title: Management of Large Prostate Gland in Men with Impaired Renal Function: Comparison of Safety, Efficacy and Outcomes of Monopolar, Bipolar Transurethral Resection and Open Prostatectomy.
abstract: OBJECTIVE
  The purpose of the study was to compare the safety, efficacy and outcome of monopolar transurethral resection of prostate (M-TURP), bipolar transurethral resection of prostate (BP-TURP) and open prostatectomy (OP) exclusively involving large prostate glands in men with renal impairment.
  
  
  METHODS
  Data of patients with gland size >90 g and serum creatinine >1.5 mg/dl, who were managed surgically at our institution from April 2009 to March 2014 were analyzed retrospectively. International Prostate Symptom Score (IPSS), quality of life (QoL) scores, PVR, serum creatinine and Q-max were recorded preoperatively and postoperatively at each follow-up visit. Follow-up was performed at 1, 3, 6 and 12 months.
  
  
  RESULTS
  M-TURP, BP-TURP and OP were the 3 types of surgeries performed. Preoperative characters were similar in all the groups. Hemoglobin drop, transfusion rates, irrigation time, catheter time and hospital days were significantly more in the OP group. Changes in sodium levels and incidence of transurethral syndrome were found to be more in the monopolar group. The follow-up data indicate a significant improvement in the IPSS, QoL, PVR and Q-max in all the groups.
  
  
  CONCLUSIONS
  This category of patients can be managed safely and efficiently by all the 3 procedures, although BP-TURP has an advantage in terms of shorter catheterization, hospitalization and fewer complications like transurethral resection syndrome.
authors.affiliation: Department of Urology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Srivastava
authors.forename: Ishwar R
authors.initials: IR
authors.lastname: Dhayal
authors.forename: Priyanka
authors.initials: P
authors.lastname: Rai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004598:Electrosurgery; D006801:Humans; D008297:Male; D009929:Organ Size; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000150:complications*; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome