The position of bipolar technology in transurethral resection of the prostate for benign prostatic obstruction: an evidence-based approach

This work was conducted with the scope to evaluate the position of bipolar technology in transurethral resection of the prostate (TURP) for treating patients with lower urinary tract symptoms secondary to benign prostatic obstruction, using an evidence-based approach. Unique clinical data from the first international, multicenter randomized controlled trial (RCT) comparing efficacy/safety of bipolar TURP (B-TURP) with that of the surgical "gold standard" (monopolar TURP (M-TURP)) are provided. Part I represents a general introduction. Part II presents best available evidence based on the results of the first focused RCT-based meta-analysis. No clinically relevant differences exist in short-term efficacy; B-TURP is preferable due to a more favourable perioperative safety profile. In Part III, applicability of the modified Clavien Classification System in grading TURP complications is evaluated for the first time. The system is a straightforward/easily applicable tool that helps urologists to classify TURP complications in a more objective/detailed way serving as a standardized platform of communication allowing for sound comparisons. Part IV refers to the first international, multicenter RCT comparing efficacy/safety of B-TURP and M-TURP. Perioperative, short-term (up to 12 months) and midterm (up to 24-36 months) safety/efficacy is similar. The potentially improved perioperative safety profile of B-TURP (elimination of dilutional hyponatremia risk) does not translate into a significant clinical benefit in experienced hands. Part V presents evidence/limitations defining current position of B-TURP. Some practical considerations are discussed along with future perspectives.