Bipolar versus monopolar technique for palliative transurethral prostate resection

Dirk P J Michielsen, Danny Coomans, Benedikt Engels, Johan G Braeckman, Dirk P J Michielsen, Danny Coomans, Benedikt Engels, Johan G Braeckman

Abstract

Introduction: The aim was to evaluate the postoperative morbidity and outcome of palliative endoscopic resections for relief of infravesical obstruction in prostate cancer patients with hormone deprivation therapy, and to investigate the added value of bipolar technology over conventional monopolar resections.

Material and methods: A retrospective study was performed on 70 patients with prostate cancer under hormone deprivation therapy undergoing 75 endoscopic procedures, by either monopolar or bipolar technology, between August 2005 and March 2009 at a single institution. The analysis used outpatient, inpatient, and operative records, and observations of electrolyte changes in the serum, postoperative morbidity, and the overall results of palliative endoscopic resections. Preoperative cancer stages and grades were compared with the pathological findings after surgery. Postoperative outcome and complications of conventional monopolar and bipolar technology were compared.

Results: Over a period of 44 months, 34 conventional monopolar resections were performed in 32 patients and 41 bipolar resections in 38 patients. Patients' profiles regarding age, initial cancer stage and grade, resection weight, resection speed, catheterization time, and hospital stay were similar in both groups. No statistically significant difference was observed in sodium drop (p = 0.802), clot retention (p = 0.565), or urinary retention (p = 0.292). The overall success rate in relieving obstruction leading to spontaneous voiding was 77%. While 38% of the patients had a high grade tumour at diagnosis, 79% were found to be high grade after the endoscopic resection (p < 0.0001).

Conclusions: Palliative endoscopic transurethral resection is an acceptable and safe adjunctive surgical treatment for voiding disorders in prostate cancer patients. Bipolar technology offers no substantial benefit over conventional monopolar technology.

Keywords: prostate; prostate cancer; transurethral resection.

References

    1. Madersbacher S, Lackner J, Brössner C, et al. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol. 2005;47:499–504.
    1. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP) – incidence management, and prevention. Eur Urol. 2006;50:969–79.
    1. Miki M, Loritani N. Tokyo, Japan: TURis. Publisher Olympus Corporation; 2004. TUR in saline.
    1. Mamoulakis C, Trompetter M, de la Rosette J. Bipolar transurethral resection of the prostate: the “golden standard” reclaims its leading position. Curr Opin Urol. 2009;19:26–32.
    1. Mamoulakis C, Ubbink DT, de la Rosette JJ. Bipolar versus monopolar transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol. 2009;56:798–809.
    1. Moul JW, Davis R, Vaccaro JA, Sihelnik SA, Belville WD, McLeod DG. Acute urinary retention associated with prostatic carcinoma. J Urol. 1989;141:1375–7.
    1. Oefelin MG. Prognostic significance of obstructive uropathy in advanced prostate cancer. Urology. 2004;63:1117–21.
    1. Thomas DJ, Balaji VJ, Coptcoat MJ, Abercrombie GF. Acute urinary retention secondary to carcinoma of the prostate. Is initial channel TURP beneficial? J R Soc Med. 1992;85:318–9.
    1. Carpentier PJ, Schröder FH. Transrectal ultrasonography in the follow-up of prostatic carcinoma patients: a new prognostic parameter? J Urol. 1984;131:903–5.
    1. Fleischmann JD, Catalona WJ. Endocrine therapy for bladder outlet obstruction from carcinoma of the prostate. J Urol. 1985;134:498–500.
    1. Varenhorst E, Alund G. Urethral obstruction secondary to carcinoma of prostate: response to endocrine treatment. Urology. 1985;25:354–6.
    1. Mazur AW, Thompson IM. Efficacy and morbidity of “channel” TURP. Urology. 1991;38:526–28.
    1. Crain DS, Amling CL, Kane CJ. Palliative transurethral prostate resection for bladder outlet obstruction in patients with locally advanced prostate cancer. J Urol. 2004;171:668–71.
    1. Engelhardt PF, Reidl CR, Crain DS, Amling CL, Kane CJ. Palliative transurethral prostate resection for bladder outlet obstruction in patients with locally advanced prostate cancer. J Urol. 2004;171:668–71.
    1. Fadlon EJ, Rees RC, McIntyre C, Sharrard RM, Lawry J, Hamdy FC. Detection of circulating prostate-specific antigen-positive cells in patients with prostate cancer by flow cytometry and reverse transcription polymerase chain reaction. Br J Cancer. 1996;74:400–5.
    1. Hanks GE, Leibel S, Kramer S. The dissemination of cancer by transurethral resection of locally advanced prostate cancer. J Urol. 1983;129:309–11.
    1. Kuban DA, el-Mahadi AM, Schellhammer PF, Babb TJ. The effect of transurethral prostatic resection on the incidence of osseous prostatic metastasis. Cancer. 1985;56:961–4.
    1. Forman JD, Order SE, Zinreich ES, Lee DJ, Wharam MD, Mellits ED. The correlation of pretreatment transurethral resection of prostatic cancer with tumor dissemination and disease-free survival. A univariate and multivariate analysis. Cancer. 1986;58:1770–8.
    1. Sandler HM, Hanks GE. Analysis of the possibility that transurethral resection promotes metastasis in prostate cancer. Cancer. 1988;62:2622–7.
    1. Hübner W, Engelhardt P, Riedl C, Häusler N, Pflüger H. Negative influence of the TURP on the clinical outcome in patients with obstructive prostate carcinoma and possible alternative. Aktuel Urol. 1999;30:4–9.
    1. Anast JW, Andriole GL, Grubb RL., 2nd Managing the local complications of locally advanced prostate cancer. Curr Urol Rep. 2007;8:211–6.
    1. Madersbacher S, Marberger M. Is transurethral resection of the prostate still justified? BJU Int. 1999;83:227–37.
    1. Kellow NH. Pacemaker failure during transurethral resection of the prostate. Anaesthesia. 1993;48:136–8.
    1. Starkman JS, Santucci RA. Comparison of bipolar transurethral resection of the prostate with standard transurethral prostatectomy: shorter stay, earlier catheter removal and fewer complications. BJU Int. 2005;95:69–71.
    1. Tefekli A, Muslumanoglu AY, Baykal M, Binbay M, Tas A, Altunrende F. A hybrid technique using bipolar energy in transurethral prostate resection: a prospective, randomized comparison. J Urol. 2005;174:1339–943.
    1. Seckiner I, Yesilli C, Akduman B, Altan K, Mungan NA. A prospective randomized study for comparing bipolar plasmakinetic resection of the prostate with standard TURP. Urol Int. 2006;76:139–43.
    1. Ho HS, Yip SK, Lim KB, Fook S, Foo KT, Cheng CW. A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline (TURIS) system. Eur Urol. 2007;52:517–22.
    1. Yoon CJ, Kim JY, Moon KH, Jung HC, Park TC. Transurethral resection of the prostate with a bipolar tissue management system compared to conventional monopolar resectoscope: one-year outcome. Yonsei Med J. 2006;47:715–20.
    1. Che XY, Song XS, Wu DJ, Wang FP, Wang QF, Wang JB. Transurethral prostatectomy with the bipolar plasma-kinetic technique for benign prostate hyperplasia: a report of 712 cases. Zhonghua Nan ke Xue. 2009;15:449–51.
    1. Autorino R, Damiano R, Di Lorenzo G, et al. Four-year outcome of a prospective randomised trial comparing bipolar plasmakinetic and monopolar transurethral resection of the prostate. Eur Urol. 2009;55:922–9.
    1. Puppo P, Bertolotto F, Introini C, Germinale F, Timossi L, Naselli A. Bipolar transurethral resection in saline (TURis): outcome and complication rates after the first 1000 cases. J Endourol. 2009;23:1145–9.
    1. Fagerström T, Nyman CK, Hahn RG. Bipolar transurethral resection of the prostate causes less bleeding than the monopolar technique: a single centre randomized trial of 202 patients. BJU Int. 2010;105:1560–4.
    1. Michielsen DP, Debacker T, De Boe V, et al. Bipolar transurethral resection in saline – an alternative surgical treatment for bladder outlet obstruction. J Urol. 2007;178:2035–9.
    1. Qu L, Wang X, Huang X, Zhang Y, Zeng X. Use of a novel ex-vivo model to compare the hemostatic properties of plasmakinetic resection, transurethral vaporisation resection and conventional transurethral resection of the prostate. Urology. 2007;70:1034–8.
    1. Civantos F, Soloway MS, Pinto JE. Histopathological effects of androgen deprivation in prostatic cancer. Semin Urol Oncol. 1996;14:22–31.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa