Comparison of bipolar transurethral resection of the prostate with standard transurethral prostatectomy: shorter stay, earlier catheter removal and fewer complications.

摘要

Authors from Detroit assess the use of the bipolar TURP against the monopolar technique; there were relatively few patients, reflecting the decreasing requirement for TURP in the USA. In addition, the amount of resected tissue was not particularly large, almost certainly a reflection of the decreasing size of resected prostatic tissue in that country. They found the bipolar TURP to have many advantages over standard monopolar TURP, and these are described. Acute urinary retention is a common urological emergency, and authors from London found that it had a measurable impact on the health-related quality of life of patients who develop this problem. They describe particularly how painful a condition it is, and that it had a significant economic burden. OBJECTIVE: To assess bipolar transurethral prostatectomy (TURP) using the Gyrus system (Gyrus Medical, Maple Grove, MD) compared with a standard monopolar TURP. PATIENTS AND METHODS: All 43 patients undergoing TURP from November 2000 to August 2002 were reviewed retrospectively; the 1.5-year observation period allowed for the detection of late complications. In all, 18 consecutive patients had standard and 25 had bipolar TURP. RESULTS: The resection was 18 g for standard and 15 g for the Gyrus TURP (part of the Gyrus chips are vaporized during resection). The Foley catheter was removed sooner (1.8 vs 3.2 days) and the hospital stay was less in the Gyrus group (1.2 vs 2.1 days). Acute complications occurred in a third of the standard group and four (16%) of the Gyrus group. Long-term complications were comparable, at two each in the standard and Gyrus groups. Four patients (15%) with small glands went home on the day of surgery, needing no bladder irrigation after Gyrus TURP. CONCLUSION: Few innovations in TURP technique have been described in the past few decades but comparing Gyrus to standard TURP showed that the former allows earlier removal of the urinary catheter and earlier discharge from hospital, while decreasing complications. The Gyrus system also has other benefits; it allows coagulation of tissue during resection, resulting in excellent intraoperative visualization, and normal saline is used as the irrigant fluid, reducing the potential for TUR syndrome. The shorter stay after Gyrus TURP can result in cost savings of up to Dollars 1200/patient/day at our institution.