Bipolar or monopolar transurethral resection for benign prostatic hyperplasia?

Area of Science:

• Urology
• Surgical Technology
• Evidence-Based Medicine

Background:

• Transurethral resection is the standard endoscopic treatment for lower urinary tract obstruction caused by benign prostatic hyperplasia (BPH) less than 80 cc.
• Monopolar resection loops were traditionally used, but bipolar energy technology has recently become prevalent.
• Evaluating the efficacy and safety of both monopolar and bipolar energy technologies is crucial.

Purpose of the Study:

• To compare the efficacy and safety of monopolar versus bipolar transurethral resection for benign prostatic hyperplasia.
• To synthesize evidence from systematic reviews and primary studies on these surgical techniques.

Main Methods:

• A comprehensive search was conducted using Epistemonikos, a large database of systematic reviews.
• Data were extracted from 13 systematic reviews, including 32 primary studies (31 randomized trials).
• A meta-analysis and GRADE approach were used to evaluate the findings.

Main Results:

• Efficacy between monopolar and bipolar transurethral resection may be comparable.
• Bipolar energy significantly reduces the incidence of transurethral resection syndrome.
• Bipolar energy use probably reduces the risk of bleeding requiring red blood cell transfusion.

Conclusions:

• Bipolar transurethral resection is a safe and effective alternative to monopolar techniques for BPH.
• Bipolar energy offers potential advantages in reducing complications such as transurethral resection syndrome and bleeding.
• Further research may confirm the superiority of bipolar energy in specific safety outcomes.