Clinical and technical aspects of bipolar transurethral prostate resection.

This review aims to provide an overview and critical assessment of the developments in transurethral electroresection in non-conductive and conductive irrigants. In the 1970s, measurements of the electric pathway in saline were performed for different locations of the neutral electrode. It was then concluded that the current pathway and the possible hazards of burn injuries to the patient should be investigated separately for each arrangement of the neutral electrode. The position and shape of the neutral electrode have decisive effects on the current flow in the patient. Thus, different electrode arrangements of the various bipolar resection systems need to be analysed separately. Furthermore, not only electrical power, but also conductivity and quality of the lubricant gel have to be considered as critical factors with regard to electrothermal injuries of the urethra. The supposedly better cutting quality seems to be based more on subjective observations than on scientific valid data. When performing "bipolar" TUR it is necessary to consider all electrotechnical and clinical aspects, particularly with regard to the potential risk of thermoelectrical urethral damage.

The Band Electrode: ongoing experience with a novel TURP loop to improve hemostasis in 265 patients.

INTRODUCTION: Intraoperative bleeding, one of the major complications of conventional transurethral resection of the prostate (TURP), has led to a search for various alternative methods of tissue ablation in patients with benign prostatic hyperplasia. In 1996, we introduced the newly designed Band Electrode, which combines a high degree of resection efficiency with a better hemostasis. MATERIAL AND METHODS: 265 consecutive patients with prostatism underwent TURP with the Band Electrode. This modified loop electrode does not consist of a thin wire but is rather a flat metal band with a width of 1.2 mm. International prostate symptom score (IPSS), Life Quality Index (L), peak urine flow and postvoid residual urine were evaluated pre- and postoperatively. Additionally, electrical parameters have been recorded with a specially designed high-frequency generator. RESULTS: Median IPSS decreased from 23 preoperatively to 8 and 9 at 12 (n = 194) and 24 months (n = 172), respectively (p < 0.001). Life Quality Index (L) dropped from 4 to 2 and 2, respectively (p < 0.001). Peak urine flow increased from 8.2 ml/s to 18.2 (at postoperative day 3), 17.8 and 17.4 ml/s, respectively (p < 0.001). Median postvoid residual urine decreased from 77 to 15, 22 and 21 ml, respectively (p < 0.001). Resected tissue mass averaged 25 (8-102) g, resection time was 36.5 (18-82) min. Indwelling catheters were removed 32 (24-72) h postoperatively. None of the patients required blood transfusions or showed signs of a TUR syndrome. Despite a 1.3 times higher power need, the total energy application in vivo was comparable to conventional TURP. CONCLUSIONS: This simple exchange of active electrodes leads to a superior hemostasis and thus safety in TURP. Resection speed, tissue ablation and total energy need remain identical.