Bipolar and monopolar transurethral resection of the prostate are equally effective and safe in this high quality randomized controled trial

Numerous surgical techniques are approved for the surgical treatment of benign prostatic obstruction (BPO).They include minimally invasive procedures such as the newly introduced prostatic urethral lift and water vapor thermal therapy, transurethral resection, vaporization or enucleation of the prostate and open or laparoscopic/robotic assisted prostatectomy and have been recommended by the guidelines of the most distinguished scientific organizations (1, 2).In clinical practice for many decades, transurethral resection of the prostate (TURP) remains the standard by which subsequent surgical modalities for the treatment of BPH have been compared.Guidelines recommend that either monopolar or bipolar TURP may be used, for patients with a moderately enlarged prostate, of up to 80 cc, depending on the surgical expertise of the practitioner (1, 2).In bipolar TURP (B-TURP), the energy does not travel through the body to reach a skin pad, as is the case for monopolar TURP (M-TURP).It is confined between the active and passive poles situated on the resectoscope tip (resection loop) (3).It may be performed in 0.9% NaCl solution and does not require the use of isoosmolar solutions (mannitol, glycine), greatly reducing the risk for acute dilutional hyponatremia and the TUR syndrome.This is especially important for larger prostates requiring prolonged surgery (4).Many studies have been published in recent years exploring the use of B-TURP and comparing it with M-TURP.Systematic reviews have also compared the two techniques, confirming comparable efficacy for both and a reduced risk for acute dilutional hyponatremia and TUR syndrome for B-TURP (5, 6).Although some studies indicate a reduced risk for blood transfusion and clot retention with B-TURP, the evidence is not strong to make a recommendation in this regard (2, 7).There are different bipolar resection devices and no evidence in favor of a specific system (3).In the present study, Otaola-Arca H. et al. (8) used the Plasma KineticTMSuperpulse generator as the energy source for bipolar TURP (PK-TURP) and prospectively compared it with M-TURP.They included patients with refractory LUTS and/or complications associated with BPO and a prostate volume < 80 cc.Of 100 randomized patients, 84 were included in the final analysis.Patients were evaluated after 1, 3, 6 and 12 months and the efficacy variables were improvement in the International Prostate Symptom Score (IPSS), quality of life question of the IPSS, Qmax, postvoid residue, prostate volume and sexual function measured by the IIEF-5.The authors showed comparable efficacy and safety outcomes for the two methods.The only difference observed was a greater improvement of the QoL score in patients who underwent PK-TURP, which was minor and considered clinically insignificant.The efficacy results of this study are in accordance with a recent meta-analysis by Cornu et al. that showed no differences comparing the two techniques (9).However, the meta-analysis showed an increased risk for dilutional hyponatremia and bleeding complica-

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