlargement (BPE): a cost minimisation analysis. World J Urol 2018; 37:873-878. [PMID: 30145778 DOI: 10.1007/s00345-018-2454-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE A cost minimisation analysis compares the costs of different interventions' to ascertain the least expensive over time. We compared different prostate targeted drug treatments with TURP to identify the optimal cost saving duration of a medical therapy for symptomatic benign prostatic enlargement (BPE). METHODS The Evolution registry is a prospective, multicentre registry, conducted by the European Association of Urology Research Foundation (EAUrf) for 24 months in 5 European countries. Evolution was designed to register the management of symptomatic BPE in clinical practice settings in 5 European countries. Direct cost evaluation associated with prostate targeted medical therapies and TURP was also recorded and analysed. RESULTS In total, 1838 men were enrolled with 1246 evaluable at 24 months. Medical therapies were more cost saving than TURP for treatment durations ranging from 2.9 to 70.4 years. Cost saving depended on both medication class and individual country assessed. Daily tamsulosin monotherapy was more cost saving than TURP for ≤ 13.9 years in Germany compared to ≤ 32.7 years in Italy. Daily finasteride monotherapy was more cost saving for ≤ 5.9 years in France compared to ≤ 36.9 years in Spain. Combination therapy was more cost saving for ≤ 5.9 years for Italian patients versus ≤ 13.8 years in Germany. CONCLUSIONS BPE medical management was more cost saving than TURP for different specific treatment durations. Information from this study will allow clinicians to convey medical and surgical costs over time, to both patients and payors alike, when considering BPE treatment.
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Affiliation(s)
- Niall F Davis
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia.
| | - G S Jack
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - W P Witjes
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands
| | - A Bjartell
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands.,Department of Urology, Lund University, Skane Hospital, Malmö, Sweden
| | - C Caris
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands
| | - A Patel
- Department of Urology, Spire London East Hospital, Roding Lane South, Redbridge, Essex, Ilford, IG4 5PZ, UK
| | - A de la Taille
- Department of Urology, Assistance Publique des Hopitaux de Paris, 54 av du Mal de Lattre de Tassigny, 94000, Créteil, France
| | - N Lawrentschuk
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - D M Bolton
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - A Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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15
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Aboutaleb H, Ali TA, Zaghloul A, Amin MM. Efficacy of bipolar ‘button’ plasma vaporisation of the prostate compared to green laser vaporisation for benign prostatic obstruction. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: http://journal of clinical urology.com/.doi: 10.1177/2051415817752855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: Our objectives were to evaluate the efficiency of transurethral bipolar plasma vaporisation of the prostate (BPVP) using the button electrode and compare it to green laser vaporisation of the prostate (GLVP). Patients and methods: During the period March 2012 to January 2017, 155 patients with benign prostatic obstruction (BPO) were enrolled in our study. Overall, 80 patients underwent BPVP and 75 GLVP. All International Prostate Symptom Scores (IPSS), quality of life (QOL), uroflow Qmax, Qave and post-void residual (PVR) urine samples were evaluated 24 hours preoperatively and at three months postoperatively. Operative time, hospital stay, catheterisation time, and complications were reported. Mean serum haemoglobin, haematocrit and serum sodium changes were reported preoperatively and within 24 hours postoperatively in both groups. Statistical analysis was performed using the SPSS program version 20 for Windows. Results: Mean age at surgery was 62.8 ± 4 (53–82) years and 63 ± 6.6 (54–86) years for the BPVP and GLVP groups respectively. Mean prostatic volume was 45 ± 10 (36–90) and 43 ± 9 (32–85) in each group, respectively. Patients from both series had similar preoperative characteristics. The mean operative duration was 58 ± 21 (range: 20–70) minutes and 57 ± 13 (range: 24–75) minutes, hospital stay was 12.2 ± 6.4 (12–60) hours vs 7 ± 3.3 (6–48) hours ( p = 0.01), and catheterisation period was 48 ± 1.28 (24–72) hours vs 6 ± 6.2 (6–7) hours ( p = 0.001). Conclusions: Both BPVP and GLVP offer good options for management of BPO with less bleeding, one-day surgery, less catheterisation time with significant improvement of IPSS, QOL score and uroflow postoperatively. However, more studies comparing the cost of both techniques are needed for a solid conclusion. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - Tamer A Ali
- Urology Department Al-Azhar University Hospitals, Cairo, Egypt; Gulf Medical University, United Arab Emirates
| | - Ahmed Zaghloul
- Department of Urology, NMC Hospital, Dubai, United Arab Emirates
| | - Moamen M Amin
- Department of Urology, NMC Hospital, Dubai, United Arab Emirates
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16
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Gerullis H, Eitzen A, Uphoff J, Daaboul F, Chavan A, Ermert L, Wawroschek F, Winter A. Recurrent symphysitis culminating in pelvic ring fracture after hyperextended transurethral prostate resection and vaporization with symphysis erosion: a case report. J Med Case Rep 2017; 11:141. [PMID: 28521832 PMCID: PMC5437573 DOI: 10.1186/s13256-017-1292-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/11/2017] [Indexed: 11/13/2022] Open
Abstract
Background Short-term and long-term complications of transurethral prostate resection can be different in nature. Capsule perforation and subsequent fistulation after resection and electrovaporization is seldom reported in the literature. Case presentation Here we report the case of a 79-year-old caucasian man with capsule perforation after transurethral prostate resection and electrovaporization resulting in a severe and recurrent symphysitis and subsequent pelvic ring fracture. The bladder-symphysis fistulation was surgically removed and additional orthopedic surgery could be avoided after definitely solving the urological problem. Conclusions Urologists should be aware of rare complications after transurethral resection and electrovaporization of the prostate.
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Affiliation(s)
- Holger Gerullis
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany.
| | - Arne Eitzen
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
| | - Jens Uphoff
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
| | - Fadi Daaboul
- Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Oldenburg, Germany
| | - Ajay Chavan
- Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Oldenburg, Germany
| | | | - Friedhelm Wawroschek
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
| | - Alexander Winter
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
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17
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He LY, Zhang YC, He JL, Li LX, Wang Y, Tang J, Tan J, Zhong K, Tang YX, Long Z. The effect of immediate surgical bipolar plasmakinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention. Asian J Androl 2016; 18:134-9. [PMID: 26178398 PMCID: PMC4736342 DOI: 10.4103/1008-682x.157395] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate (PK-TURP) for patients with benign prostatic hyperplasia (BPH) with acute urinary retention (AUR). We conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1126 BPH patients were divided into AUR (n = 348) and non-AUR groups (n = 778). After the urethral catheters were removed, the urine white blood cell (WBC) count in the AUR group significantly increased compared with the non-AUR group (P < 0.01). However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group (P < 0.001). A total of 87.1% (303/348) patients in the AUR group and 84.1% (654/778) patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group (P < 0.01). The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3–12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-PK-TURP. In conclusion, immediate PK-TURP surgery on patients accompanied by AUR was safe and effective.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Zhi Long
- Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, China
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18
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Madduri VKS, Bera MK, Pal DK. Monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: Operative outcomes and surgeon preferences, a real-world scenario. Urol Ann 2016; 8:291-6. [PMID: 27453650 PMCID: PMC4944621 DOI: 10.4103/0974-7796.184900] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Context: Monopolar transurethral resection of prostate (M-TURP) is considered the gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia. Its newly introduced modification, bipolar TURP (B-TURP), promises to overcome its most prominent shortcomings, namely bleeding and dilutional hyponatremia. Literature is conflicting regarding merits of B-TURP over M-TURP. Aims: To find a difference, if any, in perioperative outcomes between M-TURP and B-TURP in a real-wold setting. Settings and Design: Prospective nonrandomized study. Subjects and Methods: Operative outcomes of patients undergoing M-TURP and B-TURP from February 2014 to October 2015 were compared. Statistical Analysis Used: Categorical data were compared by Fischer exact test and numerical data were compared by independent samples Mann–Whitney U-test. P <0.05 was considered statistically significant. Results: The mean size of prostate operated by bipolar technology was significantly greater than those operated by monopolar technology (38.12 ± 9.59 cc vs. 66.49 ± 22.95 cc; P < 0.001). The mean fall in postoperative serum sodium concentration was 0.99 ± 0.76 mEq/L for the B-TURP group as compared to 3.60 ± 2.89 mEq/L for the M-TURP group (P < 0.001). The mean drop in postoperative hemoglobin concentration (P = 0.28) was statistically insignificant, even though larger glands were operated by B-TURP. There were three instances of the transurethral resection (TUR) syndrome in the M-TURP group whereas no TUR syndrome occurred in the B-TURP group. Conclusions: In spite of various contrary viewpoints in literature, surgeons prefer to operate on larger prostates using bipolar technology. B-TURP definitely reduces the incidence of bleeding and dilutional hyponatremia, making it a contender to replace M-TURP as the new gold standard.
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Affiliation(s)
- Vijay Kumar Sarma Madduri
- Department of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Malay Kumar Bera
- Department of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Cleves A, Dimmock P, Hewitt N, Carolan-Rees G. The TURis System for Transurethral Resection of the Prostate: A NICE Medical Technology Guidance. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:267-79. [PMID: 26818197 PMCID: PMC4871905 DOI: 10.1007/s40258-015-0221-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The transurethral resection in saline (TURis) system was notified by the company Olympus Medical to the National Institute of Health and Care Excellence's (NICE's) Medical Technologies Evaluation Programme. Following selection for medical technologies guidance, the company developed a submission of clinical and economic evidence for evaluation. TURis is a bipolar surgical system for treating men with lower urinary tract symptoms due to benign prostatic enlargement. The comparator is any monopolar transurethral resection of the prostate (mTURP) system. Cedar, a collaboration between Cardiff and Vale University Health Board, Cardiff University and Swansea University in the UK, acted as an External Assessment Centre (EAC) for NICE to independently critique the company's submission of evidence. Eight randomised trials provided evidence for TURis, demonstrating efficacy equivalent to that of mTURP for improvement of symptoms. The company presented meta-analyses of key outcome measures, and the EAC made methodological modifications in response to the heterogeneity of the trial data. The EAC analysis found that TURis substantially reduced the relative risks of transurethral resection syndrome (relative risk 0.18 [95 % confidence interval 0.05-0.62]) and blood transfusion (relative risk 0.35 [95 % confidence interval 0.19-0.65]). The company provided a de novo economic model comparing TURis with mTURP. The EAC critiqued the model methodology and made modifications. This found TURis to be cost saving at £70.55 per case for existing Olympus customers and cost incurring at £19.80 per case for non-Olympus customers. When an additional scenario based on the only available data on readmission (due to any cause) from a single trial was modelled, the estimated cost saving per case was £375.02 for existing users of Olympus electrosurgery equipment and £284.66 per case when new Olympus equipment would need to be purchased. Meta-analysis of eight randomised trials showed that TURis is associated with a statistically significantly reduced risk of transurethral resection syndrome and a reduced need for blood transfusion-two factors that may drive cost saving for the National Health Service. The clinical data are equivocal as to whether TURis shortens the hospital stay. Limited data from a single study suggest that TURis may reduce the rate of readmission after surgery. The NICE guidance supports adoption of the TURis technology for performing transurethral resection of the prostate in men with lower urinary tract symptoms due to benign prostatic enlargement.
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Affiliation(s)
- Andrew Cleves
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Heath Park Campus, Cardiff, CF14 4UJ, UK.
| | - Paul Dimmock
- National Institute for Health and Care Excellence, Manchester, UK
| | - Neil Hewitt
- National Institute for Health and Care Excellence, Manchester, UK
| | - Grace Carolan-Rees
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Heath Park Campus, Cardiff, CF14 4UJ, UK
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Kumar N, Vasudeva P, Kumar A, Singh H. Prospective Randomized Comparison of Monopolar TURP, Bipolar TURP and Photoselective Vaporization of the Prostate in Patients with Benign Prostatic Obstruction: 36 Months Outcome. Low Urin Tract Symptoms 2016; 10:17-20. [PMID: 27168018 DOI: 10.1111/luts.12135] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/21/2016] [Accepted: 02/29/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess durability of efficacy of monopolar transurethral resection of the prostate (TURP), bipolar TURP, and photoselective vaporization of the prostate (PVP) using 120W Green light laser at 36 months follow up. METHOD The 186 patients who presented with benign prostatic obstruction and planned for surgery were randomized into three groups: Group A - monopolar TURP; group B - bipolar TURP; and group C - PVP. International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5) score, quality of life (QoL) score, maximum flow rate (Qmax), prostate volume and postvoid residual urine (PVRU) were analyzed up to 36 months follow up. RESULTS The improvement observed in the mean IPSS, QoL score, Qmax, prostate volume and PVRU at 12-month was sustained till 36 months follow up. However, the mean IIEF-5 score did not show improvement in any group. Few complications noted in second and third year of follow up compared to first year follow up. The results of subgroups analysis did not reveal any significant finding, different from group analysis, for efficacy parameters. CONCLUSION Monopolar TURP, Bipolar TURP and PVP provides durable and comparable efficacy at 36 months follow up in patients with prostate size <80 mL.
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Affiliation(s)
- Niraj Kumar
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Pawan Vasudeva
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Anup Kumar
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Harbinder Singh
- Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi, India
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Economic Value of the Transurethral Resection in Saline System for Treatment of Benign Prostatic Hyperplasia in England and Wales: Systematic Review, Meta-analysis, and Cost-Consequence Model. Eur Urol Focus 2016; 4:270-279. [PMID: 28753756 DOI: 10.1016/j.euf.2016.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 02/24/2016] [Accepted: 03/08/2016] [Indexed: 11/21/2022]
Abstract
CONTEXT Monopolar transurethral resection of the prostate (M-TURP) is the current UK surgical standard of care for benign prostatic hyperplasia, a condition estimated to affect >2 million men in the United Kingdom. Although M-TURP efficacy in prostate resection is established, potential perioperative complications and associated costs remain a concern. OBJECTIVE To present up-to-date and robust evidence in support of bipolar transurethral resection in saline (TURis) as an alternative surgical option to M-TURP. EVIDENCE ACQUISITION A systematic review (SR) of electronic databases (up to 2015) for randomised controlled trials (RCTs) comparing TURis with M-TURP was conducted, followed by evidence synthesis in the form of a meta-analysis of hospital stay, catheterisation time and procedure duration, transurethral resection (TUR) syndrome, blood transfusion, clot retention, and urethral strictures. An economic analysis was subsequently undertaken from the UK National Health Service hospital perspective with costs and resource use data from published sources. EVIDENCE SYNTHESIS The SR identified 15 good-quality RCTs, of which 11 were used to inform the meta-analysis. TURis was associated with improved safety versus M-TURP, eliminating the risk of TUR syndrome and reducing the risk of blood transfusion and clot retention (relative risks: 0.34 and 0.43, respectively; p<0.05). TURis also reduced hospital stay (mean difference: 0.56 d; p<0.0001). The economic analysis indicated potential cost savings with TURis versus M-TURP of up to £204 per patient, with incremental equipment costs offset by savings from reduced hospital stay and fewer complications. CONCLUSIONS The TURis system is associated with significant improvements in perioperative safety compared with M-TURP while ensuring equivalent clinical outcomes of prostate resection. The safety benefits identified may translate into cost savings for UK health services. PATIENT SUMMARY Our review of bipolar transurethral resection in saline, the new prostate resection technique, indicates that it offers equal efficacy while reducing complications and length of hospital stay.
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Hahn RG. Fluid absorption and the ethanol monitoring method. Acta Anaesthesiol Scand 2015; 59:1081-93. [PMID: 25952458 DOI: 10.1111/aas.12550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/04/2015] [Accepted: 04/13/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Fluid absorption is a well-known complication of endoscopic surgeries, such as transurethral prostatic resection and transcervical endometrial resection. Absorption of electrolyte-free fluid in excess of 1 L, which occurs in 5% to 10% of the operations, markedly increases the risk of adverse effects from the cardiovascular and neurological systems. Absorption of isotonic saline, which is used with the new bipolar resection technique, will change the scenario of adverse effects in a yet unknown way. Hyponatremia no longer occurs, but marking the saline with ethanol reveals that fluid absorption occurs just as much as with monopolar prostate resections. METHODS Ethanol monitoring is a method for non-invasive indication and quantification of fluid absorption that has been well evaluated. By using an irrigating fluid that contains 1% of ethanol, updated information about fluid absorption can be obtained at any time perioperatively by letting the patient breathe into a hand-held alcolmeter. RESULTS Regression equations and nomograms with variable complexity are available for estimating how much fluid has been absorbed, both when the alcolmeter is calibrated to show the blood ethanol level and when it is calibrated to show the breath ethanol concentration. Examples of how such estimations should be performed are given in this review article. CONCLUSIONS The difficulty is that the anesthesiologist must be aware of how the alcolmeter is calibrated (for blood or breath) and be able to distinguish between the intravascular and extravascular absorption routes, which give rise to different patterns and levels of breath ethanol concentrations.
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Affiliation(s)
- R. G. Hahn
- Research Unit; Södertälje Hospital and Department of Anesthesiology; Linköping University; Linköping Sweden
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Hu Y, Dong X, Wang G, Huang J, Liu M, Peng B. Five-Year Follow-Up Study of Transurethral Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia. J Endourol 2015; 30:97-101. [PMID: 26352136 DOI: 10.1089/end.2015.0506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To explore the long-term clinical efficacy and safety of transurethral plasmakinetic resection of the prostate (PKRP) for benign prostatic hyperplasia (BPH). PATIENTS AND METHODS A total of 550 patients with BPH who had undergone PKRP from October 2006 to September 2009 were enrolled in this study. All patients were evaluated at baseline and follow-up (3, 12, 24, 36, 48, 60 months postoperatively) by peak flow rate (Qmax), postvoid residual (PVR), quality of life (QoL), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS). Operative details and postoperative complications regarded as safety outcomes were documented. RESULTS A total of 467 patients completed the 5-year follow-up. The mean duration of surgery was 36.43 minutes, mean catheterization time was 48.81 hours, mean hospital stay was 4.21 days. At 60 months postoperatively, the mean Qmax increased from 6.94 mL/s at baseline to 19.28 mL/s, the mean PVR decreased from 126.33 mL to 10.45 mL, the mean IPSS score decreased from 15.79 to 7.51, the mean QoL score decreased from 4.36 to 1.91, and the mean OABSS score decreased from 6.39 to 3.65 (P < 0.001), respectively. In perioperative complications, the blood transfusion rate was 2.7%, urinary tract infection rate was 3.6%; no transurethral resection syndrome (TUR syndrome) occurred. In late complications, urethral stricture rate was 5.4%, recurrent bladder outlet obstruction rate was 2.1%, and the reoperation rate was 4.5%. CONCLUSIONS PKRP is based on conventional monopolar transurethral resection of the prostate (TURP) and uses a bipolar plasmakinetic system. Our results indicate that the long-term clinical efficacy and safety of PKRP for BPH are remarkable. In particular, the incidence of urethral stricture, recurrent bladder outlet obstruction, and reoperation is low. We suggest that PKRP is a reliable minimally invasive technique that may be the preferred procedure for the treatment of patients with BPH.
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Affiliation(s)
- Yangyang Hu
- 1 Department of Urology, Shanghai Tenth People's Hospital, Tongji University , Shanghai, China .,2 Department of First Clinical Medical College, Nanjing Medical University , Nanjing, Jiangsu, China
| | - Xuecheng Dong
- 3 Department of Urology, Cixi People's Hospital, Wenzhou Medical University , Cixi, Zhejiang, China
| | - Guangchun Wang
- 1 Department of Urology, Shanghai Tenth People's Hospital, Tongji University , Shanghai, China
| | - Jianhua Huang
- 1 Department of Urology, Shanghai Tenth People's Hospital, Tongji University , Shanghai, China
| | - Min Liu
- 1 Department of Urology, Shanghai Tenth People's Hospital, Tongji University , Shanghai, China
| | - Bo Peng
- 1 Department of Urology, Shanghai Tenth People's Hospital, Tongji University , Shanghai, China .,2 Department of First Clinical Medical College, Nanjing Medical University , Nanjing, Jiangsu, China
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Fathy HM, Hussein HA, Salem HK, Azab SS, ElFayoumy HM. Transurethral bipolar prostatectomy: Where do we stand now? World J Clin Urol 2015; 4:64-67. [DOI: 10.5410/wjcu.v4.i1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/11/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023] Open
Abstract
Transurethral resection of the prostate (TURP) is considered the gold standard surgical treatment of symptomatic benign prostatic hyperplasia. TURP has gained ground in urologic centers of excellence for its effective long term results with low incidence of complications. Far away from excellence, it associated with blood loss, and TUR syndrome particularly in patients with larger prostates. For this reasons, many minimally invasive new techniques have been implemented in recent years. Bipolar technique has recently been introduced, to minimize the complications of the standard TURP technique.
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Falahatkar S, Mokhtari G, Moghaddam KG, Asadollahzade A, Farzan A, Shahab E, Ghasemi A, Allahkhah A, Esmaeili S. Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP. Int Braz J Urol 2015; 40:346-55. [PMID: 25010300 DOI: 10.1590/s1677-5538.ibju.2014.03.08] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/04/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the outcomes of bipolar transurethral vaporization of the prostate (TUVP) with bipolar transurethral resection of the prostate (TURP). MATERIALS AND METHODS In a prospective randomized trial, 88 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent bipolar TUVP (N = 39) or bipolar TURP (N = 49) from October 2010 to November 2011. The inclusion criteria were age > 50 years, prostate volume of 30-80 mL, serum PSA < 4 ng/mL, IPSS ≥ 20, Qmax ≤ 10 mL/s and failed medical therapy. The perioperative and postoperative outcomes were evaluated and the IPSS and Qmax were assessed preoperatively and 3 months after procedure in all cases. RESULTS Both groups were similar in patient age, prostate volume, preoperative IPSS and Qmax. The TUVP group had significantly lower mean values of operative time, hospital stay, catheterization period, irrigation fluid volume and serum hemoglobin, creatinine, sodium and potassium changes compared with TURP group. No significant differences were seen between two groups regarding complications (TUVP = 10.3%; TURP = 12.2%) and modified Clavien classification of complications. No TUR syndrome, obturator reflex or epididymitis occurred in both groups. Re-hospitalization and transfusion due to clot retention (N = 2) and urethral stricture (N = 1) were reported only in the TURP group. Three patients experienced urinary retention after catheter removal in the TUVP group. Two patients were re-catheterized temporarily and one patient required repeat bipolar TUVP. Three months after surgery, two groups had significant improvement in IPSS and Qmax. But the TUVP group had significantly lower IPSS and higher Qmax than TURP group. CONCLUSIONS Bipolar TUVP is a safe, effective and low cost procedure among minimally invasive surgeries of BPH. Compared with bipolar TURP, the bipolar TUVP had similar complications, better perioperative and postoperative outcomes, superior hemostasis and higher efficacy.
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Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Gholamreza Mokhtari
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | | | - Ahmad Asadollahzade
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Alireza Farzan
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Elaheh Shahab
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Ali Ghasemi
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Aliakbar Allahkhah
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
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Huang JY, Li S, Yang ZH, Zeng XT, Wang XH. Efficacy and Safety of Plasmakinetic Resection of the Prostate in Patients with a Prostate Gland Larger than 80 cc: 30-Month Follow-Up Results. J Endourol 2015; 29:925-8. [PMID: 25556314 DOI: 10.1089/end.2014.0500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy and safety of transurethral plasmakinetic resection of the prostate (PKRP) for the treatment of patients with benign prostatic hyperplasia (BPH) in men with prostate volume >80 cc. PATIENTS AND METHODS From January 2010 to December 2011, 120 patients were included in our study; among these patients, 66 had prostate sizes of 80 cc to 100 cc and 54 had prostate sizes >100 cc. Pre-, peri- and postoperative evaluations were performed. RESULTS The mean operative duration of PKRP was 112 minutes, and the mean resected tissue weight was 60.01 g. Hemoglobin level decreased by 0.65±0.52 g/dL, and serum sodium content decreased by 0.06±2.62 mmol/L. The mean catheterization time was 83.05 hours, and the mean hospital stay was 12.47 days. The short follow-up time (30 months) demonstrated significant improvement in International Prostate Symptom Score, quality of life, and postvoid residual volume compared with preoperative characteristics. One patient underwent reoperation because of a blood clot in the bladder. Twelve patients complained of retrograde ejaculation. No patient experienced urinary incontinence. CONCLUSIONS PKRP is safe and efficacious for men with BPH who have a large prostate (volume >80 cc).
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Affiliation(s)
- Jing-Yu Huang
- 1 Department of Urology, Zhongnan Hospital of Wuhan University , Wuhan, China .,2 Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University , Wuhan, China
| | - Sheng Li
- 1 Department of Urology, Zhongnan Hospital of Wuhan University , Wuhan, China .,2 Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University , Wuhan, China
| | - Zhong-Hua Yang
- 1 Department of Urology, Zhongnan Hospital of Wuhan University , Wuhan, China
| | - Xian-Tao Zeng
- 2 Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University , Wuhan, China
| | - Xing-Huan Wang
- 1 Department of Urology, Zhongnan Hospital of Wuhan University , Wuhan, China .,2 Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University , Wuhan, China
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Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol 2014; 67:1066-1096. [PMID: 24972732 DOI: 10.1016/j.eururo.2014.06.017] [Citation(s) in RCA: 547] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT A number of transurethral ablative techniques based on the use of innovative medical devices have been introduced in the recent past for the surgical treatment of benign prostatic obstruction (BPO). OBJECTIVE To conduct a systematic review of the literature and a meta-analysis of available randomized controlled trials (RCTs), and to evaluate the efficacy and safety of transurethral ablative procedures for BPO. EVIDENCE ACQUISITION A systematic literature search was performed for all RCTs comparing any transurethral surgical technique for BPO to another between 1992 and 2013. Efficacy was evaluated after a minimum follow-up of 1 yr based on International Prostate Symptom Score, maximum flow rate, and postvoid residual volume. Efficacy at midterm follow-up, prostate volume, perioperative data, and short-term and long-term complications were also assessed. Data were analyzed using RevMan software. EVIDENCE SYNTHESIS A total of 69 RCTs (8517 enrolled patients) were included. No significant difference was found in terms of short-term efficacy between bipolar transurethral resection of the prostate (B-TURP) and monopolar transurethral resection of the prostate (M-TURP). However, B-TURP was associated with a lower rate of perioperative complications. Better short-term efficacy outcomes, fewer immediate complications, and a shorter hospital stay were found after holmium laser enucleation of the prostate (HoLEP) compared with M-TURP. Compared with M-TURP, GreenLight photoselective vaporization of the prostate (PVP) was associated with a shorter hospital stay and fewer complications but no different short-term efficacy outcomes. CONCLUSIONS This meta-analysis shows that HoLEP is associated with more favorable outcomes than M-TURP in published RCTs. B-TURP and PVP have resulted in better perioperative outcomes without significant differences regarding efficacy parameters after short-term follow-up compared with M-TURP. Further studies are needed to provide long-term comparative data and head-to head comparisons of emerging techniques. PATIENT SUMMARY Bipolar transurethral resection of the prostate, photovaporization of the prostate, and holmium laser enucleation of the prostate have shown efficacy outcomes comparable with conventional techniques yet reduce the complication rate. The respective role of these new options in the surgical armamentarium needs to be refined to propose tailored surgical treatment for benign prostatic obstruction relief.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Tenon Hospital, University Paris 6, Assistance Publique-Hopitaux de Paris, Paris, France.
| | - Sascha Ahyai
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jean de la Rosette
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - Peter Gilling
- Department of Urology, Tauranga Hospital, Tauranga, New Zealand
| | - Christian Gratzke
- Department of Urology, Urologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Munich, Germany
| | - Kevin McVary
- Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy
| | - Henry Woo
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia
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Tang Y, Li J, Pu C, Bai Y, Yuan H, Wei Q, Han P. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis. J Endourol 2014; 28:1107-14. [PMID: 24754254 DOI: 10.1089/end.2014.0188] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of monopolar (M-TURP) and bipolar (B-TURP) transurethral resection of the prostate in benign prostatic hypertrophy (BPH) patients. MATERIALS AND METHODS Eligible randomized controlled trials (RCTs) were identified from electronic databases without language restrictions. Database search, quality assessment, and data extraction were independently performed. The primary postoperative outcomes of topical M-TURP and B-TURP were maximum flow rate (Qmax) and/or International Prostate Symptom Score (IPSS). Safety was estimated by TUR syndrome; need for transfusion; clot retention; bladder neck contracture (BNC); urethral stricture (US); and catheter removal time. Efficacy and safety were investigated using the Review Manager. RESULTS Thirty-one trials met the inclusion criteria. Pooled analysis revealed significant difference in efficacy between the M-TURP and B-TURP groups. Safety analysis revealed significant improvement in the TUR syndrome with B-TURP than with M-TURP. Pooled analysis revealed that clot retention was significantly higher in M-TURP than in B-TURP. Moreover, pooled analysis revealed no significant difference between both groups in the blood transfusion frequency or late complications (urethral strictures) and bladder neck constriction. CONCLUSIONS This systematic review indicates that B-TURP was significantly better in the result of Qmax and for decreasing the incidence of TUR syndrome and clot retention. No significant differences were observed in the nature of adverse events such as transfusions, retention after catheter removal, and urethral complications between both groups. Thus, B-TURP is the next generation "gold standard" for benign prostatic obstruction (BPO) because it is associated with a lower rate of clinically relevant complications such as TUR syndrome and clot retention.
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Affiliation(s)
- Yin Tang
- Department of Urology, West China Hospital, Sichuan University , Chengdu, P.R. China
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Karakose A, Aydogdu O, Atesci YZ. BiVap Saline Vaporization of the Prostate in Men With Benign Prostatic Hyperplasia: Our Clinical Experience. Urology 2014; 83:570-5. [DOI: 10.1016/j.urology.2013.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/03/2013] [Accepted: 10/13/2013] [Indexed: 11/29/2022]
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Omar MI, Lam TB, Alexander CE, Graham J, Mamoulakis C, Imamura M, Maclennan S, Stewart F, N'dow J. Systematic review and meta-analysis of the clinical effectiveness of bipolar compared with monopolar transurethral resection of the prostate (TURP). BJU Int 2013; 113:24-35. [PMID: 24053602 DOI: 10.1111/bju.12281] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
To compare monopolar and bipolar transurethral resection of the prostate (TURP) for clinical effectiveness and adverse events. We conducted an electronic search of MEDLINE, Embase, CENTRAL, Science Citation Index, and also searched reference lists of articles and abstracts from conference proceedings for randomised controlled trials (RCTs) comparing monopolar and bipolar TURP. Two reviewers independently undertook data extraction and assessed the risk of bias in the included trials using the tool recommended by the Cochrane Collaboration. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From the 949 abstracts that were identified, 94 full texts were assessed for eligibility and a total of 24 trials were included in the review. No statistically significant differences were found in terms of International Prostate Symptom Score (IPSS) or health-related quality of life (HRQL) score. Results for maximum urinary flow rate were significant at 3, 6 and 12 months (all P < 0.001), but no clinically significant differences were found and the meta-analysis showed evidence of heterogeneity Bipolar TURP was associated with fewer adverse events including transurethral resection syndrome (risk ratio [RR] 0.12, 95% confidence interval [CI] 0.05-0.31, P < 0.001), clot retention (RR 0.48, 95% CI 0.30-0.77, P = 0.002) and blood transfusion (RR 0.53, 95% CI 0.35-0.82, P = 0.004) Several major methodological limitations were identified in the included trials; 22/24 trials had a short follow-up of ≤1 year, there was no evidence of a sample size calculation in 20/24 trials and the application of GRADE showed the evidence for most of the assessed outcomes to be of moderate quality, including all those in which statistical differences were found. Whilst there is no overall difference between monopolar and bipolar TURP for clinical effectiveness, bipolar TURP is associated with fewer adverse events and therefore has a superior safety profile. Various methodological limitations were highlighted in the included trials and as such the results of this review should be interpreted with caution. There is a need for further well-conducted, multicentre RCTs with long-term follow-up data.
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Abstract
BACKGROUND Glycine 1.5% has long maintained a dominating role as an irrigating solution for monopolar transurethral resection of the prostate (TURP), as well as for certain other transurethral procedures. MATERIALS AND METHODS This review summarizes the findings of systematic experimental and clinical studies in which glycine 1.5% for irrigation was infused/absorbed and the outcome compared to at least one other irrigating fluid, including the isotonic saline used for bipolar TURP. RESULTS There were 11 studies in animals, 3 in volunteers and 6 in patients undergoing TURP. With only one exception, which is probably due to low power, these studies either show a poorer outcome after administration or absorption of glycine solution or else that glycine 2.2% is more toxic than glycine 1.5%. The poorer outcomes consisted of more tissue damage or higher mortality (animals) or more symptoms (volunteers and patients). CONCLUSION The safety of monopolar TURP would be improved by replacing glycine 1.5% with some other electrolyte-free fluid. The author argues that glycine 1.5% should be abandoned completely.
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Affiliation(s)
- Robert G Hahn
- Research Unit, Södertälje Hospital, Södertälje, and Department of Anaesthesia, Linköping University, Linköping, Sweden
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Mamoulakis C, Schulze M, Skolarikos A, Alivizatos G, Scarpa RM, Rassweiler JJ, de la Rosette JJ, Scoffone CM. Midterm Results from an International Multicentre Randomised Controlled Trial Comparing Bipolar with Monopolar Transurethral Resection of the Prostate. Eur Urol 2013; 63:667-76. [DOI: 10.1016/j.eururo.2012.10.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
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Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N'dow J, Nordling J, de la Rosette JJ. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013; 64:118-40. [PMID: 23541338 DOI: 10.1016/j.eururo.2013.03.004] [Citation(s) in RCA: 843] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/01/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To present a summary of the 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms (LUTS). EVIDENCE ACQUISITION We conducted a literature search in computer databases for relevant articles published between 1966 and 31 October 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the grade of recommendation for each treatment modality. EVIDENCE SYNTHESIS Men with mild symptoms are suitable for watchful waiting. All men with bothersome LUTS should be offered lifestyle advice prior to or concurrent with any treatment. Men with bothersome moderate-to-severe LUTS quickly benefit from α1-blockers. Men with enlarged prostates, especially those >40ml, profit from 5α-reductase inhibitors (5-ARIs) that slowly reduce LUTS and the probability of urinary retention or the need for surgery. Antimuscarinics might be considered for patients who have predominant bladder storage symptoms. The phosphodiesterase type 5 inhibitor tadalafil can quickly reduce LUTS to a similar extent as α1-blockers, and it also improves erectile dysfunction. Desmopressin can be used in men with nocturia due to nocturnal polyuria. Treatment with an α1-blocker and 5-ARI (in men with enlarged prostates) or antimuscarinics (with persistent storage symptoms) combines the positive effects of either drug class to achieve greater efficacy. Prostate surgery is indicated in men with absolute indications or drug treatment-resistant LUTS due to benign prostatic obstruction. Transurethral resection of the prostate (TURP) is the current standard operation for men with prostates 30-80ml, whereas open surgery or transurethral holmium laser enucleation is appropriate for men with prostates >80ml. Alternatives for monopolar TURP include bipolar TURP and transurethral incision of the prostate (for glands <30ml) and laser treatments. Transurethral microwave therapy and transurethral needle ablation are effective minimally invasive treatments with higher retreatment rates compared with TURP. Prostate stents are an alternative to catheterisation for men unfit for surgery. Ethanol or botulinum toxin injections into the prostate are still experimental. CONCLUSIONS These symptom-oriented guidelines provide practical guidance for the management of men experiencing LUTS. The full version is available online (www.uroweb.org/gls/pdf/12_Male_LUTS.pdf).
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Affiliation(s)
- Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
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Fagerström T, Nyman CR, Hahn RG. Degree of Vaporization in Bipolar and Monopolar Resection. J Endourol 2012; 26:1473-7. [DOI: 10.1089/end.2012.0177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tim Fagerström
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Section of Urology, Stockholm, Sweden
| | - Claes R. Nyman
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Section of Urology, Stockholm, Sweden
| | - Robert G. Hahn
- Research Unit, Södertälje Hospital, Södertälje, Sweden, and Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Akman T, Binbay M, Tekinarslan E, Tepeler A, Akcay M, Ozgor F, Ugurlu M, Muslumanoglu A. Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int 2012; 111:129-36. [DOI: 10.1111/j.1464-410x.2012.11266.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tolga Akman
- Department of Urology; Faculty of Medicine; Bezmialem Vakif University
| | - Murat Binbay
- Department of Urology; Haseki Training and Research Hospital; Istanbul; Turkey
| | - Erdem Tekinarslan
- Department of Urology; Haseki Training and Research Hospital; Istanbul; Turkey
| | | | - Muzaffer Akcay
- Department of Urology; Faculty of Medicine; Bezmialem Vakif University
| | - Faruk Ozgor
- Department of Urology; Haseki Training and Research Hospital; Istanbul; Turkey
| | - Mesut Ugurlu
- Department of Urology; Haseki Training and Research Hospital; Istanbul; Turkey
| | - Ahmet Muslumanoglu
- Department of Urology; Haseki Training and Research Hospital; Istanbul; Turkey
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Park HK, Paick SH, Lho YS, Jun KK, Kim HG. Reply by the Authors. Urology 2012. [DOI: 10.1016/j.urology.2011.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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