Role Of Prostate Ultrasonography To Predict The Efficacy Of Bipolar Prostatectomy In Benign Prostatic Hyperplasia.

Objectives: To evaluate the role of prostatic ultrasonography in predicting the clinical outcomes of bipolar transurethral resection of the prostate. Method: The prospective study was conducted at the Urology Department, Kafrelsheikh University Hospital, Cairo, Egypt from December 2018 to June 2019, and comprised male patients complaining of lower urinary tractsymptoms due to benign prostatic hyperplasia. The patients were subjected to pelvi-abdominal and transrectal ultrasonography and values were noted for the international prostate symptom score, uroflowmetry, post-void residual urine volume, ejaculatory domain, and the erectile function domain of the international index of erectile function. The safety of the procedure was assessed using the modified Clavien classification of complications. This was followed by cystourethroscopy under spinal anaesthesia, and then by bipolar resection of the prostate by a single experienced urologist. Operating time, length of hospitalisation, intraoperative and postoperative complications, catheterization time, and changes in haemoglobin levels were recorded. All evaluations were done at baseline and postoperatively at 1, 3 and 6 months. Data was analysed using SPSS 21. RESULTS: There were 109 male patients with mean age 65.53±6.27 years, mean body massindex 24.6±1.7kg/m2 . Mean total prostate volume at baseline was 86.32±43.61gm (range: 30-195m). There was a significant decrease postoperatively (p<0.001). This was associated with a concomitant improvement of international prostate symptoms score, uroflowmetry and post-void residual urine volume over six-month follow-up (p<0.001 ). Overall, 63(57.8%) subjects were sexually active, and there was no significant difference in the international index of erectile function score at baseline and postoperatively (p>0.05). CONCLUSIONS: Prostate ultrasonography can be used as a single investigating tool to evaluate the clinical outcomes after bipolar transurethral resection of the prostate.

Comparison of holmium laser, bipolar and conventional monopolar transurethral resection of bladder tumour in primary non-muscle invasive bladder cancer.

Objectives: To compare the efficiency and safety profile of conventional monopolar, bipolar plasmakinetic and holmium laser techniques for transurethral resection of bladder tumour. Method: The prospective comparative study was conducted from July 2019 to May 2021 after approval from the ethicsreview committee of Kafrelsheikh University, Egypt, and comprised patients of either gender with primary non muscle invasive bladder cancer who qualified for transurethral resection of bladder tumour. The patients were stratified into low-risk group A, intermediate risk group B and high-risk group C in accordance with the guidelines of the European Association of Urology. Comprehensive cystoscopy and panendoscopy were done in all cases. Once panendoscopy was done, tumour resection was performed with monopolar resectoscope in group A, plasmakinetic resectoscope in group B and holmium laser in group C). Data was collected at preoperative, peroperative, postoperative and follow-up stages. Data was analysed using SPSS 21. RESULTS: Of the 84 patients, 67(79.76%) were males and 17(20.23%) were females. There were 27(32.14%) patients in group A; 21(77.8%) males and 6(22.2%) females withy mean age 60.63±11.76 years. Group B had 32(38%) patients; 26(81.2%) males and 6(18.8%) females with mean age 65.34±7.55 years. Group C had 25(29.76%) patients; 20(80%) males and 5(20%) females with mean age 59.48±12.6 years. The mean follow-up period was 12.97±2.70 months in group A, 12.81±2.75 monthsin group B and 13.48±3.3 monthsin group C. Visualised complete resection was done in 23(85.8%) group A patients, 29(90.6%) group B patients and 24(96%) group C patients(p=0.018). Visualised complete resection, tumour multiplicity, tumour size, catheter duration, and hospital stay were significant predictors (p<0.05). Survival analysis showed 26(96.3%), 30(93.75%) and 25(100%) cases in groups A, B and C, respectively. CONCLUSIONS: Bipolar plasmakinetic and holmium laser techniques were found to be more effective and safer than the conventional monopolar technique for transurethral resection of bladder tumour in patients with primary non-muscle invasive bladder cancer.