Bipolar transurethral resection of the prostate causes deeper coagulation depth and less bleeding than monopolar transurethral prostatectomy.

OBJECTIVE: To investigate the hemostatic capability of mono- and bipolar transurethral resection of the prostate by comparing the perioperative blood loss with the coagulation depth achieved with mono- and bipolar transurethral resection of the prostate. METHODS: A total of 136 patients with lower urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo transurethral resection of the prostate using either a monopolar system (Karl Storz, Co., Tuttlingen, Germany) or a gyrus PlasmaKinetic bipolar system (Gyrus-ACMI Corporation, Maple Grove, MN). The operative time, resected tissue weight, decline in serum sodium and hemoglobin, postoperative bleeding, and the coagulation depth were compared. RESULTS: There were no statistically significant differences in operative time, resected tissue weight, and capsular perforation. The decline in hemoglobin and serum sodium was 1.15 ± 0.53 g/dL and 4.57 ± 0.71 mmol/L in monopolar transurethral resection of the prostate group, respectively, whereas they fell only 0.71 ± 0.42 g/dL and 2.02 ± 0.53 mmol/L in the bipolar transurethral resection of the prostate group, respectively (P <.001). The rate of postoperative bleeding was significantly higher in the monopolar transurethral resection of the prostate group (P = .027). The coagulation depths with mono- and bipolar transurethral resection of the prostate were 127.56 ± 27.76 and 148.48 ± 31.64 µm, respectively (P <.001). CONCLUSION: Our results demonstrate that bipolar transurethral resection of the prostate causes less intraoperative hemoglobin drop and postoperative bleeding than monopolar transurethral resection of the prostate, which may be associated with the deeper coagulation depth of bipolar transurethral resection of the prostate.

Bacteriuria after bipolar transurethral resection of the prostate: risk factors and correlation with leukocyturia.

OBJECTIVES: To analyze the risk factors of postoperative bacteriuria and the correlation with leukocyturia after bipolar transurethral resection of the prostate (TURP). METHODS: A total of 121 noncatheterized patients with sterile preoperative urine undergoing bipolar TURP for benign prostatic hyperplasia (BPH) were entered into the prospective study. All patients received antibiotic prophylaxis with ceftriaxone. Two urine specimens of each patient, one for urinalysis (urinary leukocyte count) and one for urine culture, were collected on removal of the catheter, 1 and 4 weeks after surgery. The risk factors of postoperative bacteriuria and correlation with leukocyturia were investigated. RESULTS: The incidence of bacteriuria after bipolar TURP was 18.2% (22/121). Multivariate analysis documented 3 independent risk factors of postoperative bacteriuria: operating time >60 minutes (P = .014), duration of catheterization >3 days(P = .001), and disconnection of the closed urine drainage system (P <10(-3)). The mean leukocyte counts in urine were 405.3, 389.5, and 113.8/µL on removal of the catheter, 1 and 4 weeks after surgery, respectively. Of 363 urine specimens, the mean concentration of leukocytes with and without bacteriuria were 323.9 and 297.6/µL, respectively (P >.05). There was no significant correlation between bacteriuria and leukocyturia (>10 leukocytes/high power field (P >.05). CONCLUSIONS: The results of our study have shown that the operating time, duration of catheterization, and disconnection of the closed urine drainage system may influence the occurrence of bacteriuria after bipolar TURP, and leukocyturia cannot reflect the possibility of postoperative bacteriuria.

[Bipolar transurethral resection of the prostate versus monopolar transurethral prostatectomy: a pathological study in a canine model].

OBJECTIVE: To compare the postoperative depths of the coagulation zones and pathological changes between bipolar transurethral resection of the prostate with plasmakinetic energy (PKRP) and monopolar transurethral prostatectomy (TURP) in canines. METHODS: Twenty-five male dogs were randomly divided into a PKRP group (n = 12), a TURP group (n = 12) and a sham-operation control group (n = 1). The dogs were sacrificed, their prostates harvested at 0 week (immediately after surgery), 1 week, 2 weeks and 8 weeks postoperatively and sectioned for pathologic analysis and measurement of the coagulation zones. RESULTS: At 0, 1 and 2 weeks after the operation, the coagulation depths were (237.73 +/- 20.12) microm, (113.03 +/- 16.65) microm and (106.01 +/- 16.36) microm in the PKRP group, and (200.75 +/-19.34) microm, (129.46 +/- 17.81) microm and (116.04 +/- 25.67) microm in the TURP group (P < 0.01). At 8 weeks, the coagulation zones completely peeled off and the wounds were covered by regenerated urothelial in both of the groups. At 0, 1, 2 and 8 weeks, different inflammatory reactions were observed in the prostates of the PKRP and TURP groups, with some glandular lumens beneath the coagulation zones expanded and epithelia damaged. However, none of these phenomena occurred in the sham-operation control group. CONCLUSION: Pathologically, PKRP and TURP inflicted basically similar effects on the prostate of the canine. However, the coagulation zone was deeper intraoperatively and became thinner postoperatively with the former than with the latter, which suggests that PKRP causes less bleeding and less penetrative thermal damage than TURP.