Bipolar transurethral resection of large prostate >100 gm: single center experience

Hussein Mamdoh, Mohamed Elbendary, Enmar Habib, Ayman Hassan


Background: Benign prostatic hyperplasia (BPH) is a common urological finding in aged men. It may be associated with deterioration of the patient’s quality of life as it may cause lower urinary tract symptoms (LUTS), urinary retention, and deterioration of the renal function. The gold standard treatment option is transurethral resection of prostate (TURP) in patients with prostate up to 80g in size. However, in larger prostates (>80 g), laser or bipolar enucleation of the prostate is considered the treatment of choice. In this setting, we decided to report a single center experience with bipolar TURP for large prostates (>100 g).

Methods: The database of our center was retrospectively reviewed to identify all the patients undergoing bipolar TURP for large prostates (>100 g) between January 2018 and January 2019. The following data was collected, age, prostate size in grams, urinalysis and culture. Moreover, the operative time, resected tissue weight, complications, hospitalization, and catheterization times were also collected Furthermore, urinary tract ultrasound (including the assessment of post voiding residual urine [PVR]), uroflowmetry (including the peak urinary flow [Qmax]), and IPSS were assessed preoperatively, at one, and 12 months postoperatively.

Results: Eight were retrieved from the database and were included in the current study. The median prostate size was 115 grams. All cases were completed by B-TURP without the need for conversion to open prostatectomy and the operative time ranged from 65 to 90 minutes. All the patients showed significant improvement of the IPSS, Qmax, and PVR at one and 12 months follow up. Only three patients in the current series (37.5%) suffered from complications. 

Conclusions: B-TURP can be used safely for the management of large prostates (>100 g); however, further studies are required to confirm these results.


TURP, Benign prostatic enlargement, Bipolar energy

Full Text:



Lloyd GL, Marks JM, Ricke WA. Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms: What Is the Role and Significance of Inflammation? Curr Urol Rep. 2019;20(9):54.

Braeckman J, Denis L. Management of BPH then 2000 and now 2016-From BPH to BPO. Asian J Urol. 2017;4(3):138-47.

EAU Guidelines: Management of Non-neurogenic Male LUTS, Uroweb. Available from: Accessed on 2021 Jan 14

Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of Transurethral Resection of the Prostate (TURP)-Incidence, Management, and Prevention. Eur Urol. 2006;50(5):969-80.

Singh H, Desai MR, Shrivastav P, Vani K. Bipolar versus monopolar transurethral resection of prostate: Randomized controlled study. J Endourol. 2005;19(3):333-8.

Omar MI, Lam TB, Alexander CE, Graham J, Mamoulakis C, Imamura M et al. Systematic review and meta-analysis of the clinical effectiveness of bipolar compared with monopolar transurethral resection of the prostate (TURP). BJU Int. 2014;113(1):24-35.

Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2008;179(5):S87-90.

Ryang SH, Ly TH, Tran AV, Oh S, Cho SY. Bipolar enucleation of the prostate-step by step. Andrologia. 2020;52(8).

Botto H, Lebret T, Barré P, Orsoni JL, Hervé JM, Lugagne PM. Electrovaporization of the prostate with the Gyrus device. J Endourol. 2001;15(3):313-6.

Mertziotis N, Kozyrakis D, Kyratsas C, Konandreas A. A prospective study of bipolar transurethral resection of prostate comparing the efficiency and safety of the method in large and small adenomas. Adv Urol. 2015;2015.

Alexander CE, Scullion MMF, Omar MI, Yuan Y, Mamoulakis C, N’Dow JMO et al. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev. 2019;2019(12).

Kwon JS, Lee JW, Lee SW, Choi HY, Moon HS. Comparison of Effectiveness of Monopolar and Bipolar Transurethral Resection of the Prostate and Open Prostatectomy in Large Benign Prostatic Hyperplasia. Korean J Urol. 2011;52:269-73.

Srivastava A, Dhayal IR, Rai P. Management of Large Prostate Gland in Men with Impaired Renal Function: Comparison of Safety, Efficacy and Outcomes of Monopolar, Bipolar Transurethral Resection and Open Prostatectomy. Urol Int. 2016;96(4):413-20.

Finley DS, Beck S, Szabo RJ. Bipolar saline TURP for large prostate glands. Sci World J. 2007;7:1558-62.

Asimakopoulos AD, Corona Montes VE, Gaston R. Robot-assisted laparoscopic radical prostatectomy with intrafascial dissection of the neurovascular bundles and preservation of the pubovesical complex: A step-by-step description of the technique. J Endourol. 2012;26(12):1578-85.

Fagerström T, Nyman CR, Hahn RG. Bipolar transurethral resection of the prostate causes less bleeding than the monopolar technique: A single-centre randomized trial of 202 patients. BJU Int. 2010;105(11):1560-4.

Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of Transurethral Resection of the Prostate (TURP)-Incidence, Management, and Prevention. Eur Urol. 2006;50:969-80.

Otaola-Arca H, Alvarez-Ardura M, Molina-Escudero R, Fernandez MI, Paez-Borda A. A Prospective Randomized Study Comparing Bipolar Plasmakinetic Transurethral Resection of the Prostate and Monopolar Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia: Efficacy, Sexual Function, Quality of Life, and Complications. Int Braz J Urol. 2020;47(1):131-4.

Xie CY, Bin ZB, Wang XH, Bin LX. Five-year follow-up results of a randomized controlled trial comparing bipolar plasmakinetic and monopolar transurethral resection of the prostate. Yonsei Med J. 2012;53(4):734-41.