64 years old, male Lower urinary tract symptoms Rectal exami | Figure 1

mbsilva99
Medical Student
64 years old, male
Lower urinary tract symptoms
Rectal examination: small nodule of stone consistency located in the middle portion of the peripheral prostate
Laboratory: elevated PSA

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

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.

Here is a cystoprostatectomy (Bladder & Prostate) specimen removed for invasive bladder cancer. The prostate is at the bottom of the pic, shown with the green arrow.
This tumor (black arrow) appears obviously necrotic, however the appearance is compounded by the presence of bladder stones. The stones can break down with the help of fluid (urine) and become somewhat of a coarse paste-like consistency. This substance is adherent to, and basically indistinguishable from, the tumor. It does, however, give us a pretty good idea of the size of the tumor itself.
In addition to this obvious area, the surrounding mucosa looks concerning as well. Is this the ‘true’ border and size of the tumor or is this just reactive change? Does the area marked with a drawn arrow demonstrate tumor involving the left ureteral orifice? (Probes entering both ureters) Are the margins free of tumor? Is the prostate involved by tumor? These are the many questions we must answer and help the Pathologist answer as a Pathologists’ Assistant.

Such a beautiful case!!!
All in one case
For a single patient
In a single procedure

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