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Bipolar Diathermy for Transurethral Resection of Prostate: 6 year Australian Single Regional Centre Experience Introduction Monopolar diathermy is considered.

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Presentation on theme: "Bipolar Diathermy for Transurethral Resection of Prostate: 6 year Australian Single Regional Centre Experience Introduction Monopolar diathermy is considered."— Presentation transcript:

1 Bipolar Diathermy for Transurethral Resection of Prostate: 6 year Australian Single Regional Centre Experience Introduction Monopolar diathermy is considered to be the surgical ‘gold standard’ for benign prostatic obstruction mainly because of its well documented long-term efficacy. (1) The incorporation of Bipolar TURP has been a significant modification, utilising normal saline, with promising results. Conclusions Our study, compared to the literature, shows that performing TURP in a regional center using bipolar diathermy had acceptable outcomes with a shorter length of stay. Results Ipswich General Hospital is a regional 300-bedded hospital in Queensland, Australia staffed with two visiting urologists, a urology trainee and a non- training registrar. It covers a population of 160000 spread over 465 square miles. Over 6 consecutive years 464 cases of TURP using bipolar diathermy were performed with a mean age of 70.63 years, median ASA grade of 2, average operative time of 58.92 mins (59.09 mins with another procedure) with maximum operative time of 159 mins (180 mins with another procedure), and median length of stay of 2 days. 218 cases (47%) had more than two co- morbidities. 40 cases (8.6%) had complications - 10 bleeding (one required blood transfusion), 9 cardiac complications, 7 urethral strictures (1.5%), 3 UTI’s, 3 urethral false passages, 2 postoperative fever, 2 laryngospasms, 1 hyponatremia (0.2%), 1 bladder neck stenosis (0.2%), 1 incontinence (0.2%) and 1 had a fall while an inpatient. 75 cases (16%) were found to have malignant histology. There were no thirty- day postoperative or surgery related mortalities. Puppo et al (2) studied 1000 bipolar TUR cases. Of these there were 376 bipolar TURP’s, median 12 month follow up with 2.7% urethral strictures, 1% bladder neck stenosis and no TURP syndromes. In a recently published international multicentre randomised control trial (3)comparing monopolar and bipolar TURP, 141 patients, underwent bipolar TURP over 3 years. Average resection time was 52 mins. 27 of the 141 patients (19.1%) had post operative complications with 18 bleeding (9 requiring blood transfusion), 5 acute urinary retentions, 2 urethral stricture, 1 febrile UTI and 1 with other complication. There were no TURP syndromes. In contrast there were 2 mortalities of 138 patients in the monopolar TURP arm of the study. Patients were only followed up for 6 weeks post surgery. In this study perioperative efficacy, safety and secondary outcomes (resection time, resection rate, capsular perforation and catheterisation time) were comparable between monopolar and bipolar TURP. Comparatively our study population had fewer overall complications, longer resection times, no perioperative mortalities, though slightly higher rate of urethral stricture formation which we attribute to longer resection times. We recommend routine Otis urethrotomy prior to large prostatic resection to prevent this complication. Methods Prospectively collected data was analyzed for TURP surgery performed using bipolar diathermy from 2003 to 2008. Two independent reviewers analyzed ORMIS electronic operative database. 544 potential cases were identified. After careful analysis 464 cases were deemed suitable for the study. 80 cases were not included due to incorrect or incomplete data entry and loss to follow up. The data was analyzed regards to age, ASA grade, co-morbidities, date of surgery, operative time, length of stay, complications, mortality and histology results. The median follow up was 3 years. Acknowledgements We would like to acknowledge the medical records unit at Ipswich General Hospital in assisting us with our endeavour. Aim The aim was to evaluate the outcomes of bipolar diathermy (Gyrus) in management of consecutive patients, with symptomatic prostatic hypertrophy, prospectively over six calendar years (2003 to 2008) in a single regional centre in Australia. Ipswich General Hospital is the first hospital in Queensland to get the bipolar diathermy with this being the largest series in the literature. References 1 Stief CG et al. Techniques and long-term results of surgical procedures for BPH. Eur Urol 2006;49:970-8. 2. Puppo et al. Transurethral resection in Saline: Outcome and complication rates after the first 1000 cases.. J Endo Urol 2009;23 (7):1145-1149 3. Mamoulakis et al. Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate. BJUI 2011;109:240-8. Devang Desai (Urology Registrar), Katrina Hopcraft (Urology Resident), Wesley Hii (Urologist), Hee Soo Teng (Urologist) Department of Urology, Ipswich General Hospital, Queensland, Australia Poster presentation sponsor No. 091


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