Clinical Studies

Chen Q, Zhang L, Fan Q, Zhou J, Peng Y & Wang Z. “Bipolar transurethral resection in saline vs traditional monopolar resection of the prostate: results of a randomized trial with 2-year follow-up.” BJU International. January 2010, doi: 10.1111/j.1464-410X.2010.09401.x.
 
OBJECTIVE: To present 2-year follow-up data of a randomized clinical trial comparing bipolar transurethral resection in saline (TURIS) with monopolar transurethral resection of the prostate (TURP).
 
RESULTS: The operative duration and resected tissue weight were similar between the groups. The mean decreases in serum sodium and haemoglobin after surgery were significantly less in the TURIS group. The mean (standard deviation) irrigant absorbed was significantly less in TURIS than in the TURP group, at 208 (344)mL vs 512 (706) mL respectively (P < 0.001). In both the TURIS and TURP groups there were significant improvements in International Prostate Symptoms Scores and maximum urinary flow rates. The acute and late complications in the groups were statistically similar.

CONCLUSION: Bipolar TURIS seems to be a safe and effective procedure, which is associated with significantly less fluid absorption and similar efficacy as traditional monopolar TURP.
 
Link to study: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2010.09401.x/abstract
 

Geavlete B, Multescu R, Georgescu D, Jecu M, Dragutescu M & Geavlete P. “Innovative Technique in Nonmuscle Invasive Bladder Cancer -- Bipolar Plasma Vaporization.” UROLOGY. 2010, doi:10.1016/j.urology.2010.08.062. 
 
OBJECTIVE: To evaluate the efficacy and safety of a newly introduced endoscopic technique in the treatment of nonmuscle-invasive bladder tumors (NMIBT), the bipolar plasma vaporization of bladder tumors (BPV-BT), and to compare it with monopolar transurethral resection of bladder tumors (TURBT).

RESULTS: The mean operative time and postoperative hemoglobin decrease were significantly improved for BPV-BT compared with TURBT (21.4 minutes vs 32.7 minutes and 0.3 g/dL vs 0.9 g/dL). The perioperative complications were more frequent in the TURBT arm. The mean catheterization period and hospital stay were significantly shorter in the BPV-BT series (2.5 vs 3.5 days and 3.5 vs 4.5 days). During follow-up, the overall residual tumors' rate at Re-TURBT was 9.3% in the BPVBT group vs 20.8% in the TURBT group. Primary site recurrences occurred in 7.4% vs 17% of the cases, whereas in patients with initial multiple tumors, the recurrence rate was 9.7% vs 25%.
 
CONCLUSIONS: BPV-BT seems to represent a promising endoscopic treatment alternative for NMIBT patients, with good efficacy, reduced morbidity, fast postoperative recovery, and significantly decreased residual tumors' rate by compared with TURBT.
 
Link to study: https://www.ncbi.nlm.nih.gov/pubmed/21167565

Geavlete B, Multescu R, Dragutescu M, Jecu M, Georgescu D & Geavlete P. “Transurethral resection (TUR) in saline plasma vaporization of the prostate vs standard TUR of the prostate: 'the better choice' in benign prostatic hyperplasia?” BJU International. January 2010, doi: 10.1111/j.1464-410X.2010.09433.x. 
 
OBJECTIVE: To evaluate the efficiency, safety and short-term outcome of transurethral resection in saline plasma vaporization of the prostate (TURis-PVP), and to compare it to the standard TUR of the prostate (TURP).
 
RESULTS: Patients from both series had similar preoperative characteristics. TURis-PVP and TURP were successfully performed in all cases (75 and 80, respectively). The operative duration, catheterization period and hospital stay were significantly shorter for TURis-PVP patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and 47.6 vs 93.1 h, respectively (all P < 0.05). At the 1, 3 and 6 months follow-ups, improvements in the variables measured were better in the TURis-PVP group: the IPSS was 4.4 vs 8.3 and the Qmax was 22.7 vs 20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6 and the Qmax was 22.3 vs 20.0 mL/s at 3 months; and the IPSS was 5 vs 9.1 and the Qmax was 21.8 vs 19.3 mL/s at 6 months (All P < 0.05).

CONCLUSIONS: TURis-PVP represents a valuable endoscopic treatment alternative for patients with BPE, with superior efficacy, short-term results and complication rates compared with monopolar TURP.
 
Link to study: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2010.09433.x/abstract

Fagerström T, Nyman CR & Hahn RG. “Bipolar transurethral resection of the prostate causes less bleeding than the monopolar technique: a single-centre randomized trial of 202 patients.” BJU International. June 2010, Volume 105, Issue 11: pages 1560–1564. 
 
OBJECTIVES: To compare bipolar with the conventional monopolar transurethral resection of the prostate (TURP) for blood loss and speed of resection.

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.
 
Link to study: http://onlinelibrary.wiley.com/doi/10.1111/j.1464410X.2009.09052.x/abstract

Fagerström T, Nyman CR & Hahn RG. “Complications and clinical outcome 18 months after bipolar and monopolar transurethral resection of the prostate.” BJU International. June 2010, Volume 105, Issue 11: pages 1560–1564. 
 
OBJECTIVE: 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.

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.
 
Link to study: https://www.ncbi.nlm.nih.gov/pubmed/21568691

Michielsen DP, Coomans D, Braeckman JG & Umbrain V. “Bipolar transurethral resection in saline: The solution to avoid hyponatraemia and transurethral resection syndrome.” Scandinavian Journal of Urology and Nephrology. 2010, 44: 228-235. 
 
OBJECTIVES: To compare serum sodium changes and the incidence of transurethral resection (TUR) syndrome after monopolar transurethral resection of the prostate (TURP) and bipolar transurethral resection in saline (TURIS) for symptomatic benign prostatic hyperplasia.

RESULTS: Over 56 months, 265 patients underwent a conventional monopolar TURP and 285 patients had a bipolar TURIS (Olympus). Patient profiles regarding age, operation time, resection weight and resection speed were similar in both groups. A drop in sodium of 2.5 mmol/l was measured in the conventional monopolar resection group. The decline of 1.5 mmol/l in the bipolar group, although smaller, was still statistically significant (p = 0.001). With longer operation times (> 1 h) the difference between the groups became more important (p < 0.001). Two clinical TUR syndromes were observed in the monopolar group, while none occurred in the bipolar group. 

CONCLUSION: Bipolar TURP in saline is a safe technique and obviates the risk of TUR syndrome. Repeated serum analysis of electrolytes after TURIS can be omitted.
 
Link to study: http://www.tandfonline.com/doi/abs/10.3109/00365591003720275

Michielsen DP & Coomans D. “Urethral Strictures and Bipolar Transurethral Resection in Saline of the Prostate: Fact or Fiction?” Journal of Endourology. August 2010, Volume 24, Number 8: Pp. 1333-1337. 
 
OBJECTIVE: To compare the incidence of urethral strictures after monopolar transurethral resection of the prostate (TURP) and bipolar transurethral resection in saline (TURIS) for symptomatic benign prostatic hyperplasia.
 
RESULTS: Over 48 months, 255 patients were treated with conventional TURP and 263 patients with TURIS. Patient related, operation, and hospitalization characteristics were similar in both groups. After a mean follow-up of 32.1 months (range 50–7 months), the incidence of urethral strictures was 2.4% in the TURP group. After a comparable period of 31.4 months (range 50–7 months), the incidence in the TURIS group was 1.5%. No statistically significant difference was obtained (P = 0.539). These values were compared with the results of other randomized controlled trials with the same or other bipolar technology. No statistically significant difference in urethral structures was noticed between monopolar and bipolar resections (P = 0.739).

CONCLUSION: With a stricture incidence of 1.5%, bipolar transurethral prostate resection has a low stricture rate, comparable with monopolar TURP (2.4%).
 
Link to study: http://online.liebertpub.com/doi/abs/10.1089/end.2009.0575

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.” Journal of Endourology. July 2009, Volume 23, Number 7: Pp. 1145-1149.
 
OBJECTIVES: TURis® is an emerging technique that shows the same efficacy of monopolar resection. However, there is currently little available data on the safety of bipolar devices. We assessed outcome and safety of TURis on a large cohort of patients with at least 6 months' follow-up.
 
RESULTS: None of the patients operated experienced a TUR syndrome or a thermal skin lesion. The median follow-up of the entire cohort was 12 months (range, 6–24 months); 663 patients had at least 1-year follow-up (66.3%). Urethral stricture occurred in 27 patients (2.7%). Four patients developed a bladder neck contracture after transurethral resection of prostate (1%). Early postoperative clot retention occurred in 21 patients (2.1%), and 11 patients needed one or more transfusion (1.1%). Only six patients (2%) submitted to TUR of a neoplastic lesions at the lateral bladder wall experienced an unwanted trigger of the obturator reflex.
 
CONCLUSIONS: TURis offers the patient the same results as monopolar technology guaranteeing maximum safety without increasing the incidence of urethral strictures.
 
Link to study: http://online.liebertpub.com/doi/abs/10.1089/end.2009.0011