Bipolar Plasma Enucleation of the Prostate: Do We Really need High Energy LASER?

Benign prostatic hyperplasia (BPH) is a common urologic disorder that affects 33.5% of men aged 60 to 70

years. For a long time, transurethral resection of the prostate (TURP) has been the standard surgical treatment of patients with small to medium-sized prostates. Because of the considerable complications that are associated with TURP—for example, the need for blood transfusions (2.0%–4.8%) and tran-surethral resection (TUR) syndrome (0%–1.1%),2 especially for glands larger than 45 g—and resection time greater than 45 minutes, numerous alternatives have been tested to study their efficacy and safety compared with conventional TURP.

One of the most extensively studied alternative techniques for the management of BPH is holmium laser enucleation of the prostate (HoLEP) that uses the holmium laser to enucleate

the prostatic adenoma from the surgical capsule in a way similar to open prostatectomy. This technique has the advantage of the possibility of enucleating larger adenomas with less risk of bleeding and almost no risk of TUR syndrome because physiologic saline is used as the irrigating fluid. In all studies that compare HoLEP with conventional TURP, HoLEP has been established as an effective therapy to relieve

bladder outlet obstruction from BPH, regardless of the size of the prostate with less bleeding, shorter catheterization time, and shorter hospital stay. The longer operative time, the higher costs, and the steep learning curve of HoLEP were always in favor of conventional TURP and were considered

by most expert urologists in this field as a limiting factor for the spreading of the technique.

One of the other alternatives that has been studied recently is bipolar transurethral resection of the prostate in saline (TURis). In this technique, electricity runs between an active

and a passive electrode, converting the irrigation solution (ie, physiologic saline) into a plasma layer that disintegrates tissue on contact. Intraoperative blood loss was found in several studies to be less with the bipolar resection compared with the monopolar resection. The evolution of the bipolar

TURP raised a question: Would it be able to provide all advantages of HoLEP and compensate for its drawback?

Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R. Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose?. Journal of endourology. 2011 Aug 1;25(8):1347-52.