Adverse Effects Post TURP- A Systematic Review and Meta-Analysis of the Safety Profiles of Monopolar and Bipolar Procedures

Benign Prostate Hyperplasia is a condition characterised by overgrowth of the tissue within the prostate. With an increasingly aging population, this condition will become more prevalent. Benign prostate hyperplasia can be treated using a range of options, depending on symptom severity. The current surgical procedure of choice is TURP which may be performed using the single loop electrical current monopolar procedure or the bipolar vaporisation procedure. While monopolar TURP is considered the gold standard, the morbidity and mortality issues associated with this procedure cannot be ignored. The bipolar procedure is a newer technique which is gaining traction for its equal quality of life results and improved safety profile. This systematic review and meta-analysis seeks to assess the safety profile of these surgical procedures. 35 studies were included for analysis; the overall level of evidence was graded as low. Our primary outcome, prevention of TURP syndrome was found to be statistically significant in favour of the bipolar procedure(P<0.0001; RR[95%CI]=4.7[2.34,9.47]). We also examined need for transfusion, urethral stricture formation, urinary retention, urinary incontinence, length of stay and erectile dysfunction post procedure. Reduction in the need for transfusion(P=0.001; RR[95%CI]=1.99 [1.3,3.02]) and reduction in length of stay(P=0.02; RR[95%CI]=0.83[0.14,1.53]) were found to be statistically significant. Our review confirms that the bipolar surgical procedure is associated with reduced surgical morbidity. Based on these findings, we recommend that bipolar resection be considered the procedure of choice for patients with BPH.