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PP-06

Bipolar resection versus standard transurethral resection of the prostate: A prospective randomized study with 2-year follow-up

Saturday, 29 June, 2013 - 11:15
Board 1

Poster Presenter: R. Khiarikhiariramzi@gmail.com

Bipolar resection versus standard transurethral resection of the prostate
 A prospective randomized study with 2-year follow-up

 Khiari R, Mansouri O, Ghorbel J, Rebaï H, Zouari M B., Cherif M, Maarouf J, Dridi M,  Khouni H, Ghozzi S, Ben Rais N.

Tunis Military Hospital, Urology Department, Tunis, Tunisia

Introduction

Transurethral resection of prostate (TURP) is a standard operative procedure for patients with LUTS/benign prostate hypertrophy.

The main disadvantage of conventional TURP with monopolar current is the need to use non-conducting solutions such as glycine for carrying out resection wich entails the potential risk of TURP syndrome.

Recent technological advances have led to the development of new bipolar resection systems that permit normal saline to be used as irrigant.

Objectives

 To compare prospectively the  safety and efficacy of bipolar transurethral resection B-TURP (us­ing 0.9% saline irrigation) versus conventional monopolar resection of prostate M-TURP  (using 1.5% glycine irrigation) through a serie of 60 cases.

Materials & Methods

From January 2010 to April 2012, 60 patients who underwent TURP for HBP under locoregional anesthesia, have been recruited in our  prospective randomized study.
Inclusion criteria :

older> 50 years, DRE: unsuspected prostate, PSA< 4ng/ml, LUTS with HBP, Complicated HBP (Hematuria, Infection..), urine culture< 0

Exclusion criteria included :

Suspected prostate cancer, neurogenic bladder, previous prostate surgery, bladder tumour, urethral stricture, associated bladder stones and renal impairment.

Approval for this study was obtained from the local ethics committee.
Each patient signed an informed consent.
Our population was randomely divided in two groups:
Group I: 29 patients treated with M-TURP using Erbee cautery with cutting and coagulation respectively: 100 and 60
Group II: 31 patients treated with B-TURP Olympus bipolar resection system (TURIS). Generator settings for cutting and coagulation were 160-180 W and 100-120 W.
Postoperative follow-up at 1, 3, 6, 12 and 24 months with IPSS, Qmax.

Statistical analysis was made by Chi-square test, and ANOVA test with significant p< 0.05 (IC~95%).

Results

 Mean patient age, Mean serum tPSA, Mean IPSS, Mean Qmax and prostatic volume were similar in booth group (Table 1).

Mean resection time was 58.53 ± 10.81 min (GI) and 54.3 ± 12.2 min (GII) with no statistical difference, P< 0.05 (Table 2)

The average decrease in postoperative serum sodium in GI and GII groups were respectively 8.7 and 1.2 meq/l. (Table 3).

The mean duration of drainage was 52 ± 14 hours and 26.6 ± 11 hours respectively in monopolar and bipolar groups. This difference was statistically significant (p=0.031), as the difference in hospital stay (p=0.0021), (Table 4)
Improvements in IPSS and Qmax were comparable.at 1, 3, 6, 12, 18 and 24 months (Table 5)
 

Conclusion

Bipolar TURP offers comparable clinical results to monopolar procedur
Resection of large prostate without important electrolytic changes
The switch to bipolar TURP: the cost of equipment purchase and at use the fragility of the handle.
 

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