The Clinical Effect of Bipolar Transurethral Resection in Saline of Benign Prostate Hyperplasia with Long Term Follow-Up

Abstract

Transurethral resection of the prostate (TURP) is considered as the gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Long-term follow-up of the clinical effect of bipolar transurethral resection of the prostate (B-TURP) in saline for BPH is required. Objective: To compare, with long term follow-up, the efficacy and safety of B-TURP in the treatment of BPH with prostate gland volumes of <45 ml, >45 ml, and larger than 60 ml. Materials and Methods: From January 2006 to December 2016, 318 patients with a mean age of 69.45 ± 8.37 years and a median prostate volume of 42 cm 3 (56.51 - 32.47) were treated with B-TURP by single urologist (SP) at the Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. We retrospectively analyzed the perioperative status of patients’ status follow-up for at least 6 months and up to 5 years. Post-void residual (PVR) and maximum flow rate (Qmax) were assessed preoperatively and postoperatively. Operative time, length of catheterization and hospitalization and complications were all reported. Results: The main indication for B-TURP was failure of medication (81.13%). Perioperative results showed no statistical significance among the groups in terms of catheterization days and the hospitalization length. During the follow-up, the improvement of postoperative parameters was compared with preoperative subscales, at different periods from baseline and after 24, 36, 48, and 60 months post treatment. PSA, Q max, PVR, and average flow rate were significantly different from pre-operation data ( p < 0.005). Regarding TURP complications, significant differences were observed in relation to transient incontinence (5.87%), urinary tract infection (2.5%), urinary retention/catheterization (1.57%), contracture of bladder neck (4.4%), urethral strictures (4.09%), recurrence of BPH (2.83%), hypotonic bladder (0.6%) and erectile dysfunction (7.8%). No TUR syndrome or secondary hemorrhage was recorded in the study. Interestingly, complications in patients on ongoing oral anticoagulation were not found. Conclusion: With long-term follow-up, B-TURP is a safe and effective technique for BPH management with prostate gland < 45 ml, > 45 ml and larger than 60 ml.