TY - JOUR
TI - Safety and Efficacy of Bipolar Versus Monopolar Transurethral Resection
of the Prostate in Patients with Large Prostates or Severe Lower Urinary
Tract Symptoms: Post Hoc Analysis of a European Multicenter Randomized
Controlled Trial
AU - Skolarikos, A.
AU - Rassweiler, J.
AU - de la Rosette, J. J. and
AU - Alivizatos, G.
AU - Scoffone, C.
AU - Scarpa, R. M.
AU - Schulze, M. and
AU - Mamoulakis, C.
JO - Asian Journal of Urology
PY - 2016
VL - 195
TODO - 3
SP - 677-684
PB - EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
SN - 2214-3882
TODO - 10.1016/j.juro.2015.08.083
TODO - prostatic hyperplasia; prostate; randomized controlled trial;
transurethral resection of prostate; treatment outcome
TODO - Purpose: We compare bipolar vs monopolar transurethral prostate
resection safety/secondary outcomes including efficacy in patients with
large prostate volume or severe lower urinary tract symptoms.
Materials and Methods: From July 2006 to June 2009 candidates for
transurethral prostate resection were recruited at 4 centers, randomized
1: 1 into monopolar/bipolar transurethral prostate resection arms and
followed up to 36 months. Post hoc data analysis from patients with
large prostate volume or severe lower urinary tract symptoms is
presented. Patients with large prostate volume or severe lower urinary
tract symptoms were defined as those with transrectal ultrasound based
prostate volume greater than 80 ml or International Prostate Symptom
Score greater than 19. Safety was estimated using sodium/hemoglobin
changes immediately after surgery, complications during the early
postoperative period (up to 6 weeks), and short-term (up to 12 months)
and midterm (up to 36 months) followup. Secondary outcomes included,
among others, efficacy quantified by changes in maximum urine flow rate,
post-void residual urine volume and International Prostate Symptom Score
compared with baseline.
Results: A total of 279 patients were randomized. Post hoc analysis of
data from patients with a large prostate volume or severe lower urinary
tract symptoms was based on analysis A-in 62 of 279 participants
(22.3%) (monopolar transurethral prostate resection 32, bipolar
transurethral prostate resection 30) or analysis B-in 126 of 279
participants (45.2%) (monopolar transurethral prostate resection 57,
bipolar transurethral prostate resection 69). Mean (SD) prostate volume
was 108.0 (25.9) ml for monopolar transurethral prostate resection and
108.9 (23.4) ml for bipolar transurethral prostate resection (p =
0.756). Mean International Prostate Symptom Score was 25.0 (4.2) for
monopolar transurethral prostate resection and 25.3 (3.7) for bipolar
transurethral prostate resection (p = 0.402). Neither safety nor any
secondary outcome differed significantly between the arms throughout
followup. The only exception was the decrease in sodium (analysis A),
which was significantly greater after monopolar transurethral prostate
resection (-4.2 vs -0.7 mmol/l, p = 0.023) and did not translate into a
significant difference in transurethral resection syndrome rates
(monopolar transurethral prostate resection 1 of 32 vs bipolar
transurethral prostate resection 0 of 30, p = 1.000).
Conclusions: Bipolar and monopolar transurethral prostate resection show
similar safety/efficacy in these patient subpopulations.
ER -