Changing trends in patients undergoing Transurethral Resection of Prostate (TURP) and comparison of monopolar TURP with bipolar TURP: A single centre experience

Background: Transurethral Resection of the Prostate (TURP) remains the gold standard for the surgical management of Benign Enlargement of Prostate (BEP), despite advances in pharmacotherapy and newer endoscopic techniques. Monopolar TURP (M-TURP) has been challenged by bipolar TURP (B-TURP) because of its perceived safety advantages. Aim and Objectives: To compare the perioperative complications and outcomes of M-TURP and B-TURP, and analyze the changing trends in patient profiles and indications for TURP over time. Material and Methods: This retrospective study analyzed patients undergoing TURP at our center from January 2010 to December 2013 (M - TURP, n = 253) and January 2015 to December 2018 (B-TURP, n = 219). Patients with a prostate size >100 ml, prior prostate surgery, or urethral stricture were excluded. Data on patient characteristics, intraoperative variables, and postoperative outcomes were compared using statistical tests (t-test, Mann-Whitney U, chi-square, Fisher's exact test; p < 0.05). Results: A 13% decline in TURP procedures was observed from 2010–2013 to 2015–2018. No significant differences were noted in age, symptom score, prostate size, or comorbidities between the groups. The proportion of patients refractory to medical therapy significantly decreased in the B-TURP group (p = 0.009). M-TURP was associated with a greater decrease in hemoglobin (p < 0.001), TUR syndrome (2.4%, p = 0.03), blood transfusions (2.7%, p = 0.01), and re-TURP (0.8%, p = 0.1) than B-TURP, which had none of these complications. Mean American Urological Association Symptom Score at 6 months was lower in the B-TURP group (5.01) than in the M-TURP group (6.06, p < 0.001), although the difference was not clinically significant. Conclusion: B-TURP is as effective as M-TURP, with reduced complications, including no TUR syndrome, lower transfusion rates, and fewer re-TURPs. The decline in TURP procedures reflects the increased efficacy of medical therapy. B-TURP should be considered the new standard for the surgical management of BEP.