Bipolar Button Transurethral Enucleation of Prostate in Benign Prostate Hypertrophy Treatment: A New Surgical Technique

ObjectiveTo evaluate the safety and efficacy of transurethral bipolar enucleation with a button electrode (B-TUEP) for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia.Materials and MethodsBetween July 2011 and March 2012, a single surgeon performed 50 B-TUEP. Preoperative and postoperative assessments included prostate-specific antigen, International Prostate Symptoms Score (IPSS), International Index of Erectile Function-5 (IIEF-5), quality of life (QoL) index, uroflowmetry with postvoiding residual (PVR) urinary volume, and prostate volume measured by transrectal ultrasonography. Intraoperatively, we evaluated B-TUEP time (enucleation and resection time). Perioperatively, we evaluated hemoglobin dosage, bladder irrigation time, catheterization time, acute urinary retention events, length of stay, patient readmission, and any endoscopic retreatments.ResultsThree months after surgery, 82% of the patients presented a significant improvement in maximum urine flow (Qmax; P <.001). At 6 and 12 months, 80% and 83.3% of patients maintained the significant improvement (P <.001). The secondary end points IPSS, QoL, IIEF-5, and PVR presented a statistically significant improvement compared with baseline values. No significant change in hemoglobin values was observed before and after surgery. Bladder irrigation time was comprised between 24 and 36 hours for about 80% of patients. In one case, second-look hemostatic endoscopy was needed. Length of stay after surgery was <48 hours in 88% of cases. Readmission was required for 6% of patients for hematuria, and 6 months later, 2 other patients developed bladder neck contracture treated with transurethral incision of the prostate.ConclusionB-TUEP using the Gyrus PK system is a rapid and safety technique with optimal outcomes.