Bipolar transurethral resection of the prostate - technical modifications and early clinical experience

The purpose of the study was to update the current modifications of transurethral resection of the prostate (TURP) using bipolar high frequency current and to report on our first own clinical experience. Based on a Medline search covering the period from January 2000 to September 2006 and our clinical experience with three different devices (VISTA-ACMI, Gyrus, Storz), the technical basis of these modifications was described. In addition, an analysis of the actual outcome (handling, complications, morbidity) of bipolar TURP (n=124) compared to a parallel series of monopolar TURP (N=148) was carried out. Recently, five different modifications of bipolar resection devices (ACMI, Gyrus, Olympus, Storz, Wolf) have been introduced. Experimental and clinical data were available for four of these modifications (VISTA-ACMI, Gyrus, Olympus, Storz). The devices differ in terms of modification of the passive electrode (two loops, single loop, resectoscope sheath). Bipolar technology allows the use of 0.9% sodium chloride (instead of glycine) as irrigant. In all bipolar devices, a slight prolongation was noted for initiation of the cut, with the VISTA showing the poorest cutting behaviour. Finest apical dissection could be performed with the Storz device. Phase III-studies comparing bipolar and monopolar TURP showed advantages for bipolar concerning the rate of TUR-syndrome/fluid absorption, bleeding, catheter time, whereas the resection speed was similar. In two studies using two different devices (Gyrus, Olympus) a higher rate of urethral strictures was detected. We conclude that TURP still represents the reference standard in the management of benign prostatic hyperplasia. Initial data suggest that bipolar technology is safe and effective. It may offer some advantages with respect to the reduction of TUR-syndrome, less conductive trauma (i.e. tissue charring), cheaper irrigation solution, and a shorter catheter time. In addition to already existing phase III-studies, larger randomized mulit-institutional trials will have to substantiate these advantages.