Bipolar transurethral enucleation and resection of the prostate: Whether it is ready to supersede TURP?

doi:10.1016/j.ajur.2017.12.001

Asian Journal of Urology, 2018, 5 (1): 48-54 doi: 10.1016/j.ajur.2017.12.001

Original Article

Current Issue | Archive | Adv Search

Bipolar transurethral enucleation and resection of the prostate: Whether it is ready to supersede TURP?

Xu Peng,Xu Abai,Chen Binshen,Zheng Shaobo,Xu Yawen,Li Hulin,Shen Haiyan,Liu Chunxiao

Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China

Abstract
Related Citation (12)

Download:

HTML

PDF (658KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective

According to the EAU Guidelines, transurethral resection of the prostate (TURP) has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia (BPH). However, its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique. We reported the patient outcomes with our technique.

Methods

We retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate (B-TUERP) between March 2015 and September 2015. Pre- and perioperative parameters were obtained from medical charts. Postoperative follow-ups were administrated at 1, 3, 6, 12 and 24 month(s) after surgery, respectively.

Results

All the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%. Q_max was significantly improved immediately after surgery, followed by a continuous improvement throughout the follow-ups. Following a steep decrease in mean prostate specific antigen (PSA) and post void residual (PVR) observed within the first half year after surgery, the serum PSA was then maintained at a constant level of 0.61 ng/mL. Temporary urinary retention was found in four cases (7.7%). Stress urinary incontinence occurred in five patients (9.6%), with the condition resolved in 1-2 weeks without extra treatment. Urethral strictures and bladder neck contractures, as the most commonly observed long-term complications, developed in four patients (7.7%). No recurrence was found during 2 years of follow-ups. An improvement in International Index of Erectile Function (IIEF-5) scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery, and sustained throughout the 24-month period.

Conclusions

Enucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practice. Currently, bipolar resection is a commonly employed procedure in clinical settings, and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists. Based on these findings, we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.

Key words： Benign prostatic hyperplasia TURP Enucleation Bipolar Endoscopic surgery

Received: 02 September 2017 Published: 07 March 2018

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Xu Peng
	Xu Abai
	Chen Binshen
	Zheng Shaobo
	Xu Yawen
	Li Hulin
	Shen Haiyan
	Liu Chunxiao

TRENDMD:

Cite this article:

Xu Peng,Xu Abai,Chen Binshen, et al. Bipolar transurethral enucleation and resection of the prostate: Whether it is ready to supersede TURP?[J]. Asian Journal of Urology, 2018, 5(1): 48-54.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2017.12.001 OR http://www.ajurology.com/EN/Y2018/V5/I1/48

Perioperative data of the patients (n=52) (mean±SD).

Boundary of verumontanum and hyperplasia gland. A prostate specimen from a prostate cancer patient which showed that the apical portions of the adenoma were more than 1 cm distal to the verumontanum. The yellow circle represent verumontanum, and the blue dotted line on behalf of distal boundary of hyperplasia gland.

En bloc gland is peeled off from the surgical capsule and pushed to the bladder which could be treated by morcellator.

Treatment of 12 o'clock. Use brief cutting instead of blunt dissection without cutting beyond the yellow line to preserve partial urethral valve at 12 o'clock, that avoiding injury of the sphincter.

Follow-up data.

Enucleation based on the surgical capsule. (A) Enucleation of the middle lobe; (B) Preserving the physiological gradient of the bladder neck (after enucleation of the middle lobe); (C) Enucleation of the left lobe; (D) Enucleation of the right lobe; SC, surgical capsule; BN, bladder neck; RL, right lobe; LL, left lobe.

[1]	Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, et al . EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2015;67: 1099-109.
[2]	Wendt-Nordahl G, Hacker A, Reich O, Djavan B, Alken P, Michel MS . The Vista system: a new bipolar resection device for endourological procedures: comparison with conventional resectoscope. Eur Urol. 2004;46: 586-90.
[3]	Fayad AS, Elsheikh MG, Zakaria T, Elfottoh HA, Alsergany R, Elshenoufy A, et al . Holmium laser enucleation of the prostate versus bipolar resection of the prostate: a prospective randomized study. “pros and cons”. Urology. 2015;86: 1037-41.
[4]	Singh H, Desai MR, Shrivastav P, Vani K . Bipolar versus monopolar transurethral resection of prostate: randomized controlled study. J Endourol. 2005;19: 333-8.
[5]	Ho HS, Yip SK, Lim KB, Fook S, Foo KT, Cheng CW . A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline (TURIS) system. Eur Urol. 2007;52: 517-22.
[6]	Eckhardt MD, van Venrooij GE, Boon TA . Urethral resistance factor (URA) versus Scha¨fer’s obstruction grade and Abrams- Griffiths (AG) number in the diagnosis of obstructive benign prostatic hyperplasia. Neurourol Urodyn. 2001;20: 175-85.
[7]	Liu C, Zheng S, Li H, Xu K . Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics. J Urol. 2010;184: 2440-5.
[8]	Xu A, Zou Y, Li B, Liu C, Zheng S, Li H , et al. A randomized trial comparing diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia. J Endourol. 2013; 27: 1254-60.
[9]	Shimizu Y, Hiraoka Y, Iwamoto K, Takahashi H, Abe H, Ogawa H . Is complete resection of hypertrophic adenoma of the prostate possible with TURP? J Nippon Med Sch. 2005;72: 146-8.
[10]	Walz J, Graefen M, Huland H . Basic principles of anatomy for optimal surgical treatment of prostate cancer. World J Urol. 2007;25: 31-8.
[11]	Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, et al . A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol. 2010;57: 179-92.
[12]	Walz J, Epstein JI, Ganzer R, Graefen M, Guazzoni G, Kaouk J, et al . A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol. 2016; 70: 301-11.
[13]	da Silva RD, Bidikov L, Michaels W, Gustafson D, Molina WR, Kim FJ . Bipolar energy in the treatment of benign prostatic hyperplasia: a current systematic review of the literature. Can J Urol. 2015;22(Suppl. 1): 30-44.
[14]	Hiraoka Y, Akimoto M . Transurethral enucleation of benign prostatic hyperplasia. J Urol. 1989;142: 1247-50.
[15]	Gilling PJ, Kennett K, Das AK, Thompson D, Fraundorfer MR . Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol. 1998;12: 457-9.
[16]	Shah HN, Sodha HS, Kharodawala SJ, Khandkar AA, Hegde SS, Bansal MB . Influence of prostate size on the outcome of holmium laser enucleation of the prostate. BJU Int. 2008;101: 1536-41.
[17]	Elzayat EA, Elhilali MM . Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol. 2007;52: 1465-71.
[18]	Neill MG, Gilling PJ, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR, et al . Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology. 2006;68: 1020-4.
[19]	Liu CX, Xu AB, Zheng SB, Li HL . Real endo-enucleation of prostate for treatment of benign prostatic hyperplasia. J Urol. 2006
	(Suppl. 17): 453.
[20]	Chen Y, Xu H, Xu H, Gu M, Zhou J, Cai Z , et al. Comparison of plasmakinetic enucleation of the prostate with holmium laser enucleation of the prostate in the treatment of benign prostate hyperplasia. Int J Clin Exp Med. 2016;9: 7328-33.
[21]	Brunckhorst O, Ahmed K, Nehikhare O, Marra G, Challacombe B, Popert R . Evaluation of the learning curve for holmium laser enucleation of the prostate using multiple outcome measures. Urology. 2015;86: 824-9.
[22]	Elkoushy MA, Elshal AM, Elhilali MM . Postoperative lower urinary tract storage symptoms: does prostate enucleation differ from prostate vaporization for treatment of symptomatic benign prostatic hyperplasia? J Endourol. 2015;29: 1159-65.
[23]	Furuya Y, Akakura K, Tobe T, Ichikawa T, Igarashi T, Ito H . Changes in serum prostate-specific antigen following prostatectomy in patients with benign prostate hyperplasia. Int J Urol. 2000;7: 447-51.
[24]	Geavlete B, Stanescu F, Iacoboaie C, Geavlete P . Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia casesda medium term, prospective, randomized comparison. BJU Int. 2013;111: 793-803.
[25]	Palaniappan S, Kuo TL, Cheng CW, Foo KT . Early outcome of transurethral enucleation and resection of prostate compared with transurethral resection of the prostate. Singap Med J. 2016;57: 676-80.
[26]	Zhao Z, Zeng G, Zhong W, Mai Z, Zeng S, Tao X . A prospective, randomised trial comparing plasmakinetic enucleation to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: three-year follow-up results. Eur Urol. 2010;58: 752-8.
[27]	Zhu L, Chen S, Yang S, Wu M, Ge R, Wu W , et al. Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70 ml: a prospective, randomized trial with 5-year followup. J Urol. 2013;189: 1427-31.
[28]	Geavlete B, Bulai C, Ene C, Checherita I, Geavlete P . Bipolar vaporization, resection, and enucleation versus open prostatectomy: optimal treatment alternatives in large prostate cases? J Endourol. 2015;29: 323-31.
[29]	Zong HT, Peng XX, Yang CC, Zhang Y . The impact of transurethral procedures for benign prostate hyperplasia on male sexual function: a meta-analysis. J Androl. 2012;33: 427-34.
[30]	Mishriki SF, Grimsley SJ, Lam T, Nabi G, Cohen NP . TURP and sex: patient and partner prospective 12 years follow-up study. BJU Int . 2012;109: 745-50.
[31]	Capogrosso P, Ventimiglia E, Ferrari M, Serino A, Boeri L, Capitanio U, et al . Long-term sexual outcomes after holmium laser enucleation of the prostate: which patients could benefit the most? Int J Impot Res. 2016;28: 189-93.
[32]	Kim SH, Yang HK, Lee HE, Paick JS, Oh SJ . HoLEP does not affect the overall sexual function of BPH patients: a prospective study. Asian J Androl. 2014;16: 873-7.
[33]	Xu YW, Liu CX, Zheng SB, Li HL, Fang P, Chen BS, et al . Transurethral enucleation of the prostate for treatment of benign prostatic hyperplasia in patients less than 50 years old. Nan Fang Yi Ke Da Xue Xue Bao. 2010; 30: 2708-10 [article in Chinese].