الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Monopolar (TURP) which considered the gold standard surgical therapy for men with LUTS due to BPH was recently challenged by TURis system that uses the bipolar energy for transurethral resection of the prostate, thus avoiding the need for glycine irrigation and its associated complications. This study were performed to compare the safety and efficacy of bipolar TURP with monopolar TURP, and to evaluate safety and efficacy of bipolar TURP in large prostate that were risky to be managed by monopolar technique. All Patients were preoperatively evaluated in detail by medical history, physical examination including DRE, laboratory investigations including preoperative serum sodium level, and imaging evaluation including abdomino-pelvic and transrectal ultrasound. IPSS was determined in all cases. Patients were further assessed by uroflowmetry (Qmax). Assessment of IPSS, Qmax, and PVR urine volume were omitted in men presented by urinary retention. In all groups; resection time, resected volume, resection speed and ratio were analyzed. Blood loss and decreases in Hemoglobin and sodium values were determined. Postoperative catheter time and hospital stay were recorded. Intraoperative and postoperative complications and the need for blood transfusion were noted. The improvements of IPSS, Qmax, and PVR urine after one and three months were also recorded for all patients. We found that, the differences were statistically insignificant regarding to operative time, resection time, resected tissue weight, and irrigation fluid volume used, But regarding to the resection rate and ratio there were highly significant differences in favor of the bipolar group, Perioperative blood loss was significantly less in bipolar group than in monopolar group and this difference became highly significant when correlated with resection time and resected volume. Serum Na+ DROP was highly significant less in bipolar group, and hemoglobin decline was less after bipolar TURP than monopolar TURP but the difference was insignificant; however there were 2 cases of blood transfusion in monopolar group and none of cases in bipolar group required blood transfusion. The mean postoperative bladder irrigation time, postoperative catheter time and postoperative hospital stay were significantly less in bipolar group than monopolar group. And compared to baseline there was a highly significant improvement for IPSS, Qmax, and PVR urine volume in each group at one and 3 months follow up period, but the differences between groups were insignificant except for Qmax at 3 months follow up which was significantly higher in the bipolar group. In bipolar group we reported no cases of perioperative complications and 2 cases of post operative complications with overall complications rate of (5.7%), while in monopolar group we reported 2 cases of perioperative complications and 5 cases of postoperative complications with overall complications rate of (20%), also we reported 2 cases needed blood transfusion in monopolar group, and none of bipolar group patients needed blood transfusion.
The bipolar special group section we found that bipolar technology make it possible to perform TURP for patients with very large prostate sizes that were risky to be performed by the standard monopolar technology, with a satisfactory safety profile and with favorable efficacy that can make bipolar TURP an excellent alternative to open prostatectomy with less intraoperative and postoperative morbidity, and with shorter and smoother postoperative course, and we expect that bipolar TURP will have a greater chance to become the golden standard in management of large prostate size despite the advances in other endoscopic and minimally invasive procedures such as Laser ablation, laser enucleation, and bipolar enucleation of the prostate, due to its familiarity to most of surgeon who were used to perform monopolar TURP for decades.
Conclusion We found that bipolar TURP can be a promising endoscopic treatment alternative for patients with BPH, showing comparable efficacy, shorter hospital stay, and faster recovery compared to standard monopolar TURP, with less incidence of intraoperative and postoperative complications, and with an additional advantage of allowing transurethral resection of large prostate effectively with a satisfactory safety profile. But due to the small size of this study and the short follow up period we see that our results need to be validated in a larger scale study with more extended follow up period.