Comparison between normal saline and Ringer's acetate in bipolar transurethral resection of the prostate.

OBJECTIVE: The standard surgical treatment for benign prostatic hypertrophy (BPH) is transurethral resection of the prostate (TURP). The aim of this study was to compare normal saline (NS) (0.9% sodium chloride) and Ringer's acetate (RA) as irrigation fluid with regard to visibility, resection feasibility, coagulation and bleeding in bipolar TURP. MATERIALS AND METHODS: Twenty patients (mean age 70 years) who were diagnosed with BPH were recruited to the study. The first three 3 liter bags of irrigation fluid contained either NS or RA and were administered in a randomized fashion. The surgeon assessed visibility, bleeding, coagulation, resection efficacy and overall outcome after each 3 liter bag on a scale of 1-10. RESULTS: The results disclosed only marginal differences between the two fluids with regard to the recorded parameters. All of the differences lacked statistical significance (p > .05). CONCLUSION: RA can be used as an irrigation fluid in bipolar TURP with no obvious difference in comparison with NS.

Degree of vaporization in bipolar and monopolar resection.

PURPOSE: To compare the in vitro degree of vaporization in bipolar and monopolar resection. MATERIALS AND METHODS: Using either a bipolar system or a monopolar system, samples of chicken muscle and lamb kidney were resected in an isolated basin and then desiccated in an incubator. The percentual degree of vaporization for each sample was obtained as a difference between the total fresh weight of the sample and the calculated fresh weights of the resected tissue and remains. RESULTS: Reference samples showed that the water content was 73% in muscle and 77% in kidney. More muscle (mean 52%) than kidney (32%; P<0.0001) tissue was vaporized. The fraction of vaporized tissue was significantly higher in the bipolar technique. In muscle, the differences between monopolar and bipolar were 17% (P<0.05) and 26% (P<0.001), respectively, depending on the type of irrigation used. For kidney, the differences were 27% (P<0.01) and 34% (P<0.01), respectively. Further exploration of the degree of vaporization when using the bipolar resection showed that the choice of loop (P<0.0001), fluid (P<0.03), and tissue (P<0.0001) were all independently associated with the degree of vaporization. CONCLUSIONS: This study indicated that vaporization removes 50% more tissue than the weight of the resected tissue during conventional tissue resection. Bipolar standard loop resection resulted in a significantly higher degree of vaporization in both muscle and kidney than did monopolar technique. Bipolar resection worked satisfactorily in Ringer's acetate.

Complications and clinical outcome 18 months after bipolar and monopolar transurethral resection of the prostate.

PURPOSE: To compare bipolar resection with the conventional monopolar transurethral resection of the prostate (TURP) with respect to peri- and postoperative complications and long-term outcome. PATIENTS AND METHODS: Patients with consecutive benign prostatic hyperplasia needing surgery (n=185) from the hospital's waiting list were randomized to TURP using either a bipolar or a monopolar system. Peri- and postoperative parameters were monitored, complications were registered, and timed micturition/International Prostate Symptom Score (TM/IPSS) forms were collected at 3 and 6 weeks and at 6 and 18 months. RESULTS: Bipolar surgery was followed by a 16% to 20% higher percentage of the patients reporting ongoing improvement (fractional IPSS change >2) at 3 and 6 weeks after the surgery (p<0.05). There were fewer readmissions in the bipolar group than in the monopolar (5 vs. 13, p<0.05). No differences between the groups with respect to hospital stay and catheter duration was recorded. Bipolar and monopolar TURP resulted in marked and sustained improvements of IPSS, bother score, and TM. CONCLUSIONS: Bipolar TURP, using the transurethral resection in saline (TURis) system, resulted in significantly fewer postoperative readmissions, faster postoperative recovery, and equally long-lasting good results in TM/IPSS and bother score, as in monopolar TURP.

Bipolar transurethral resection of the prostate causes less bleeding than the monopolar technique: a single-centre randomized trial of 202 patients.

OBJECTIVE: To compare bipolar with the conventional monopolar transurethral resection of the prostate (TURP) for blood loss and speed of resection. PATIENTS AND METHODS: In all, 202 consecutive patients from the hospital waiting list were randomized to undergo TURP using either a bipolar system (Surgmaster TURis, Olympus, Tokyo, Japan) or a monopolar system (24 F, Storz, Tübingen, Germany). The blood loss during and after surgery was measured using a photometer. Other variables compared included indices of resection speed and transfusion rate. RESULTS: There were no statistically significant differences in operative duration, resection weight, resection speed or radicality of resection. However, the median blood loss was 235 mL for the bipolar and 350 mL for monopolar TURP (P < 0.001). The decrease in blood haemoglobin concentration during the day of surgery was smaller in the bipolar group (5.5% vs 9.6%P < 0.001). Fewer patients were transfused with erythrocytes (4% vs 11%, P < 0.01), which can be explained by the much lower 75th percentile for blood loss in the bipolar group (at 472 vs 855 mL, respectively). CONCLUSIONS: Bipolar TURP using the TURis system was performed with the same speed as monopolar TURP but caused 34% less bleeding, the difference being greatest (81%) for the largest blood losses. Bipolar TURP also required fewer erythrocyte transfusions than the conventional monopolar technique.

Glucose as a marker of fluid absorption in bipolar transurethral surgery.

BACKGROUND: Historically, a reduced serum sodium concentration has been used to diagnose absorption of electrolyte-free irrigating fluid during transurethral resection of the prostate (TURP). In bipolar TURP, the irrigating solution contains electrolytes, thus invalidating the serum sodium method. In this study, we investigated whether glucose can be used to diagnose the absorption of irrigating fluid during TURP procedures. METHODS: The serum glucose and sodium concentrations were measured in 250 patients undergoing monopolar TURP using either 1.5% glycine or 5% glucose for urinary bladder irrigation. The glucose kinetics was analyzed in 10 volunteers receiving a 30-min infusion of 20 mL/kg of acetated Ringer's solution with 1% glucose. These data were then used in computer simulations of different absorption patterns that were summarized in a nomogram for the relationship between the glucose level and administered fluid volume. RESULTS: There was a statistically significant inverse linear relationship between the decrease in serum sodium and the increase in glucose levels after absorption of 5% glucose during TURP (r(2) = 0.80). The glucose concentration increased, from 4.6 (sd 0.4) to 8.3 (0.9) mmol/L, during the experimental infusions. Regardless of the absorption pattern, all simulations indicated that the uptake of 1 L of fluid containing 1% glucose corresponded to an increase in the glucose level of 3.7 (sd 1.6) mmol/L at the end of surgery, whereas 2 L yielded an increase of 6.9 (1.7) mmol/L. CONCLUSIONS: In bipolar TURP, the addition of glucose to a concentration of 1% in the electrolyte-containing irrigation fluid can be used as a tracer of absorption that is comparable with measuring serum sodium after monopolar TURP.

Blood loss and postoperative complications associated with transurethral resection of the prostate after pretreatment with dutasteride.

OBJECTIVE: To determine whether pretreatment with dutasteride, a dual 5alpha-reductase inhibitor (5ARI), reduces surgical blood loss or postoperative complications in patients with benign prostatic hyperplasia (BPH) who undergo transurethral resection of the prostate (TURP). PATIENTS AND METHODS: This double-blind, randomized, placebo-controlled, multicentre study comprised 214 patients with BPH. Placebo was compared with dutasteride 0.5 mg/day 2 weeks before and after TURP, or 4 weeks before and 2 weeks after TURP. Surgical blood loss was measured using a haemoglobin photometer (HemoCue AB, Angelholm, Sweden) and postoperative adverse events were recorded. Microvessel density (MVD) was calculated by immunostaining and light microscopy of the prostatic chips. RESULTS: Although dutasteride reduced serum dihydrotestosterone (DHT) by 86-89% in 2-4 weeks, and intraprostatic DHT was approximately 10 times lower than in the placebo group, the (adjusted) mean haemoglobin (Hb) loss during surgery was 2.15-2.55 g Hb/g resectate with no significant difference in blood loss between the groups either during or after TURP. Clot retention occurred in 6-11% and urinary incontinence in 14-15% of patients during the 14 weeks after TURP, with no difference between the groups. The MVD at TURP was also similar for all groups. CONCLUSION: There were no significant reductions in blood loss during or after TURP or complications afterward with dutasteride compared with placebo, despite significant suppression of intraprostatic DHT. Blood loss and transfusion rates in the placebo group were lower than those previously reported in studies where there was a beneficial effect of a 5ARI, relative to placebo, on bleeding during TURP.