The advent of the bipolar resection system increased the overall percentage of endoscopic procedures done as transurethral resections of the prostate (TURPs).
Retreatment rates have not influenced the continued adoption of new endoscopic and minimally invasive treatments.
Socioeconomic factors involved in acceptance and use of laser technology have not been described.
With the widespread use of medical therapy for BPH, there has been a trend toward less use of surgical management.
Younger men are more likely to undergo treatment for BPH than older men.
Subjective symptoms (such as dysuria) can be influenced by observer reporting.
In a randomized controlled trial (RCT), comparison with TURP assumes that the surgeon performing the TURP has been sufficiently trained and can produce predictable results.
Intent to treat analyses are commonly reported.
Reports of long-term treatment efficacy are highly influenced by a loss of patients to follow-up and, possibly, reporting of responder data only.
Comparisons across surgical techniques are often unfair because new technologies are frequently compared with a historic, and often inferior, data set.
apical portion of the prostate.
anterior portion of the prostate.
median lobe, if present.
absorption of non–sodium-containing irrigating fluid, leading to an acute dilutional hyponatremia.
irrigating fluid placed at a less than ideal height above the patient.
a serum sodium of greater than 130 mEq/L.
absorption of fluid during procedures such as holmium laser enucleation of the prostate (HoLEP) and bipolar TURP.
intraoperative ureteral injury.
Improved visualization during bipolar TURP may also lead to a decrease in capsular perforations and operating time.
A relative risk of 0.53 for blood transfusion with bipolar resection was found in meta-analysis.
All of the above.
In a meta-analysis of patients undergoing bipolar TURP, authors concluded that by treating 50 patients with bipolar TURP, one case of TUR syndrome could be prevented.
Late complications such as bladder neck contracture and need for retreatment of BPH do not appear to be much different from those found with conventional TURP.
There is a large startup cost associated with the procedure due to the required purchase of new generators and equipment.
It leads entirely to tissue vaporization.
Is available only as a monopolar technology
Was first described in 2005
Frequently leads to lower hemostasis related complications (transfusion, clot retention) compared to monopolar TURP
increase density of nerve endings in the prostate.
have comparable results in both the low energy and high energy platforms.
frequently cause erectile dysfunction.
induce changes in prostate volume of greater than 50%.
improve AUA Symptom Score (AUASS) by approximately 60% at 1 year.
have never shown a statistically significant improvement in objective measures such as peak urinary flow.
have never been performed.
have significant side effects and should not be performed as part of research.
are poorly tolerated by the patient.
frequently show statistically significant decreases in AUASS.
Urinary tract infection
has an equivalent need for retreatment for lower urinary tract symptoms (LUTS) due to BPH compared to TURP.
is not recommended in patients with metallic pelvic prostheses.
should only be performed on prostates less than 50 mL in size.
now universally regulates temperature based on impedance.
is required to be done in a hospital-based operating room with overnight admission.
It commonly results in TUR syndrome.
It causes retrograde ejaculation in 80% of cases.
It results in removal of a large volume of prostate adenoma.
It is generally only used in prostates larger than 60 mL.
It may have a lower rate of ejaculatory dysfunction in patients when done unilaterally.
Signs denoting that a laser is in use need only be displayed on the most commonly used door for that operating room.
Eye protection is required for the surgeon only.
Eye protection is required only when a video camera is not used during the case.
All windows or wall openings from the operating room (OR) must be covered.
All laser energy is readily absorbed by air/irrigating fluid, making it safe to use in the OR.
preceded HoLEP chronologically and conceptually.
requires the use of a morcellator.
follows anatomic planes to remove the prostate in lobes.
has been shown to be superior to TURP in recent meta-analyses.
uses a thulium laser.
Overall complication rates increase significantly with increasing prostate size.
Bladder neck contracture may be more common in smaller prostate glands.
Transient urinary retention is seen in more than 50% of patients.
When observed, urinary incontinence is generally permanent.
A morcellator-related bladder injury has never been reported.
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