Bipolar versus monopolar transurethral resection of the prostate: a prospective randomized trial focusing on bleeding complications.

PURPOSE: We compare monopolar vs bipolar transurethral resection of the prostate in patients with benign prostatic hyperplasia, focusing on functional outcomes as well as rates of bleeding complications and the transurethral resection syndrome. MATERIALS AND METHODS: A total of 137 patients with benign prostatic hyperplasia (mean age 67 years, range 47 to 91) were prospectively randomly assigned to undergo monopolar (67) or bipolar (70) transurethral resection of the prostate. Patient characteristics of the 2 groups were similar. Hemoglobin (as a marker of blood loss) was measured preoperatively and perioperatively. I-PSS, I-PSS-QoL score, maximal flow rate and post-void residual urine volume were assessed preoperatively and 3 and 12 months postoperatively. Duration of surgery, indwelling catheter use and hospitalization were also documented, as were postoperative clot retention requiring removal by catheterization or surgery, and rates of bladder neck and/or urethral strictures. RESULTS: No significant perioperative differences were found in duration of surgery, catheterization or hospitalization, or in blood loss or rates of blood transfusion and transurethral resection syndrome. Postoperatively there were no significant differences in I-PSS or I-PSS-QoL scores, or rates of rehospitalization, clot retention, blood transfusions, reoperation or urethral strictures. However, bladder neck stricture occurred significantly more often in the bipolar group (8.5% vs 0%, p = 0.02). The 3 and 12-month followup showed significant and equal improvement in micturition in the 2 groups. CONCLUSIONS: Bipolar and monopolar transurethral resection of the prostate are effective and safe techniques for the surgical treatment of benign prostatic hyperplasia. The only significant difference between them was a significantly higher rate of bladder neck strictures with bipolar resection of the prostate.

Forget the blood, not the stone! Microhaematuria in acute urolithiasis and the role of early CT scanning.

BACKGROUND: Although urinalysis is simple and inexpensive to perform, the finding of microhaematuria on urinalysis may be unreliable for diagnosing urolithiasis. OBJECTIVE: To evaluate microhaematuria as a diagnostic marker for urolithiasis compared with low-dose unenhanced multidetector computed tomography (MDCT) as the "gold standard". SETTING: A level 1 emergency department in a tertiary referral university teaching hospital. DESIGN: Retrospective analysis. METHODS: A study was undertaken to assess whether the finding of microhaematuria was diagnostic for urolithiasis using a low-dose unenhanced MDCT-based diagnosis as the reference standard by reviewing the records of all patients who presented to the emergency department with colicky flank pain and underwent a CT scan between January 2003 and December 2005. RESULTS: Urolithiasis was present (as defined by low-dose unenhanced MDCT) in 507/638 patients (79%); 341/638 (53%) were true positive for urolithiasis, 76 (12%) were true negative, 55 (9%) were false positive and 166 (26%) were false negative. Microhaematuria as a test for urolithiasis in patients presenting to the emergency department therefore has a sensitivity, specificity, positive predictive value and negative predictive value of 67%, 58%, 86% and 31%, respectively. 58% of the urinalysis results were negative for haematuria in the subset of patients with significant alternative diagnoses. CONCLUSIONS: The sensitivity, specificity and negative predictive value of microhaematuria on urinalysis for urolithiasis using unenhanced MDCT as the reference standard were low. This suggests that, when urolithiasis is clinically suspected, unenhanced MDCT is indicated without urinalysis being a prerequisite.