Bipolar Versus Monopolar Transurethral Resection of the Prostate: A Prospective Randomized Trial Focusing on Bleeding Complications

Purpose: We compare monopolar vs bipolar transurethral resection of the prostate in patients with benign prostatic hyperplasia, focusing on functional outcomes as well as rates of bleeding complications and the transurethral resection syndrome. Materials and Methods: A total of 137 patients with benign prostatic hyperplasia (mean age 67 years, range 47 to 91) were prospectively randomly assigned to undergo monopolar (67) or bipolar (70) transurethral resection of the prostate. Patient characteristics of the 2 groups were similar. Hemoglobin (as a marker of blood loss) was measured preoperatively and perioperatively. I-PSS, I-PSS-QoL score, maximal flow rate and post-void residual urine volume were assessed preoperatively and 3 and 12 months postoperatively. Duration of surgery, indwelling catheter use and hospitalization were also documented, as were postoperative clot retention requiring removal by catheterization or surgery, and rates of bladder neck and/or urethral strictures. Results: No significant perioperative differences were found in duration of surgery, catheterization or hospitalization, or in blood loss or rates of blood transfusion and transurethral resection syndrome. Postoperatively there were no significant differences in I-PSS or I-PSS-QoL scores, or rates of rehospitalization, clot retention, blood transfusions, reoperation or urethral strictures. However, bladder neck stricture occurred significantly more often in the bipolar group (8.5% vs 0%, p = 0.02). The 3 and 12-month followup showed significant and equal improvement in micturition in the 2 groups. Conclusions: Bipolar and monopolar transurethral resection of the prostate are effective and safe techniques for the surgical treatment of benign prostatic hyperplasia. The only significant difference between them was a significantly higher rate of bladder neck strictures with bipolar resection of the prostate.