الفهرس 
Complications of transurethral resection of the prostate (TURP)Only 14 pages are availabe for public view
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Abstract
Summary
Benign prostatic hyperplasia (BPH) represents a major health problem in our population and results in a substantial workload in urology practice. BPH frequency and importance are rising, owing to gradual changes in lifestyle and rapid increases in the elderly population .Although benign, this disease has a progressive evolution and has a negative impact on the health-related quality of life of the patients, marked by obstructive and irritative lower urinary tract symptoms (LUTS) (Geavlete et al., 2010).
Transurethral resection of the prostate (TURP) under monopolar electrocautery using glycine solution or distilled water irrigation is the gold standard surgical mode for BPH because of its long term treatment efficacy (Reich et al., 2006). Concerns have been raised, however, regarding monopolar TURP complications, such as transurethral resection (TUR) syndrome, bleeding, and urethral stricture (Rassweiler et al., 2006, Reich et al., 2008).
The development of bipolar vaporization and resection systems in the last decade has become more important because they allow removal of tissue using an iso-osmotic saline solution and may provide improved surface coagulation during resection without requiring a return electrode applied to the skin (Qu et al., 2008).
The aim of this study is to evaluate the role of bipolar hybrid prostate surgery as regards as improvement of catheterization time, hospital stay, irrigation fluid, operative time and complications profile and to compare the efficacy of bipolar hybrid prostate surgery with the transurethral resection in saline bipolar system and monopolar TURP.
This study is an exploratory comparative randomized clinical trial in which 60 patients with symptomatic BPH of El Demerdash hospital will be divided into 3 groups from June 2013 till June 2015. Each group includes 20 patients. In group І patients underwent conventional TURP, in group ΙΙ patients underwent TURis and in group ΙΙΙ patients underwent hybrid bipolar vaporization and resection after obtaining informed consent and approval of research ethical committee.
Results of the present study showed that:
●There were no statistically significant differences among the 3 groups in baseline parameters (age, PSA and prostate volume).
●No medical comorbidities were found in 38.33% of patients and that hypertension was the most common medical comorbidity.
●The most common indication for operation is refractory urinary retention (50%), followed by failed medical treatment (36.66%) then obstructive uropathy (11.6%) and finally recurrent hematuria (1.6%).
●Spinal anesthesia was used in the majority of patients (93.3%).
●Hybrid significantly decreased the operative time in comparison with TURP group but although it is less than TURis group operative time, the decrease is statistically insignificant.
● Hybrid decreased significantly the intraoperative irrigation fluid volume in comparison with TURP and TURis.
● Hybrid decreased Na less than TURP did and the difference was statistically significant, while hybrid decreased Na more than TURis did but that was insignificant.
● Hybrid decreased Hb less than TURP and TURis did and the difference was statistically significant.
● Hybrid significantly decreased the postoperative irrigation and hospital stay times in comparison with TURP and TURis.
● Hybrid significantly decreased the catheter time in comparison with TURP but although it is less than TURis catheter time, the decrease is statistically insignificant.
●Compared with baseline, there were significant improvements in IPSS, Qol, Qmax, Qav and PVRU after surgery in all groups.
●As regards complications, our study showed the rate of blood transfusion, TUR syndrome and clot retention was lower in hybrid in comparison with the other 2 procedures while the irritaive symptoms were more in hybrid group.
So, hybrid seems to a promising treatment alternative to conventional TURP and TURis especially in high risk groups.