MONOPOLAR VERSUS BIPOLAR TRANSURETRAL RESECTION OF PROSTATE: EVALUATION OF THE IMPACT ON ERCTILE FUNCTION
MH. Rebai, M. Raboudi, R Khiari, S. Ghozzi, N. Ben Rais.
Urology department, Tunis military hospital, Tunisia
To compare monopolar and bipolar transurethral resection of the prostate (M-TURP and B-TURP, respectively) in terms of impact on erectile function. Other baseline/ perioperative parameters potentially influencing erectile function (EF) after TURP were secondarily investigated.
From January 2010 to February 2013, consecutive TURP candidates with benign prostatic obstruction were prospectively randomized 1:1 into M-TURP/B-TURP arms and followed up at 1, 3, 6, 12, 18, 24, 30 and 36 months after surgery. In all, 60 eligible patients were enrolled.
Erectile function was quantified using the international index of erectile function Questionnaire (IIEF-5) at baseline and at each subsequent visit. Differences in erectile dysfunction severity at each visit compared with baseline (EF evolution), classified patients into ‘improved’, ‘stable’ or ‘deteriorated’. Pre and postoperative IIEF scores and differences in the distribution of EF evolution were compared between arms throughout follow-up.
The baseline characteristics were comparable between the two arms. The groups were comparable in terms of comorbidities evaluated by the Charlson score (4.42 vs 4.32, P = 0.83).
In M-TURP arm, 41 % of patients presenting with ED (mild dysfunction: 31 %, moderate dysfunction: 7 % and severe dysfunction: 3 %). In B-TURP arm, 32 % of patients presenting with ED (mild dysfunction: 26 %, moderate dysfunction: 6 % and severe dysfunction: 0 %). There were no differences between arms in terms of preoperative EF score (18,3 vs 19,5, P = 0.08).
There were no differences between arms in the distribution pattern of ED severity or in the distribution of EF evolution at any time compared with preoperative EF score (at 3 month, improved : 20,6 % vs 16,1 %, stable : 55,1 % vs 48,3 %, deteriorated : 24,3 % vs 35,6 %).
Resection type was not a significant predictor of postoperative ED.
In theory, bipolar systems cause less lesions in periprostatic tissues. However, our study did not show any significant difference between monopolar and bipolar TURP in terms of impact on erectile function.