SIU 2024: (MC-08) Monopolar TURP - "The Gold Standard"
Speaker: Dr. Sujeet Poudyal, Nepal
Important Takeaways
-
Monopolar TURP remains a gold standard for BPH treatment due to its longstanding safety, efficacy, affordability, and predictable outcomes.
-
Compared to newer technologies like bipolar TURP and laser, monopolar TURP has substantially lower costs, both operationally and in instrumentation.
-
Clinical parameters, such as IPSS (International Prostate Symptom Score), prostate size reduction, and retreatment rates, show no significant differences between monopolar and bipolar TURP.
-
While risks such as TURP syndrome and bleeding may increase with prostate size, careful patient selection and risk management can mitigate these complications.
-
The EAU guidelines support monopolar TURP for prostate sizes between 30–80 ml, though it can also be performed on larger prostates with precautions.
Key Highlights
Introduction to Monopolar TURP:
Monopolar Transurethral Resection of the Prostate (TURP) was introduced in the 1920s as an alternative to open surgery, revolutionising treatment for benign prostatic hyperplasia (BPH). Dr. Sujit underscored its evolution as a time-tested, economically feasible method that remains a cornerstone in BPH surgery.
Clinical Efficacy and Long-Term Outcomes:
Monopolar TURP has shown consistent long-term results, largely attributable to decades of refinement in both technology and technique. Its efficacy is evidenced by significant improvements in patient-reported outcomes, such as quality of life and post-void residual urine (PVRU), with complications reported in less than 5% of cases.
Cost-Effectiveness:
In comparison to bipolar TURP, monopolar TURP is significantly more affordable, with nearly half the operational and instrument costs. This makes it an accessible choice, especially in resource-limited settings. Despite its lower cost, it achieves similar clinical outcomes, further reinforcing its role as a primary treatment option.
Characteristics of an Ideal Modality for BPH Treatment:
Dr. Sujit outlined three critical attributes for BPH treatment modalities: efficacy, safety, and cost-effectiveness. He emphasised that monopolar TURP continues to meet these criteria, rendering it suitable for a broad range of patients, particularly when balancing safety with affordability.
Guidelines and Size Considerations:
The European Association of Urology (EAU) guidelines recommend monopolar TURP for prostates sized between 30 and 80 ml. Although complications, such as urethral stricture, bleeding, and TURP syndrome, are more likely in larger prostates, the session highlighted that these can be managed effectively through careful patient selection and procedural adjustments.
Comparative Efficacy with Bipolar TURP:
When comparing monopolar TURP with bipolar TURP, both demonstrate similar outcomes in IPSS, prostate volume reduction, and retreatment rates. A meta-analysis noted that bipolar TURP had a slight advantage in reducing TURP syndrome and blood transfusions, though differences were minimal. Importantly, the two modalities have near-identical efficacy across most clinical parameters.
Comparison with Laser Techniques:
Laser techniques offer a safe alternative with similar efficacy at the three-year follow-up but have certain limitations, such as longer operative time and higher incidences of postoperative dysuria. Monopolar TURP provides shorter operative times with generally acceptable complication rates, reinforcing its continued preference in many clinical settings.
Conclusion:
Dr. Sujit concluded by affirming monopolar TURP as the ""gold standard"" for BPH management due to its cost-effectiveness, similar clinical outcomes to newer modalities, and the extensive experience base among clinicians. He advised that monopolar TURP remains a dependable, accessible option, particularly for settings where budget constraints are critical.
Société Internationale d'Urologie Congress, 23-26 October 2024, New Delhi, India.
