الفهرس 
ENDOSCOPIC ASPECTS OF PROSTATE ANATOMYOnly 14 pages are availabe for public view
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Abstract
T
he most common cause of LUTS in the aging male is Benign Prostatic Hyperplasia (BPH), accounting for more than 50% of men aged 60–69 years and as many as 90% of men aged 70–89 years.
Patients with mild LUTS are commonly reassured having them treated with watchful waiting or lifestyle modification, while medical therapy is targeting those who complain of moderate LUTS, negatively affecting their QOL with no absolute surgical indication.
Patients who cannot tolerate the drugs, whose disease is refractory to treatment, who develop complications of BPH while receiving medical therapy, whose symptoms affect their QOL negatively or who have absolute indications for surgery which are recurrent or refractory urinary retention, recurrent UTIs, Treatment-resistant visible haematuria (resistant to 5-ARIs treatment), Overflow incontinence, bladder stones, dilatation of the upper urinary tract with or without renal insufficiency, Bladder diverticula are considered for surgical therapy.
The aim of our study was to compare safety and efficacy of Monopolar TUEP versus Bipolar TUEP for treating LUTS due to BPH in aging males.
In our study, we compared between M-TUEP and B-TUEP in the management of LUTS due to BPH regarding the intraoperative time, immediate postoperative Haemoglobin and serum sodium levels, follow up IPSS and QOL questionnaire scores at one and six months and follow up of Uroflowmetry, prostate size and postvoid residual urine at six months postoperatively.
In terms of immediate postoperative complications of haemoglobin loss and DROP of serum sodium level, the loss of Hb was more with the M-TUEP than B-TUEP group being 0.032 and 0.023 respectively, but without a statistical significance (P-value 0.39). No patients required blood transfusion in both groups. While as for the decrease in serum sodium level was more with the M-TUEP than B-TUEP group being 0.043 and 0.036 respectively, and also without a statistical significance (P-value 0.97). And none of the patients in both groups developed TUR syndrome.
At 1month follow-up, there was statistically significant difference between both groups with regard to improvement in postoperative IPSS favouring M-TUEP (Median of Delta Change in IPSS (1 month Postoperative – Preoperative) was -0.5242 in M-TUEP and -0.2838 in B-TUEP group with P-value 0.008). Meanwhile, there was no statistically significant difference between both groups regarding improvement in postoperative QoL (Median of Delta Change in QoL (1 month Postoperative – Preoperative) was -0.5 in M-TUEP and -0.5 in B-TUEP group with P-value 0.837).
At 6 month follow-up, there were no statistically significant differences between both groups with regard to improvements in postoperative IPSS(Median of Delta Change in IPSS (6 months Postoperative – Preoperative) was -0.6687 in M-TUEP and -0.7165 in B-TUEP group with P-value 0.695), QoL score(Median of Delta Change in QoL (6 months Postoperative – Preoperative) was -0.75 in M-TUEP and -0.775 in B-TUEP group with P-value 0.613), Qmax(Median of Delta Change in Qmax was 1.54321 in M-TUEP and 1.08519 in B-TUEP group with P-value 0.106), Qaveage(Median of Delta Change in Qaverage was 1.85 in M-TUEP and 1.33425 in B-TUEP group with P-value 0.055), Prostate volume (Median of Delta Change in prostate volume was -0.4939 in M-TUEP and -0.565 in B-TUEP group with P-value 0.317) or PVR(Median of Delta Change in PVR was -0.75 in M-TUEP and -0.785 in B-TUEP group with P-value 0.337). Also there were no statistical differences in these same values compared 1month with 6 months after surgery except IPSS favouring B-TUEP group.
There was overall significant improvement of these parameters in both groups comparing preoperative with postoperative values at 1and 6 month follow-up.
In our single-center trail, M-TUEP has the same safety and efficacy as B-TUEP, so M-TUEP can replace B-TUEP with a low incidence of complications.
CONCLUSION
M-TUEP was shown to be a safe and highly effective technique for relief of Bladder Outlet Obstruction (BOO). The clinical efficacy of M-TUEP is sustainable for up to 6 months of follow-up. Our single-center results show that M-TUEP has the same efficacy as B-TUEP for the surgical treatment of symptomatic BPH.
So, M-TUEP can replace B-TUEP with the same efficacy and comparable safety.