Peer-review started: September 25, 2018
First decision: November 20, 2018
Revised: November 22, 2018
Accepted: January 21, 2019
Article in press: January 22, 2019
Published online: March 12, 2019
Trans-urethral resection of prostate (TURP) is one of the most commonly performed operations in urology to treat bladder outflow obstruction (BOO) in men as well as a key endo-urological training tool in the British National Health Service (NHS) for training junior urologists. The working hypothesis is that prostate resection speed (PRS) in the context of bipolar TURP surgery, is not a key factor in major complication rates or broad patient outcomes at 3 mo after surgery, and therefore supervising consultants should not focus primarily on resection speed when teaching TURP.
The study was motivated to identify whether resection speed during TURP training should be a key factor.
The main objective was to identify whether TURP resection speed affected significant complication and broad outcomes at 3 mo. The study found that resection speed did not correlate with significant complication and broad outcomes at 3 mo. The authors propose that PRS should not be a key factor during TURP training.
Participants included: all Bipolar TURPs undertaken between 13/04/2016 and 27/06/2017. Exclusions: patients undergoing concomitant operations or where intra-operative equipment problems occurred. Patients identified via operative logbooks and case notes retrieved electronically.
The study found that PRS did not correlate with significant complication and broad outcomes at 3 mo. The authors propose a similar study with increased power and qualitative assessment of symptomatic improvement in relation to PRS.
PRS did not correlate with significant complication and broad outcomes at 3 mo. The authors conclude that PRS should not be a key factor during TURP training as increasing experience will lead to natural acquisition of speed. PRS is not a cardinal factor in bipolar TURP surgery for significant complication rates or broad outcomes 3 mo after surgery. In the era of monopolar TURP resection, PRS was highly relevant due to risks of TURP syndrome. In bipolar surgery the use of saline as irrigation fluid minimises this risk. Therefore the authors propose a paradigm shift in training whereby less focus is placed on PRS and greater emphasis on sound safe surgical technique.
The authors propose a paradigm shift in training whereby less focus is placed on PRS and greater emphasis on sound safe surgical technique. The authors propose a similar study with increased power and qualitative assessment of post-operative symptomatic improvement in relation to PRS. Prospective high-powered study with IPSS evaluation pre- and post-TURP and correlation with PRS.