Features of the Intraoperative Period in Patients with Large-volume Benign Prostatic Hyperplasia Depending on the Method of Surgical Correction of Infravesical Obstruction

Benign prostatic hyperplasia (BPH) is a common condition among elderly men that significantly affects their quality of life. Although monopolar transurethral resection of the prostate (TURP) has long remained the gold standard for surgical treatment, advances in technology have led to the development of modern alternative approaches. The objective: the aim of the study was to analyse the course of the intraoperative period inpatients with BPH of large and very large volumes, depending on the method of invasive intervention, taking into account anatomical features of vesicourethral segment. Materials and methods. This retrospective single-center study included patients who underwent interventional procedures for BPH between 2019 and 2021. Depending on the surgical technique used, all patients were divided into four groups: the first group (n = 106) – mechanical methods of enucleation of hyperplastic prostate tissue; the second group (n = 51) – monopolar TURP of the prostate; the third group (n = 302) – bipolar TURP of the prostate; and the fourth group (n = 104) – bipolar transurethral enucleoresection of the prostate. Results. Studied groups did not differ significantly in age (H = 2.8, p = 0.380) or body weight (F = 1.7, p = 0.409). Patients in the fourth group had significantly shorter durations of surgical intervention compared to the first (p = 0.0001) and second groups (p = 0.029). The fourth group also showed a 6.8-fold lower (p = 0.0003) volume of intraoperative blood loss compared to the first group, 3.13 times lower (p = 0.0002) than the second group, and 2.79 times lower (p = 0.0011) than the third group. Thus, a clear correlation is observed between the chosen surgical method and the volume of intraoperative blood loss. The use of certain surgical techniques significantly reduced the need for transfusion therapy: patients in the fourth group required erythrocyte mass transfusions (χ2 = 6.93, p = 0.032) and fresh frozen plasma transfusions (χ2 = 17.5, p = 0.005) significantly less frequently compared to other groups. Patients in the fourth group also required a shorter duration of urethral bladder drainage (51 (156; 72) hours) compared to the other groups (H = 13.2, p = 0.0011). The postoperative hospitalization period was also shorter in the fourth group (5 (4; 6) days) compared to the first (8 (5; 14) days, p = 0.003), second (7 (4.25; 10) days, p = 0.0031), and third groups (7 (6; 9) days, p = 0.0012). Conclusions. The highest efficacy of hyperplastic tissue removal was demonstrated in group of patients with bipolar enucleoresection of the prostate, characterized by lower intraoperative blood loss, shorter urethral drainage duration, and shorter hospitalization compared to groups with mechanical enucleation (adenomectomia), monopolar and bipolar TURP.