INTRODUCTION: The objective of this prospective randomized controlled study was to compare transurethral resection of the prostate in saline (TURPis) using the TURis system with the standard monopolar TURP, to determine evidence of safety and efficacy.
METHODS: Patients with symptomatic benign prostatic hyperplasia (BPH), aged 50 years or older, with estimated prostate volume (PV) ≤ 80 mL, maximum flow rate (Qmax) ≤ 15 mL/s, and an International Prostate Symptom Score (IPSS) ≥ 14 were included in the study. A total of 38 patients ranging in age from 52-78 years completed the study. Patients were randomly allocated to receive either TURP or TURPis in a 1:1 ratio. Primary endpoints were: (1) declines in serum sodium (Na+) and hemoglobin (Hb); (2) incidence of TUR syndrome; and (3) changes in IPSS, quality of life (QoL), and maximum flow rate (Qmax). Secondary endpoints included: (1) differences in procedure, irrigation, catheterization, and hospitalization times; (2) variations in blood transfusion, recatheterization, and clot retention rates; (3) changes in prostate specific antigen (PSA), prostate volume (PV), and postvoid residual urine (PVR); and (4) incidences of postoperative complications. Patients were followed for 6 months
RESULTS: The mean PV for the entire study population was 44.1 mL (SD = 2.0; range, 29-78 mL). There were no significant differences between groups on any of the baseline variables. Mean (standard deviation) declines in serum Na+ were 4.8 (1.1) and 0.9 (0.3) mmol/L for the patients receiving TURP and TURPis, respectively (P < .001). Mean declines in Hb were 1.5 (0.6) and 0.7 (0.4) g/dL for the patients receiving TURP and TURPis, respectively (P < .002). The patients receiving TURPis had significantly smaller declines for both of these variables. When compared with the patients receiving TURP, those receiving TURPis had significantly shorter mean times for the procedure (P < .03), irrigation (P < .001), catheterization (P < .02), and hospitalization (P < .02). The patients receiving TURPis had significantly fewer clot retentions (P < .05) than the patients receiving TURP. None of the patients in either group required blood transfusion or demonstrated TUR syndrome. One patient receiving TURP developed a bladder neck contracture; 1 patient receiving TURPis experienced urethral stricture. Efficacy outcomes (IPSS, QoL, Qmax, PSA, PV, and PVR) revealed that all changes from baseline were statistically significant in both groups (P < .05). However, none of the between-group comparisons reached statistical significance.
CONCLUSION: TURPis has the potential to be the new gold standard for BPH treatment. The present study demonstrated that over a 6-month period, TURPis has efficacy similar to TURP. TURPis has additional advantages of smaller declines in serum sodium and hemoglobin, reduced irrigation and catheterization times, shorter hospital stay, and elimination of TUR syndrome.
KEYWORDS: Benign prostatic hyperplasia; Bipolar; Bipolar transurethral resection; Prostate; Transurethral resection syndrome
CORRESPONDENCE: Dr. Taha Abo-Almagd Abdel-Meguid, PO Box 80215, Jeddah 21589, Saudi Arabia ().
CITATION: UroToday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.05