Prostate Bipolar Enucleation and Resection Versus Open Prostatectomy

Benign prostatic hyperplasia (BPH) is a frequent disease in aging men accompanied by bladder outlet obstruction (BOO). Open prostatectomy (OP) is still considered the first-line treatment for more than 80 ml prostate size. In this study, a mixed technique called transurethral bipolar enucleation and resection of the prostate (TBERP) was compared to the standard open prostatectomy.

This is a Comparative, Prospective Study conducted on men over 50 years.The patients were randomly distributed into two groups treated by TBERP and OP. Patients were evaluated preoperatively and at 1-week post catheter removal and 1-3-months postoperatively in terms of blood loss, operation time, the weight of resected prostatic tissues, post-operative catheterisation period, hospital stay, IPSS, PVR, prostate volume, early complications (recatheterization, urine retention, UTI and irritative symptoms) and late complications (urinary incontinence, urethral stricture and bladder neck contracture).

• transurethral bipolar enucleation and resection of the prostate (Procedure), also known as TUVERP: transurethral bipolar enucleation and resection of the prostate
• open surgical transvesical prostatectomy (Procedure), also known as Transvesical prostatectomy: open surgical transvesical prostatectomy

Primary outcomes

• operative time [Three months]: To measure the difference between the two procedure regarding operative time measured in minutes.
• recovery outcome [Three months]: To measure the difference between the two procedure regarding mean hospital stays measured in days and catheterization period measured in days

Secondary outcomes

• peri-operative complication [Three months]: to measure the difference between the two procedures regarding incidence of early complications including re-catheterization, acute urinary retention, early irritative symptoms and urinary tract infections and incidence of late complications Including urinary incontinence, Urethral strictures,and bladder neck contracture.
• weight of resected prostatic tissues [Three months]: to measure the difference between the two procedures regarding weight of resected prostatic tissues Measured in gram
• post-operative International Prostate Symptom Score (IPSS) score. [Three months]: to measure the difference between the two procedures regarding IPSS score. Score 0 to 7 points considered mild symptoms, 8 to 19 points considered moderate symptoms, 20 to 35 points considered severe symptoms

Sex: Male, ages: 50 Years to any

Inclusion Criteria:

* Male patients
* Age more than 50 years
* Prostate size of more than 80 ml
* IPSS ≥ 8, and maximum urinary flow rate (Qmax) ≤ 15 mL/s
* Indications for surgery

  * Refractory retention (failed ≥1 trial of voiding).
  * Associated bladder Stones.
  * Associated recurrent gross Hematuria.
  * Associated with recurrent Infections.
  * Associated renal insufficiency.
  * Bother symptoms refractory to medical treatment.

Exclusion Criteria:

* Uncorrectable coagulopathy.
* Patient with active UTI.
* Prostate less than 80 ml.
* Severe associated comorbidities.
* Previous urethral, prostate, and bladder surgeries,
* Patients diagnosed with neurogenic bladder.
* Patients diagnosed with prostate cancer.

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• Tarek Salem, professor, Study director, Helwan university faculty of medicine