Urology Video Journal (Jun 2022)
Bipolar TURP in a patient undergoing redo prostate surgery and the use of PlasmaButton for vaporisation and coagulation
Abstract
Introduction and objectives: Transurethral Resection of Prostate (TURP) was first introduced in 1930s for management of benign prostatic hyperplasia (BPH). Monopolar TURP (MTURP) was the mainstay for surgical management of BPH, but bipolar TURP (BTURP) has shown to be safer in terms of post-operative complications (Autorino et al.,2009; Alexander et al.,2020). Here, we present a video demonstrating our technique of BTURP in a patient who failed to respond to medical treatment. Methods: A 68-year old male presented with worsening lower urinary tract symptoms (LUTS) and failed medical treatment. He had previously had a MTURP in 2017 but he had a regrowth of his prostate and a repeat TURP was planned. He was also on treatment for hypothyroidism and acid reflux. A BTURP was offered to the patient which he agreed to. This was carried out using the transurethral resection in saline (TURis) (Olympus, Germany) bipolar system via a 26F resectoscope sheath. We have edited the video to demonstrate the procedure for all urologists. Results: A BTURP was carried out with minimal bleeding. A small regrowth of prostate was noted, and this was resected. The surgical capsule was preserved throughout the procedure. The procedure time was 15 min and estimated blood loss was 25 ml. After resection, the plasma button was used to vaporise tissues and coagulate the bleeding points. Weight of the resected prostate was 6 gm and pathology demonstrated glandular hyperplasia, patchy chronic inflammation, with no evidence of malignancy. The patient was discharged home on the first postoperative day after a successful trial of void within 24 h of his procedure. At 2 months follow-up the patient was voiding well and happy with the outcome of his procedure.The pre-operative flow rate and post void residual volumes improved from 11 ml/sec to 209 ml to 18 ml/sec and 13 ml respectively during the post-operative follow-up. Conclusion: This video demonstrates that BTURP is a good procedure for BPH. The previous systematic reviews published demonstrated safer outcomes of BTURP compared to MTURP with less blood loss, transfusion and TUR syndrome for the former procedure. BTURP seems to achieve excellent clinical outcomes and perhaps might be an excellent alternative to MTURP. The use of PlasmaButton leads to good vapoorisation and cogulation with smooth post-operative tissue surface.
