Transurethral resection of prostate: a comparison of standard monopolar versus bipolar saline resection.
BACKGROUND
Transurethral resection syndrome is an uncommon but potentially life threatening complication. Various irrigating solutions have been used, normal saline being the most physiological. The recent availability of bipolar cautery has permitted the use of normal saline irrigation.


METHODS
In a randomized prospective study, we compared the safety and efficacy of bipolar cautery (using 0.9% normal saline irrigation) versus conventional monopolar cautery (using 1.5% glycine irrigation). Pre and postoperative hemoglobin (Hb) and hematocrit values were compared. Hemodynamics and arterial oxygen saturation were monitored throughout the study. Safety end points were changes in serum electrolytes, osmolarity and Hb/PCV (packed cell volume). Efficacy parameters were the International Prostate Symptom Score (IPSS) and Qmax (maximum flow rate in mL/sec) values.


RESULTS
Mean preoperative prostate size on ultrasound was 60 +/- 20cc. Mean resected weight was 17.6 +/- 10.8 g (glycine) and 18.66 +/- 12.1 g (saline). Mean resection time was 56.76 +/- 14.51 min (glycine) and 55.1 +/- 13.3 min (saline). The monopolar glycine group showed a greater decline in serum sodium and osmolarity (4.12 meq/L and 5.14 mosmol/L) compared to the bipolar saline group (1.25 meq/L and 0.43 mosmol/L). However, this was not considered statistically significant. The monopolar glycine group showed a statistically significant decline in Hb and PCV (0.97 gm %, 2.83, p < 0.005) as compared to the bipolar saline group (0.55 gm % and 1.62, p < 0.05). Patient follow- up (1,3,6 and 12 months postoperatively) demonstrated an improvement in IPSS and Qmax in both the groups.


CONCLUSIONS
We concluded that bipolar transurethral resection of prostate is clinically comparable to monopolar transurethral resection of prostate with an improved safety profile. However, larger number of patients with longer follow up is essential.
Singhania
Piyush
P
Department of Urology, T N Medical College & B Y L Nair Hospital, Mumbai, India. piyushsnghn@yahoo.co.in
Nandini
Dave
D
Sarita
Fernandes
F
Hemant
Pathak
P
Hemalata
Iyer
I
D005998:Glycine / Q000378:metabolism; D018684:Glycine Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011188:Potassium / Q000097:blood; D011300:Preoperative Care; D011467:Prostate / Q000601:surgery*; D011470:Prostatic Hyperplasia / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012964:Sodium / Q000097:blood*; D012965:Sodium Chloride / Q000627:therapeutic use; D007507:Therapeutic Irrigation / Q000379:methods; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome
D018684:Glycine Agents; D012965:Sodium Chloride; D012964:Sodium; D011188:Potassium; D005998:Glycine