Safety and Efficacy of Bipolar Transurethral Resection of the Prostate vs Monopolar Transurethral Resection of Prostate in the Treatment of Moderate-Large Volume Prostatic Hyperplasia: A Systematic Review and Meta-Analysis

Comparing Urethral Stricture Rates Following Bipolar and Monopolar Transurethral Resection of the Prostate: A Retrospective Study

Aim The aim is to compare the incidence of urethral strictures and other complications following monopolar and bipolar transurethral resection of the prostate (TURP). Method We conducted a retrospective study to compare patients who underwent bipolar TURP with those who underwent monopolar TURP between 2017 and 2023. The collected data included demographics, age, history of urethral stricture, prostate size, operation duration, and postoperative complications, such as blood transfusion, transurethral resection (TUR) syndrome, and other relevant data points. Results The COVID-19 pandemic significantly affected the number of surgeries performed. A total of 572 patients who underwent TURP at our center during this period were identified, 302 of whom underwent monopolar TURP, and 270 underwent bipolar TURP. Bladder neck stenosis was more frequently identified in the monopolar group compared to the bipolar group (1.99% (6) vs. 0.7% (2)). In the monopolar group, 6.62% (20) of the patients had strictures compared to 4.07% (11) in the bipolar group; however, this difference is not statistically significant. The bipolar group had a higher incidence of urinary incontinence (5.6% (15) vs. 3.3% (10)), whereas the monopolar group had higher readmission rates (18.8% (57) vs. 13.7% (37)) and a higher frequency of delayed trial without catheter (TWOC) (84% (254) vs. 75.9% (205)). Conclusion We believe that our findings contribute towards resolving the debate between stricture complication rates in monopolar versus bipolar TURP. Our analysis revealed no statistically significant differences in stricture rates between the two groups. However, we noted differences in other complications, such as higher rates of urinary incontinence in the bipolar group, whereas the monopolar group had increased rates of readmission and bladder neck stenosis.

Polygenic risk score predicting susceptibility and outcome of benign prostatic hyperplasia in the Han Chinese

BACKGROUND

Given the high prevalence of BPH among elderly men, pinpointing those at elevated risk can aid in early intervention and effective management. This study aimed to explore that polygenic risk score (PRS) is effective in predicting benign prostatic hyperplasia (BPH) incidence, prognosis and risk of operation in Han Chinese.

METHODS

A retrospective cohort study included 12,474 male participants (6,237 with BPH and 6,237 non-BPH controls) from the Taiwan Precision Medicine Initiative (TPMI). Genotyping was performed using the Affymetrix Genome-Wide TWB 2.0 SNP Array. PRS was calculated using PGS001865, comprising 1,712 single nucleotide polymorphisms. Logistic regression models assessed the association between PRS and BPH incidence, adjusting for age and prostate-specific antigen (PSA) levels. The study also examined the relationship between PSA, prostate volume, and response to 5-α-reductase inhibitor (5ARI) treatment, as well as the association between PRS and the risk of TURP.

RESULTS

Individuals in the highest PRS quartile (Q4) had a significantly higher risk of BPH compared to the lowest quartile (Q1) (OR = 1.51, 95% CI = 1.274-1.783, p < 0.0001), after adjusting for PSA level. The Q4 group exhibited larger prostate volumes and a smaller volume reduction after 5ARI treatment. The Q1 group had a lower cumulative TURP probability at 3, 5, and 10 years compared to the Q4 group. PRS Q4 was an independent risk factor for TURP.

CONCLUSIONS

In this Han Chinese cohort, higher PRS was associated with an increased susceptibility to BPH, larger prostate volumes, poorer response to 5ARI treatment, and a higher risk of TURP. Larger prospective studies with longer follow-up are warranted to further validate these findings.

Evaluation of Current Surgical BPH Interventions for Young and Elderly Men

PURPOSE OF REVIEW

Benign prostatic hyperplasia affects the quality of life of a significant number of men, especially as they age. There are continuous innovations in the surgical management of benign prostatic hyperplasia, but many of these innovations are studied in the core population of men 50-70 years of age. This review focuses on the outliers of men aged 18-50 and 70 and older.

RECENT FINDINGS

Older populations have more comorbidities, higher rates of antithrombotic medications, and advanced symptoms. Properly selected older men can safely have significant objective and subjective improvement in their symptoms. The literature was scarce when evaluating younger men; however, ejaculatory preserving techniques are promising providing improvement in symptoms and preserving ejaculation. This review demonstrates that in properly selected elderly patients, improvements in quality of life while also providing safe surgical interventions can be achieved. Ejaculatory preservation techniques demonstrate promising results, but further studies are required to elucidate true outcomes.

Monopolar Transurethral Enucleoresection of Prostate: Feasibility of Modified Nesbit's Enucleoresection with Apical Release

Background: Transurethral resection of the prostate (TURP) has been the standard surgical treatment for Benign Hyperplasia of the Prostate (BPH) for decades. Our objective was to evaluate the outcome of our new technique: Monopolar Transurethral Enucleoresection of the Prostate (TUERP) with apical release (bring it all to centre). Methods: A prospective study of all cases undergoing TUERP at a tertiary centre from January 2020 to October 2022 was performed. Patient demographics, intraoperative variables and postoperative results along with follow-up data were collected. Data of all the cases who had completed a one-year follow-up post-surgery were included and analysed. Results: A total of 240 patients with complete data including a one-year follow-up were included. Mean prostatic volume was 55.3 ± 11.6 gm, and 28 (11.67%) cases were >100 gm. The mean operative time was 31.7 ± 7.6, and mean haemoglobin drop at 24 h was 0.73 ± 1.21 gm/dL. The overall complication rate was 16.67%, with only two (0.83%) Clavien-Dindo III complications (haematuria and clots needing evacuation) and the other complications being Clavien-Dindo I/II complications. Sustained improvement at 1 year of follow-up was noted: Qmax: 25.2 ± 5.6 mL/s, IPSS: 4.7 ± 2.5 and PVR: 22.5 ± 9.6 mL. Conclusions: Monopolar TUERP with a modified Nesbit's enucleoresection with apical release can be considered a promising technique, which needs further studies to be validated with appropriate comparisons.

Complications of GreenLight Laser vs Transurethral Resection of the Prostate for Treatment of Lower Urinary Tract Symptoms: Meta-analysis of Randomized Trials

OBJECTIVE

To compare perioperative outcomes and complications between GreenLight and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia.

METHODS

A systematic review and random effects meta-analysis of randomized trials comparing GreenLight with TURP was completed. Primary outcomes included periprocedural milestones, 12 predefined complications, Clavien-Dindo class III-V complications, reoperations (all-cause), and a composite of reoperations and readmissions. Metaregression assessed the relationship between patient- and study-level factors with periprocedural outcomes and reoperation rates.

RESULTS

The review included 13 randomized trials with 1757 patients (839 GreenLight; 918 TURP). Procedure time was 10 minutes (95% CI: 5 to 15; P < .001) longer with GreenLight, while catheterization time (mean difference=-1.3days; 95% CI: -1.7 to -0.9; P<.001) and hospital stay (mean difference=-2.1days; 95% CI: -2.5 to -1.7; P<.001) were shorter. Bleeding-related complications, including clot retention (risk ratio [RR]=0.12; 95% CI: 0.05 to 0.32; P<.001) and transfusion (RR=0.26; 95% CI: 0.12 to 0.58; P = .001), as well as sexual dysfunction (RR=0.66; 95% CI: 0.45 to 0.98; P = .04), were less frequent with GreenLight. All other complications occurred at similar frequencies between groups. The risks of reoperation (RR: 1.17; 95% CI: 0.82 to 1.66; P = .38) and reoperation or readmission (RR: 1.05; 95% CI: 0.76 to 1.44; P = .79) did not differ.

CONCLUSION

GreenLight achieved shorter catheterization times and hospital stays with lower rates of sexual dysfunction and bleeding-related complications compared to TURP.

The Effect of Protective Coil Embolization of Penile Anastomoses during Prostatic Artery Embolization on Erectile Function: A Propensity-Matched Analysis

PURPOSE

To explore whether coil embolization of penile collateral arteries to prevent nontarget embolization during prostatic artery embolization (PAE) negatively affects erectile function.

MATERIALS AND METHODS

Retrospective analysis was performed on a prospectively maintained multicenter PAE database on all patients with benign prostatic hyperplasia (January 2014 to July 2016). International Index of Erectile Function (IIEF-5) scores were collected at baseline and within 12 months after the procedure. A logistic regression and nearest neighbor propensity-matched analysis (matched for age, baseline IIEF-5 scores, and use of 5α-reductase inhibitors) and paired t test were used to evaluate for differential impact on IIEF-5 scores between the group of patients who underwent (unilateral) penile collateral coil embolization and a matched control group of patients who did not.

RESULTS

Of a total of 216 patients, 26 underwent coil protection of an accessory pudendal vessel/penile collateral. After exclusions, 22 propensity-matched pairs were identified. The mean IIEF-5 score at baseline for the coil-embolized group was 14.8 ± 8.3 (out of a possible score of 30) and that for the matched control group was 14.0 ± 7.8. At the 12-month follow-up after the procedure, the mean follow-up IIEF-5 score was 15.5 ± 8.0 for the coil-embolized group and 14.2 ± 8.2 for the matched control group. The change in IIEF-5 scores after PAE was not significantly different between the 2 groups (0.66 ± 3.8 vs 0.20 ± 2.0; P = .64; 95% CI, -1.53 to 2.44).

CONCLUSIONS

When penile collateral arteries were identified, protective coil embolization of penile collateral/accessory pudendal vessels during PAE was unlikely to affect erectile function negatively.

Intraoperative and postoperative outcomes of thulium laser enucleation versus bipolar resection in the transurethral treatment of benign prostatic hyperplasia: a meta-analysis

To compare the intraoperative and postoperative outcomes of thulium laser enucleation of the prostate (ThuLEP) vs bipolar transurethral resection of the prostate (B-TURP) in treating patients with benign prostatic hyperplasia (BPH). Clinical trials of ThuLEP and B-TURP in treating BPH were searched systematically by using PubMed, Cochrane Library databases, and EMBASE (until May 2021). The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was followed. The datum was calculated by Review Manager version 5.3.0. Four articles including 782 patients were studied in this analysis. The analysis discovered that there was no significant difference in operative time and percentage of tissue removed between ThuLEP and B-TURP. But the intraoperative irrigated volume and postoperative hemoglobin (Hb) decrease in the ThuLEP group was significantly less compared with the B-TURP group. The catheterization time and hospitalization duration in the B-TURP group was significantly longer than that in the ThuLEP group. Compared with those before treatment, the micturition indexes of the two groups improved significantly. But no significant difference was identified between ThuLEP and B-TURP for the variation of international prostate symptom score, quality of life, maximum flow rate, and post-void residual. By analyzing the postoperative complications, there were no significant discrepancies between ThuLEP and B-TURP in the incidence of blood transfusion, recatheterization, transient incontinence, bladder neck contracture, and urethral stricture. The micturition indexes and clinical symptoms were significantly improved after ThuLEP and B-TURP for patients with BPH. However, ThuLEP was more effective than B-TURP in terms of intraoperative irrigated volume, postoperative Hb decrease, catheterization time, and hospitalization duration.

Risk Factors for Early Urethral Stricture After Mono-Polar Transurethral Prostate Resection: A Single-Center Experience

Aim

This study aimed to investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and the risk factors affecting the development of urethral stricture in patients treated in our clinic.

Material and methods

This retrospective study included patients who underwent TURP due to benign prostate hyperplasia (BPH) and had complete postoperative follow-up data of at least 12 months. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between urethral stricture and eight parameters (age, body mass index [BMI], prostate volume, number of comorbidities, amount of tissue removed, operative time, perioperative blood loss, and catheterization duration).

Results

Of the 3069 patients who underwent TURP in our clinic during the study period, 1740 patients with complete clinical data were included in the study. Mean age was 67.83 ± 5.80 years and mean body mass index (BMI) was 27.63 ± 4.31 kg/m². Median preoperative prostate volume was 50.0 (range, 41.0-62.0) mm³ and the average amount of tissue removed during surgery was 20.0 (range, 12.0-30.0) g. Urethral stricture was detected in 3.9% (67/1740) of the patients during a minimum of 12 months of follow-up period after TURP. In multivariate analysis, prolonged operative time and high comorbidity burden were found to be risk factors for urethral stricture (p<0.001 for both).

Conclusion

Early urethral stricture remains an important complication of TURP. Our results show that prolonged operative time and high comorbidity burden are factors that increase the risk of urethral stricture.