TURP is the gold standard surgical treatment for Benign prostatic hyperplasia (BPH). The main indications of TURP are –
1. Moderate to severe lower urinary tract symptoms not responding to medical therapy.
2. Acute urinary retention with atleast one failed catheter free trial.
3. Chronic retention with backpressure changes.
4. Complications of BPH like recurrent urinary tract infections, gross haematuria, bladder stones or diverticuli.
Surgical principles remain the same for any TURP wherein it is an endoscopic resection technique in which the obstructing part of the prostate is resected in a stepwise manner with the help of electric current thereby achieving a wide open prostatic fossa.
Bipolar TURP v/s Monopolar TURP
Bipolar TURP as compared to Monopolar TURP has a specialized loop which has an active electrode, and the returning electrode is on the loop itself or on the insulated part of the loop or on the inner aspect of the sheath. Both the electrodes are very close to each other and when activated, it generates a plasma corona effect which leads to effortless cutting of the tissue. There is no stray current involved as in Monopolar TURP thereby minimizing any deep thermal or nerve damage.
Bipolar TURP utilizes Normal saline as an irrigation medium which is physiological thereby eliminating the dreaded complication of TURP syndrome or dilutional hyponatremia (reduced sodium levels in the blood) wherein large amounts of hypo-osmolar solution can be absorbed into the circulation causing hyponatremia which can be seen in Monopolar TURP where Glycine is used as an irrigation medium.
Due to this very fact, the resection times were limited to 60 minutes traditionally in Monopolar TURP, hence larger prostates had to be staged. But with Bipolar TURP, the resection can be easily extended upto 90 minutes without any complication and larger prostates can be dealt with in a single sitting.
Bipolar TURP has a better haemostatic ability and lesser charring of tissues thereby enabling better delineation of anatomy.
Bipolar TURP is a minimally invasive technique, completely endoscopic, painless and patients are discharged on the 3rd day after removing the catheter. Recovery is quick and patients can resume work immediately after discharge.
It would be wise to remember that in today’s era of modern technology, TURP was the first NOTES procedure ( Natural orifice transluminal endoscopic surgery) wherein an organ is removed completely endoscopically without any cuts involved.