Benign prostatic hyperplasia (BPH) is a common chronic progressive disease resulting in
the enlargement of the prostate gland and bladder outlet obstruction in aging men.
Because of the increasing aged population and advancements in diagnostic tools, the
incidence and importance of BPH have increased. BPH can be treated either with watchful
waiting, drug therapy, or surgery being the most effective treatment option for BPH.
Transurethral resection of the prostate (TURP) has been recognized as the standard
treatment for BPH with morbidity rate varies from 18% and 26%.
Until now, only open prostatectomy and transurethral Holmium laser enucleation of the
prostate (HoLEP) have shown an equal efficacy and durability compared to TURP.
An increasing number of endoscopic techniques have been attempted to overcome these
complications. One of the technical modifications of TURP is the bipolar transurethral
resection of the prostate (B-TURP) which enables urologists to use normal saline solution
as an irrigation fluid to overcome the risk of TUR syndrome occurrence and requires less
energy.
Currently bipolar TURP is considered a valid alternative to monopolar TURP offering
similar efficacy with lower peri-operative morbidity.
Moreover, the bipolar system can also be used to enucleate entire large prostate glands,
achieving an effective alternative to TURP and open simple prostatectomy (OP), and
reducing complications associated with these techniques, including risk of bleeding and
blood transfusion.
The crux of the idea behind enucleation is that it depends on removing the prostatic
tissue along the surgical capsule as in open prostatectomy, but in a minimally invasive
setting, with the same tissue removal capability.
Despite a growing amount of data reported in the literature, it remains unclear how PKEP
compares to more established B-TURP in the surgical treatment of BPH
The aim of the study is to assess the surgical efficacy, safety, and peri-operative
morbidity of bipolar plasmakinetic enucleation of the prostate (PKEP) in comparison with
bipolar transurethral resection of the prostate (B-TURP) for the treatment of patients
with symptomatizing prostates.
A prospective randomized controlled study was conducted in 52 patients diagnosed with
lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) whose prostates >
60 gm. The perioperative parameters, therapeutic effects and complications were compared
between the two groups before and 3 months after surgery.
Preoperative evaluation included detailed medical history, thorough clinical examination,
International Prostate Symptom Score (IPSS), digital rectal examination (DRE), prostate
volume, post-voiding residual urinary volume (PVR), PSA level and maximum flow rate
(Qmax).
Intraoperative evaluation included operative time, irrigating fluid volume, the volume of
removed prostate tissue, blood loss, and intraoperative complications.
Postoperative evaluation included the mean hemoglobin and hematocrit differences,
catheterization period, hospital stay, postoperative complications and follow up IPSS,
PVR and Qmax.