Safety and effectiveness of bipolar transurethral resection of prostate in managing large size glands in the oldest old: A retrospective analysis

• Main Author: Priyanka Rai, Rohit Srivastava, Sunil Kumar Singh, Alok Srivastava
• Format: Article
• Language: English
• Published: Bulgarian Association of Young Surgeons 2020-06-01
• Series: International Journal of Surgery and Medicine
• Subjects: oldest old; large gland; bipolar turp
• Online Access: http://www.ejos.org/index.php?fulltxt=107213&fulltxtj=136&fulltxtp=136-1589474258.pdf

Aims and Objectives: The study was performed to evaluate the efficacy and safety of bipolar transurethral resection of prostate (BP-TURP) in the oldest old (>85yrs) with large glands. Methods: Patients of age >85 years and gland size >60 g, who were operated for Benign Prostatic Hyperplasia (BPH) (BP-TURP) at our institution from January 2014 to January 2018 , were included in the study and data was collected retrospectively. Exclusion criteria were any evidence of suspected neurogenic bladder, bladder cancer, increased serum prostate specific antigen (PSA) (> 4 ng/ml) & history of urethral or prostatic surgery. The patients were divided into two groups according to gland size, one was with an estimated size of >60 g but ≤90 g (Group 1) and the other with >90g (Group 2). Pearson’s Chi square test was used to test for the significant differences for categorical data and Student t test and Mann Whitney U test for continuous variables. The difference was considered significant if p value was <0.05. Results: The baseline parameters of the groups were almost similar with more than 50% of patients in both groups being of American Society of Anesthesiologists (ASA) grade 3 or more. Fall in haemoglobin and serum sodium levels, operative time, quantity of saline infusion used, weight of resected tissue, time to removal of catheter and hospital stay were significantly more in group 2. The follow up data indicates significant improvement in International Prostate Symptom Score (IPSS), quality of life due to urinary symptoms (QoL), post void residue (PVR) and maximum urinary flow rate in uroflowmetry (Q -max) in both groups as compared to baseline with low and acceptable complication rates. Limitation was the study being a single centre series and short follow up. Conclusion: Elderly patients (>85 years) with large glands can be safely treated with BP -TURP with good outcomes and low complication rates.