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Benign prostate hyperplasia

A 62 year old patient with difficulty in passing urine, decrease urine output, no burning sensation , pain in abdomen, bowel habit normal,

Systemic examination: per rectal examination shows normal anal tone, hard mass in anterior part.

Examination shows enlarged prostate approximately to 49.4 gm in weight.

Grade I prostatomegaly

Treatment: Tab tamsulosin 0.4mg po od 2weeks

Prostatic specific antigen (PSA) : 4.62ng/ml

What should be done for further management of patient? Is surgery necessary?

Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction

Review question How does surgery using bipolar technology compare with traditional monopolar technology for men with an enlarged prostate causing difficulty with urination?

Background People with an enlarged prostate can experience difficulty passing urine. This occurs because the enlarged prostate compresses the urinary tube from which urine leaves the bladder. One option for treatment of this condition is telescopic surgery, which acts to remove prostate tissue and relieve the blockage. This is traditionally performed using a technology called monopolar TURP (short for 'transurethral resection of the prostate'). In recent times, a technique called bipolar TURP has been developed. This approach uses saline instead of other watery fluids and may put men at lower risk for a problem called TUR syndrome, which is a rare but potentially serious complication caused by fluid absorption, but it is unclear how the two procedures compare overall.

How up‐to‐date is this review? The studies included in this review are those that were available via an electronic database search conducted on 19 March 2019.

Study characteristics We searched the medical literature for clinical trials up to 19 March 2019. We found 59 randomised trials that compared BTURP with MTURP. These studies included a total of 8924 patients. The longest period of follow‐up for the outcomes of interest was 12 months after treatment.

Key results

• Compared to MTURP, BTURP probably results in similar reduction in urinary symptoms and bother.
• It probably slightly reduces both the risk of TUR syndrome and the need for blood transfusion.
• Erectile function is probably similar after both procedures, as is the risk of urinary incontinence and the need for a repeat procedure.

Quality of evidence The quality of evidence for the outcomes of ability to pass urine, patient bother, TUR syndrome, need for blood transfusion, and erectile function was considered to be moderate. The quality of evidence for the outcomes of urinary leakage after the procedure and need for a repeat procedure was low.