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