UroToday.com - For many decades, transurethral resection of the prostate (TURP) has been considered the benchmark of surgical management for BPH. The ideal irrigant for TURP would be a nonconductive medium that does not interfere with diathermy, has a high degree of translucency, has osmolality similar to that of serum, and causes only minimal side effects when absorbed. Traditionally, a 1.5% glycine solution is used for irrigation during TURP. The absorption of irrigating fluid is a consistent cause of complications. One unique complication of TURP is transurethral resection (TUR) syndrome, a dilutional hyponatremia that occurs when the irrigant solution is absorbed into the bloodstream. Additionally, there are still concerns regarding other complications (eg, bleeding, the need for blood transfusion, urethral strictures, bladder neck contracture).

There are many alternatives and modifications of TURP that aim to improve the outcome and reduce the associated morbidity. The most significant recent technical modification of TURP is the incorporation of bipolar technology. Bipolar TURP (B-TURP) addresses a fundamental flaw of monopolar TURP (M-TURP) by allowing resection in normal saline, and the technique seems to be promising. The goal of B-TURP is to allow immediate debulking of a large obstructing prostatic adenoma with the same benefits of monopolar resection, but with a lower incidence of complications from systemic absorption of hypotonic irrigant.

I planned to conduct a prospective randomized controlled study to compare transurethral resection of the prostate in saline (TURPis) using the TURis system with the standard M-TURP, to determine level 1b evidence of safety and efficacy.

Patients with symptomatic benign prostatic hyperplasia (BPH), aged 50 years or older, with estimated prostate volume (PV) ≤ 80 mL, maximum flow rate (Qmax) ≤ 15 mL/s, and an International Prostate Symptom Score (IPSS) ≥ 14 were included in the study. A total of 38 patients ranging in age from 52-78 years completed the study. Patients were randomly allocated to receive either TURP or TURPis in a 1:1 ratio. Primary endpoints were:

(1) declines in serum sodium (Na+) and hemoglobin (Hb);

(2) incidence of TUR syndrome; and

(3) changes in IPSS, quality of life (QoL), and maximum flow rate (Qmax).

Secondary endpoints included:

(1) differences in procedure, irrigation, catheterization, and hospitalization times;

(2) variations in blood transfusion, recatheterization, and clot retention rates;

(3) changes in prostate specific antigen (PSA), prostate volume (PV), and postvoid residual urine (PVR); and

(4) incidences of postoperative complications. Patients were followed for 6 months.

The mean PV for the entire study population was 44.1 mL. There were no significant differences between groups on any of the baseline variables. The patients receiving TURPis had significantly smaller declines for both of serum sodium and hemoglobin. When compared with the patients receiving TURP, those receiving TURPis had significantly shorter mean times for the procedure, irrigation, catheterization, and hospitalization. The patients receiving TURPis had also significantly fewer clot retentions than the patients receiving TURP. None of the patients in either group required blood transfusion or demonstrated TUR syndrome. One patient receiving TURP developed a bladder neck contracture; 1 patient receiving TURPis experienced urethral stricture. Efficacy outcomes (IPSS, QoL, Qmax, PSA, PV, and PVR) revealed that all changes from baseline were statistically significant in both groups. However, none of the between-group comparisons reached statistical significance.

We concluded that TURPis has the potential to be the new gold standard for BPH treatment. The present study demonstrated that over a 6-month period, TURPis has efficacy similar to TURP. TURPis has additional advantages of smaller declines in serum sodium and hemoglobin, reduced irrigation and catheterization times, shorter hospital stay, and elimination of TUR syndrome.

Written by Taha Abo-Almagd Abdel-Meguid, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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