title: Incidence of urethral stricture after bipolar transurethral resection of the prostate using TURis: results from a randomised trial.
abstract: OBJECTIVE
  To assess whether bipolar transurethral resection of the prostate (B-TURP) using the TURis system has a similar level of efficacy and safety to that of the traditional monopolar transurethral resection of the prostate (M-TURP), and to evaluate the impact of the TURis system on postoperative urethral stricture rates over a 36-month follow-up period.
  
  
  METHODS
  A total of 136 patients with benign prostatic obstruction were randomised to undergo either B-TURP using the TURis system or conventional M-TURP, and were regularly followed for 36 months after surgery. The primary endpoint was safety, which included the long-term complication rates of postoperative urethral stricture. The secondary endpoint was the follow-up measurement of efficacy.
  
  
  RESULTS
  In peri-operative findings, no patient in either treatment group presented with transurethral resection syndrome, and the decline in levels of haemoglobin and hematocrit were similar. The mean operation time was significantly extended in the TURis treatment group compared with the M-TURP group (79.5 vs 68.6 min; P = 0.032) and postoperative clot retention was more likely to be seen after M-TURP (P = 0.044). Similar efficacy findings were maintained throughout 36 months, but a significant difference in postoperative urethral stricture rates between groups was detected (6.6% in M-TURP vs 19.0% in TURis; P = 0.022). After stratifying patients according to prostate volume, there was no significant difference between the two treatment groups with regard to urethral stricture rates in patients with a prostate volume ≤ 70 mL (3.8% in M-TURP vs 3.8% in TURis), but in the TURis group there was a significantly higher urethral stricture rate compared with the M-TURP group in patients with a prostate volume >70 mL (20% in TURis vs 2.2% in M-TURP; P = 0.012). Furthermore, the mean operation time for TURis was significantly longer than for M-TURP for the subgroup of patients with a prostate volume > 70 mL (99.6 vs 77.2 min; P = 0.011), but not for the subgroup of patients with a prostate volume ≤ 70 mL.
  
  
  CONCLUSIONS
  The TURis system seems to be as efficacious and safe as conventional M-TURP except that there was a higher incidence of urethral stricture in patients with larger preoperative prostate volumes.
authors.affiliation: Department of Urology, Osaka Medical College, Osaka, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Komura
authors.forename: Teruo
authors.initials: T
authors.lastname: Inamoto
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Takai
authors.forename: Taizo
authors.initials: T
authors.lastname: Uchimoto
authors.forename: Kenkichi
authors.initials: K
authors.lastname: Saito
authors.forename: Naoki
authors.initials: N
authors.lastname: Tanda
authors.forename: Koichiro
authors.initials: K
authors.lastname: Minami
authors.forename: Rintaro
authors.initials: R
authors.lastname: Oide
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Uehara
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Takahara
authors.forename: Hajime
authors.initials: H
authors.lastname: Hirano
authors.forename: Hayahito
authors.initials: H
authors.lastname: Nomi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kiyama
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Watsuji
authors.forename: Haruhito
authors.initials: H
authors.lastname: Azuma
mesh_terms: D000368:Aged; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011470:Prostatic Hyperplasia / Q000601:surgery; D020728:Transurethral Resection of Prostate / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000209:etiology*; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery
keywords: bipolar; randomised controlled trial; transurethral resection of the prostate