Yonsei Med J.  2012 Jul;53(4):734-741. 10.3349/ymj.2012.53.4.734.

Five-Year Follow-Up Results of a Randomized Controlled Trial Comparing Bipolar Plasmakinetic and Monopolar Transurethral Resection of the Prostate

• Xie CY
• Zhu GB
• Wang XH
• Liu XB

• KMID: 1716871
• DOI: http://doi.org/10.3349/ymj.2012.53.4.734

Abstract

PURPOSE
To report the 5-year follow-up results of a randomized controlled trial comparing bipolar transurethral resection of the prostate (TURP) with standard monopolar TURP for the treatment of benign prostatic obstruction (BPO).
MATERIALS AND METHODS
A total of 220 patients were randomized to bipolar plasmakinetic TURP (PK-TURP) or monopolar TURP (M-TURP). Catheterization time was the primary endpoint of this study. Secondary outcomes included operation time, hospital stay, as well as decline in postoperative serum sodium and hemoglobin levels. All patients were assessed preoperatively and followed-up at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Parameters assessed included quality of life, transrectal ultrasound, serum prostate-specific antigen level, postvoid residual urine volume, maximum urinary flow rates (Qmax), and International Prostate Symptom Score. Patient baseline characteristics, perioperative data including complications, and postoperative outcomes were compared. Complication occurrence was graded according to the modified Clavien classification system.
RESULTS
PK-TURP was significantly superior to M-TURP in terms of operation time, intraoperative irrigation volume, resected tissue weight, decreases in hemoglobin and sodium, postoperative irrigation volume and time, catheterization time, and hospital stay. At 5 years postoperatively, efficacy was comparable between arms. No differences were detected in safety outcomes except that the clot retention rate was significantly greater after M-TURP.
CONCLUSION
Our results indicate that PK-TURP is equally as effective in the treatment of BPO, but has a more favorable safety profile in comparison to M-TURP. The clinical efficacy of PK-TURP is long-lasting and comparable with M-TURP.

Keyword

Randomized controlled trial; bipolar plasmakinetic; transurethral resection of the prostate; follow-up

MeSH Terms

Aged
Aged, 80 and over
Humans
Male
Middle Aged
Prostate/*surgery
Transurethral Resection of Prostate/adverse effects/*methods
Treatment Outcome

Reference

1. Lowe FC. Goals for benign prostatic hyperplasia therapy. Urology. 2002. 59:2 Suppl 1. 1–2.

2. Reich O, Gratzke C, Stief CG. Techniques and long-term results of surgical procedures for BPH. Eur Urol. 2006. 49:970–978.

3. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006. 50:969–979.

4. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008. 180:246–249.

5. Mamoulakis C, Trompetter M, de la Rosette J. Bipolar transurethral resection of the prostate: the 'golden standard' reclaims its leading position. Curr Opin Urol. 2009. 19:26–32.

6. Mamoulakis C, Ubbink DT, de la Rosette JJ. Bipolar versus monopolar transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol. 2009. 56:798–809.

7. Mamoulakis C, Efthimiou I, Kazoulis S, Christoulakis I, Sofras F. The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol. 2011. 29:205–210.

8. Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, et al. Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate. BJU Int. 2012. 109:240–248.

9. Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010. 58:384–397.

10. Burke N, Whelan JP, Goeree L, Hopkins RB, Campbell K, Goeree R, et al. Systematic review and meta-analysis of transurethral resection of the prostate versus minimally invasive procedures for the treatment of benign prostatic obstruction. Urology. 2010. 75:1015–1022.

11. Mamoulakis C, de la Rosette JJ, Ubbink DT. Re: Burke et al.: systematic review and meta-analysis of transurethral resection of the prostate versus minimally invasive procedures for the treatment of benign prostatic obstruction (Urology 2010;75:1015-1022). Urology. 2010. 75:1235–1236.

12. Yoon CJ, Kim JY, Moon KH, Jung HC, Park TC. Transurethral resection of the prostate with a bipolar tissue management system compared to conventional monopolar resectoscope: one-year outcome. Yonsei Med J. 2006. 47:715–720.

13. Yang S, Lin WC, Chang HK, Hsu JM, Lin WR, Chow YC, et al. Gyrus plasmasect: is it better than monopolar transurethral resection of prostate? Urol Int. 2004. 73:258–261.

14. Erturhan S, Erbagci A, Seckiner I, Yagci F, Ustun A. Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1-year follow-up. Prostate Cancer Prostatic Dis. 2007. 10:97–100.

15. de Sio M, Autorino R, Quarto G, Damiano R, Perdonà S, di Lorenzo G, et al. Gyrus bipolar versus standard monopolar transurethral resection of the prostate: a randomized prospective trial. Urology. 2006. 67:69–72.

16. Ho HS, Cheng CW. Bipolar transurethral resection of prostate: a new reference standard? Curr Opin Urol. 2008. 18:50–55.

17. Huang X, Wang XH, Qu LJ, Pu XY, Zeng X. Bipolar versus monopolar transurethral resection of prostate: pathologic study in canines. Urology. 2007. 70:180–184.

18. Bhansali M, Patankar S, Dobhada S, Khaladkar S. Management of large (>60 g) prostate gland: PlasmaKinetic Superpulse (bipolar) versus conventional (monopolar) transurethral resection of the prostate. J Endourol. 2009. 23:141–145.

19. Chen Q, Zhang L, Fan QL, Zhou J, Peng YB, Wang Z. Bipolar transurethral resection in saline vs traditional monopolar resection of the prostate: results of a randomized trial with a 2-year follow-up. BJU Int. 2010. 106:1339–1343.

20. Fagerström T, Nyman CR, Hahn RG. Bipolar transurethral resection of the prostate causes less bleeding than the monopolar technique: a single-centre randomized trial of 202 patients. BJU Int. 2010. 105:1560–1564.

21. Michielsen DP, Coomans D, Braeckman JG, Umbrain V. Bipolar transurethral resection in saline: the solution to avoid hyponatraemia and transurethral resection syndrome. Scand J Urol Nephrol. 2010. 44:228–235.

22. Issa MM, Young MR, Bullock AR, Bouet R, Petros JA. Dilutional hyponatremia of TURP syndrome: a historical event in the 21st century. Urology. 2004. 64:298–301.

23. Rassweiler J, Schulze M, Stock C, Teber D, De La Rosette J. Bipolar transurethral resection of the prostate--technical modifications and early clinical experience. Minim Invasive Ther Allied Technol. 2007. 16:11–21.

24. Autorino R, Damiano R, Di Lorenzo G, Quarto G, Perdonà S, D'Armiento M, et al. Four-year outcome of a prospective randomised trial comparing bipolar plasmakinetic and monopolar transurethral resection of the prostate. Eur Urol. 2009. 55:922–929.

25. Michielsen DP, Coomans D. Urethral strictures and bipolar transurethral resection in saline of the prostate: fact or fiction? J Endourol. 2010. 24:1333–1337.

26. Tefekli A, Muslumanoglu AY, Baykal M, Binbay M, Tas A, Altunrende F. A hybrid technique using bipolar energy in transurethral prostate surgery: a prospective, randomized comparison. J Urol. 2005. 174(4 Pt 1):1339–1343.