Safety and Efficacy of Bipolar Versus Monopolar Transurethral Resection of the Prostate: A Comparative Study.

PURPOSE: Transurethral resection of the prostate (TURP) is considered gold standard for surgical treatment of benign prostatic hyperplasia (BPH). In this study, we aimed to compare post-operative clinical outcomes and adverse effects between monopolar and bipolar TURPs. MATERIALS AND METHODS: The study included 590 patients who underwent TURP by a single urologist (E.H.) between June 2006 and June 2014 with a diagnosis of BPH. Patients were divided into two groups as monopolar TURP (group 1, n = 300) and bipolar TURP (group 2, n = 290). Patients receiving oral anticoagulants or aspirin and those with prostate cancer diagnosis were not included in the study. Data regarding pre-operative age, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post voiding residual urine volume (PVR), serum prostate specific antigen (PSA) levels and prostate volume (Vp) of the patients were gathered from medical records. Groups were compared in terms of catheterization, operation time, hemoglobin (Hb) decrease, and IPSS, Qmax, and PVR values at post-operative 12th month follow-up visit. RESULTS: From pre-operative to post-operative period, IPSS, Qmax and PVR showed significant improvements within both groups (P < .001). When groups were compared with each other, bipolar TURP group had significantly lesser catheterization time and hemoglobin decrease than monopolar TURP group, while no significant differences were detected regarding all other variables. CONCLUSION: Bipolar and monopolar TURPs are both effective and safe treatment modality for BPH. Bipolar TURP is superior to conventional monopolar TURP in terms of catheterization time and Hb decrease.

The role of bipolar transurethral vaporization in the management of benign prostatic hyperplasia.

OBJECTIVES: A prospective randomized study was conducted to evaluate the safety and effectiveness of bipolar plasma vaporization with a novel electrode that produces vaporization of the tissue (transurethral vaporization of the prostate, TUVP) immersed in isotonic saline compared to the standard transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: From February 2009 to February 2010, 90 patients with BPH were randomized into two groups, and underwent conventional TURP (group 1) or TUVP (group 2) utilizing bipolar plasma vaporization with an innovative electrode (Olympus Winter & Ibe GmbH, Hamburg, Germany). International Prostate Symptom Scores (IPSS), transrectal ultrasonographic findings, maximal urine flow rates (Qmax), and postvoiding residual urine (PVRU) volumes of all cases were evaluated preoperatively and 1 month, 3 months, and 1 year postoperatively. Preoperative and postoperative serum hemoglobin, hematocrit and sodium concentrations of all patients were measured. All patients included in the study were monitored for 1 year. RESULTS: In patients in group 1 (n = 47; mean age: 64.7 ± 7.3 years) TURP was performed. The patients in group 2 (n = 43; mean age: 65.4 ± 8.9 years) underwent bipolar TUVP. Cases in the two study groups matched for demographic characteristics and clinical parameters were assessed. The evaluation of IPSS scores, PVRU, Qmax, and prostatic volumes of the patients 1 month, 3 months, and 1 year postoperatively did not reveal any significant differences between the two groups. In group 2 (TUVP), postoperative catheter indwelling times were significantly shorter, and Na serum concentrations were also markedly lower (p < 0.005). CONCLUSION: We detected similar effectiveness and morbidity rates in both groups. Bipolar TUVP has advantages such as shorter catheter indwelling times and hospital stays, and fewer bleeding episodes without any risk of transurethral resection syndrome. We believe that TUVP might be an alternative to TURP which is currently the 'gold standard' treatment in BPH.

Ginkgo biloba (EGb 761) usage attenuates testicular injury induced by testicular ischemia/reperfusion in rats.

INTRODUCTION: We investigated the effect of ginkgo biloba on testicular ischemia-reperfusion (IR) injury. MATERIALS AND METHODS: Thirty-two Wistar Albino rats were randomly assigned into four groups. Torsion/detorsion (T/D) performed to the rats in group 1, group 2 received ginkgo biloba (50 mg/day) for a month before T/D, group 3 received only gingko biloba (50 mg/day) for a month and group 4 was defined as sham group. After 1 month the testes were removed. RESULTS: Mean testicular malondialdehyde, nitrate and nitrite levels were significantly increased in group 1 compared to groups 2, 3 and 4 (P<0.05). The rats in group 3 provided basal histological appearance. In group 1, edema, congestion and hemorrhage between seminiferous tubules were predominant. In group 2, histopathologic features were markedly less than group 1. CONCLUSIONS: Malondialdehyde, nitrate and nitrite levels were increased after unilateral testicular torsion. EGb 761 has a protective effect on testicular injury induced by IR.

Comparison of transurethral prostate resection and plasmakinetic prostate resection according to cautery artefacts in tissue specimens.

OBJECTIVES: The objectives were to evaluate cautery artifacts histopathologically in tissue specimens after plasmakinetic prostate resection (PKRP) and transurethral prostatectomy (TURP), and compare the results of the two procedures. MATERIALS AND METHODS: The histopathological specimens of 65 patients who underwent PKRP and TURP were examined retrospectively. Tissue chips for examination were selected randomly. Artifactual pathological patterns that were identified in the specimens included: abnormal cellular orientation and spindling, artifactual cellular detachment from the underlying basement membrane, atypical cytological changes and stromal coagulative necrosis. Each pattern identified was awarded 1 point. The severity of the cautery artefact was graded as absent, mild, moderate or severe according to the sum of points in each specimen. RESULTS: In TURP, the artefacts were graded absent (9%), mild (6%), moderate (18.7%), and severe (65.6%) changes. In PKRP, the artefacts were graded absent (6%), mild (18.1%), moderate (36.3%), and severe (39.4%) changes. While the number of mild and moderate artefacts observed was higher in PKRP (P = 0.023), severe artefacts were observed in higher numbers with TURP (P = 0.034). No prostate cancer was detected during the follow-up period. CONCLUSIONS: It has been observed that the application of TURP causes fewer mild to moderate artefacts and PKRP causes fewer severe artefacts in the histopathological evaluation of specimens in comparison to each other.

Plasmakinetic prostate resection in the treatment of benign prostate hyperplasia: results of 1-year follow up.

AIM: In our randomized prospective study, we aimed to evaluate the efficiency of plasmakinetic resection of prostate (PKRP) by comparing the preoperative and postoperative results of the transurethral resection of prostate (TURP) and PKRP techniques which we administered in patients with benign prostate hyperplasia (BPH) in our clinic. METHODS: Of 57 patients for whom we thought an operative intervention was necessary, 30 cases in the first group had a TURP and 24 cases in the second group had a PKRP. International prostate symptom scores (I-PSS), uroflowmetry, measurement of residual urine amount and ultrasonography were performed for each patient both preoperatively and postoperatively (first month and first year). Operation times, urethral catheterization times, preoperative and postoperative Hb, Htc and serum Na values of the patients were compared and the complications of the groups were also compared. RESULTS: On first month and first year follow up between the groups, there was no significant statistical difference in I-PSS, maximum flow rate, average flow, residual urine and size of the prostate. The decrease in serum Na level was found to be significantly higher in the TURP group (P < 0.05). The operation times were not significantly different between the groups. While the postoperative catheterization time was 75.7 h in TURP group, it was found to be 42 h in PKRP group and it was clear that catheterization time was significantly shorter (P < 0001). CONCLUSION: It is obvious that PKRP is as efficient as TURP and it has a similar morbidity. In our opinion, PKRP makes a promising treatment for BPH with its advantages, such as early removal of postoperative urethral catheter, a shorter hospital stay and the absence of TUR syndrome risk.

Stoller afferent nerve stimulation in woman with therapy resistant over active bladder; a 1-year follow up.

AIM: In this prospective observational study, we investigated the efficacy of Stoller afferent nerve stimulation (SANS) in subjects with overactive bladder who failed anticholinergic treatment. METHODS: Thirty-five subjects with overactive bladder who failed therapy with oxybutynin participated in this study. Treatment (n = 35) was given once a week for 30 minutes for overall 10 weeks. In treatment, SANS device (Urosurge) was used. Subjects were assessed with 3-day voiding diary, SEAPI quality of life questionnaires and cystometry before therapy after completion of therapy and at one-year follow-up. RESULTS: In 54% (n = 19) of subjects complete recovery was obtained after treatment. Urgency and SEAPI were reduced significantly whereas urine volume increased significantly (p < 0.01). Complete recovery was maintained in eight of the 19 subjects at one year. CONCLUSIONS: SANS treatment has a short-term positive effect in patients with resistant overactive bladder. However, it was also established that efficacy was maintained at 1 year in only 23% of subjects.

Transurethral electrovaporization of the prostate: is it any better than standard transurethral prostatectomy? 5-year follow-up.

BACKGROUND AND PURPOSE: At present, transurethral resection of the prostate (TURP) is regarded as the most effective treatment for benign prostate hyperplasia (BPH). In the present randomized study, we compared TURP with transurethral electrovaporization of the prostate (TUVP). PATIENTS AND METHODS: A series of 77 BPH patients who underwent operation between 1996 and 2001 were included in the study, 40 who had TURP with a standard resection loop and 32 who had TUVP with a Spike loop. All available patients were evaluated preoperatively, at 1 month and 3 months after the operation (N=73), and 5 years after the operation (N=44). The International Prostate Symptom Score (IPSS), sexual function questionnaire, uroflowmetry (Qmax), postvoiding residual urine volume (PVR), and transrectal ultrasonography were used. In addition, postoperative serum sodium concentration, serum hematocrit, duration of catheterization, and operation time were compared. RESULTS: In the TUVP group, the mean IPSS decreased from 17.3 to 6.5, the PVR from 88 to 35 mL, and the prostate volume from 39 to 24 cc, while the Qmax increased from 6.3 to 12.9 mL/sec and the average flow from 2.6 to 7.9 mL/sec. In the TURP group, the mean IPSS decreased from 17.6 to 6.1, the PVR from 95 to 38 mL, and the prostate volume from 38 to 23 cc, while the Qmax increased from 5.9 to 13.2 mL/sec and the average flow from 2.4 to 8.3 mL/sec. Thus, significant improvements were observed in both groups, and the differences between them 5 years later were not significant P>0.05). Postoperative serum hemoglobin and hematocrit were significantly lower in the TURP group (P>0.05). However, no difference was seen in serum sodium concentrations. Also, there was no difference in the duration of the operations. The catheterization period was 22+/-5.7 hours in the TUVP group, while it was 75.7+/-10.5 hours in the TURP group (P<0.001). When morbidities observed during follow-up were evaluated, no significant difference was seen. CONCLUSIONS: The TUVP procedure is as effective as TURP with similar morbidity. The advantages of TUVP are that the urethral catheter is withdrawn earlier, hospitalization is shorter, and bleeding is less. Its disadvantage is that tissue cannot be sampled for histologic diagnosis. In our opinion, in order to exploit the advantages of this technique, TUVP should be preferred in elderly patients without any suspicion of prostate cancer for whom bleeding during operation is a source of risk.