الفهرس 
Introduction and aim of the studyOnly 14 pages are availabe for public view
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Abstract
BPH is the most common benign tumor in men, and its incidence is age related, the prevalence of histologic BPH in autopsy studies rises from approximately 20% in men aged 41–50, to 50% in men aged 51–60, and to > 90% in men older than 80, although clinical evidence of disease occurs less commonly, symptoms of prostatic obstruction are also age related.
Transurethral resection of prostate (TURP) is the gold standard option for the surgical management of benign prostate hyperplasia. It is primarily, the removal of tissue from the transition zone of the prostate to reduce benign prostatic obstruction. It can be performed either by monopolar or bipolar diathermy system.
The conventional monopolar transurethral resection of the prostate (M-TURP) has potential risks such as skin burns, excessive heating of deep tissues, inadvertent nerve stimulation (e.g. obturator reflex) and cardiac pacemaker malfunction. Additionally, monopolar TURP requires hypo-osmolar irrigation fluids (e.g. glycine), which, if absorbed in high volumes, may lead to TUR syndrome.
In an attempt to overcome some of these disadvantages, bipolar technology that can use normal saline as an irrigation fluid, was proposed as an alternative to monopolar TUR as a treatment for BPH.
The study included 40 patients with a diagnosis of benign enlargement of the prostate undergoing TURP randomly allocated in to 2 groups of 20 patients each, The first group was treated with monopolar diathermy and the second group was treated with bipolar diathermy, patients in both groups were comparable regarding age, indication for surgery, size of the prostate and all the preoperative laboratory investigations , and patients were blinded to the operation equipment, but not to surgeons.
Resection time and volume of irrigant used was calculated also the weight of the resected gland. The patients vital parameters (pulse, blood pressure, oxygen saturation monitor¬ing by pulse oximeter) were monitored and clinical signs of transurethral resection (TUR) syndrome (anxiety, nausea, vomiting) were watched for.
Postoperative follow up included a complete blood picture and serum electrolytes (sodium and potassium), need of Blood transfusion, duration of hospital stay, any postoperative complications e.g clot retention and uroflowmetry.
TUR syndrome was observed in 3 of our patients from the monopolar group but none of the bipolar group with a statistically significant difference in the level of serum Na in the monopolar group 132.68 ± 7.66 mmol/L compared with bipolar group 138.57 ± 3.97 mmol/L (p value= 0.004), blood loss also was slightly more evidant in the monopolar group indicated by the difference in the Hb level pre and post operatively, (1.40 ± 0.82) gm/dl loss in the monopolar group versus (0.84 ± 0.43) gm/dl loss in the bipolar group, but the operative time was longer in the bipolar group.
The improvement in Q max at each assessment was comparable in both groups with no statistically significant difference (p value = 0.78 ).
Conclusion and recommedation
- Monopolar TURP has some limitations in a group of patients with large prostates which require long operative time, these limitations are set to avoid the potential risk of TUR syndrome.
- Bipolar TURP is an effective surgical methods for treatment of the obstructive symptoms due to BPH with improvement in the safety profile regarding the incidence of complications especially TUR syndrome.
- Patient with large sized prostate whose operative time is expected to be long (more than one hour) better to be operated by the bipolar resection system.