Search

Aims: To compare outcomes of monopolar vs bipolar transurethral resection of the prostate (TURP) in the management of exclusively moderate-large volume prostatic hyperplasia in terms of maximum flow rate as a surrogate for clinical efficacy, duration of catheterization, hospital stay, operative time, resection weight, transurethral resection (TUR) syndrome, acute urinary retention (AUR), clot retention, and blood transfusion. Methods: We conducted a search of electronic databases (PubMed, MEDLINE, EMBASE, CINAHL, and CENTRAL), identifying studies comparing the outcomes of monopolar and bipolar TURP in the management of large-volume prostatic hyperplasia. The Cochrane risk-of-bias tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa scale for observational studies were used to assess included studies. Random effects modeling was used to calculate pooled outcome data. Results: Three RCTs and four observational studies were identified, enrolling 496 patients. No difference was observed in the clinical efficacy between each procedure at 3 months postoperatively ( p  = 0.99), 6 months ( p  = 0.46), and 12 months ( p  = 0.29). The use of bipolar TURP was associated with significantly shorter inpatient stay ( p  = 0.01) and a shorter duration of catheterization ( p  = 0.05). Monopolar TURP was associated with an increased risk of TUR syndrome ( p  = 0.03). Operative time ( p  = 0.58), resection weight ( p  = 0.16), AUR ( p  = 0.96), clot retention ( p  = 0.79), and blood transfusion ( p  = 0.39) were similar in both groups. Conclusion: Our meta-analysis demonstrated that bipolar TURP in the treatment of moderate-large volume prostatic disease may be associated with a significantly lower rate of TUR syndrome and shortened length of hospital stay, with similar efficacy when compared with monopolar TURP. Further high-quality RCTs with adequate sample sizes are required to compare both monopolar and bipolar TURP to open prostatectomy or laser enucleation in the treatment of exclusively large-volume prostates with stricter definition of size.

Aims: To investigate whether spinal anesthesia with an obturator nerve block (SA+ONB) can be effectively used for transurethral resection of bladder tumor (TURBT) during the coronavirus disease 2019 (COVID-19) pandemic to improve patient outcomes while also avoiding aerosol-generating procedures (AGPs). We aimed to compare outcomes of TURBTs using spinal anesthesia (SA) alone vs SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumor resection, tumor recurrence, and local anesthetic toxicity. Methods: We conducted a comprehensive search of electronic databases (MEDLINE, PUBMED, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar, and Web of Science), identifying studies comparing the outcomes of TURBT using SA vs spinal with an ONB. The Cochrane risk-of-bias tool for randomized-controlled trials (RCTs) and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modeling was used to calculate pooled outcome data. Results: Four RCTs and three cohort studies were identified, enrolling a total of 448 patients. The use of SA+ONB was associated with a significantly reduced risk of obturator reflex ( p  < 0.00001), bladder perforation ( p  = 0.02), incomplete resection ( p  < 0.0001), and 12-month tumor recurrence ( p  = 0.005). ONB was not associated with an increased risk of local anesthetic toxicity (0/159). Conclusion: Our meta-analysis suggests that TURBT using SA+ONB is superior to the use of SA alone. During the COVID-19 pandemic, where avoidance of AGPs such as a general anesthesia is paramount, the use of an ONB with SA is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of ONB as well as comparing this method with general anesthesia with complete neuromuscular blockade.