According to the EAU ( European Association of Urology) guidelines, the “gold standard” approaches for surgical treatment BPH are monopolar TURP for patients when the prostate size ranges from 30 to 80 cc, and open prostatectomy or holmium laser enucleation (HoLEP) or Bipolar TURP for patients with prostate size > 80 ccs . Bipolar TURP is associated with a high success rate reflected by substantial improvements in symptom scores, urinary flow rate, PVR, and low retreatment on long-term follow-up. Bipolar electrosurgical technology is a new modality, where the current flows from the loop (the active electrode) to the loop tube and the resectoscope itself . In our study, 109 patients underwent bipolar TURP using saline irrigation with a good success rate postoperatively.
The correlation between prostate volume and many variables of BPH has been evaluated using different investigations, e.g., ultrasonography and cystourethroscopy. While Green et al. concluded that TRUS provided an accurate measurement of the prostate volume and could be used to evaluate the response to therapy for patients with BPH . In our study, we use TRUS to evaluate the preoperative and postoperative prostate volume. We also detected that pelvi-abdominal ultrasonography is also essential for the assessment of PVR and urinary bladder changes.
The efficacy of bipolar TURP had been measured by the impact of such technique on residual prostatic tissue volume, Qmax, IPSS, and PVR, compared to baseline, which was provided at follow-up periods of 1,3 and 6 months. In our study, residual tissue measured by ultrasonography 1,3,6 months after TURP provided a good estimate of the clinical result; the correlation of the residual tissue with all outcome variables suggested that the smaller the residual tissue, the greater the improvement in the outcome variables. The explanation is that the better clinical result after TURP correlates significantly with the completeness of resection of the obstructing adenoma, and the maximum effect was obtained at six months.
In our study, The reported progressive decrease in the estimated residual prostate volume was associated with a dramatic improvement of IPSS, Qmax, and PVR over the six months of follow up. The mean preoperative prostate volume estimated by ultrasonography, IPSS, Qmax, PVR were 86.32 ± 43.61, 25.68 ± 2.67, 8.94 ± 2.70, (median) 100ml, respectively (P < 0.001 ). The mean postoperative (at 6 month) prostate volume estimated by ultrasonography, IPSS, Qmax, PVR were 23.67 ± 6.03, 4.87 ± 3.30, 19.77 ± 5.22, (median) 15ml, respectively (P < 0.001 ).
In agreement with our results, Hassona et al. In bipolar TURP group, the mean postoperative prostate size has decreased from 63.33 ± 9.71 to 25.87 ± 3.76 at three months follow up ultrasound and also showed improved mean Qmax from 8.47 ± 1.36 to 19.87 ± 3.78 at three months; the mean PVR improved from 131.20 ± 32.48 to 30.93 ± 7.06 at three months . ZhengX et al., in their study, indicated that bipolar TURP had improvement in 6-month IPSS, 1-, 6- and 12-month Qmax, 6-month PVR, and 3- and 6-month QoL . Kumar et al. showed improvement of Qmax in Bipolar TURP group from 7.05 ± 1.87 to 18.07 ± 5.88, 19.27 ± 5.17, 20.48 ± 5.15, 19.93 ± 5.17 1,3,6,12 months, respectively .
Hastak et al. suggested that normal prostate tissue, which is compressed by the enlarged adenoma, is released after resecting the adenoma and occupies part of the resection cavity . The same observation was reported in our study explaining the residual tissue at six months of follow up, despite resection of the enlarged adenoma of the transitional zone.
Suspected mechanisms in ED following TURP are thermal and/or chemical injuries of the erectile nerves traveling just beneath the prostatic capsule and may be due to the psychological effects post TURP [17,18,19,20]. In our study, according to IIEF-15 validated questionnaire, no change was observed in IIEF-ED scores at 3,6 months postoperatively compared with the preoperative scores. For the ejaculatory function, our study reported a significant decrease at 3, 6 months of follow up.
Mean operative time was 63.05 ± 20.53 in our study. Bogdan et al. have demonstrated in their study that the mean operative time was 52.1 and 55.6 minutes in the bipolar TURP and Plasma kinetic vaporization of the prostate (PKVP) group, respectively . Our study's longer operative time is that a considerable number of our patients presented with a larger prostate adenoma size than those described in their study. The mean catheterization time and mean hospital stay were 4.86 ± 1.84 and 2.13 ± 0.53 days. In similar studies, Tefekli and de Sio et al. reported shorter catheterization and hospitalization times in the bipolar resection group [22,23].
Three patients ( 2.8% ) of our study needed a blood transfusion after the surgery comparison to previously published studies where the transfusion rate in Bipolar TURP was 3.4% [24,25]. Bogdan et al., in their study, stated that 5.9% of patients who underwent Bipolar TURP needed recatheterization .while in this study, the cases needed recatheterization was nine patients (8.3%) due to clot retention .