Bipolar versus monopolar transurethral resection for benign prostatic hypertrophy: a prospective comparative study

Srinivasrao P., Mallidu Shashidhar


Background: The transurethral resection of the prostate (TURP) is a well-known surgical procedure for treating benign prostatic hypertrophy in males. Monopolar TURP (MTURP) has been used in the past, however the morbidity associated with MTURP has led to the development of new surgical procedures. Energy is restricted between electrodes at the resectoscope site in bipolar TURP (BTURP), permitting the use of physiological irrigation medium. In terms of patient outcomes, there is still some doubt about the distinctions between various surgical procedures. This study aims to evaluate the efficacy of monopolar (M-TURP) and bipolar (B-TURP) TURP.

Methods: In this prospective comparison trial, 100 patients were enrolled and table randomized to either M-TURP or B-TURP surgery for prostatic hyperplasia. Prostate size, post-void volume and hemoglobin were recorded pre and postoperatively. Resection time was noted.

Results: Patients were divided into two groups, namely M-TURP and B-TURP. The mean age of patients was comparable between both groups. There is a significantly lower mean resection time in M-TURP compared to B-TURP. Drop-in hemoglobin levels (g/dl) in M-TURP patients were higher than in B-TURP. The M-TURP group showed a higher reduction in post-void residual volume than the B-TURP group. B-TURP group had a larger reduction in gland size than the M-TURP group.

Conclusions: M-TURP and B-TURP are safe and effective procedures for treating BPH.


Benign prostatic hyperplasia, Bipolar, Monopolar, TURP

Full Text:



Elshal AM, Elkoushy MA, Elmansy HM, Sampalis J, Elhilali MM. Holmium: YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate. J Urol. 2014;191:148-54.

Ho HSS, Yip SKH, Lim KB, Fook S, Foo KT, Cheng CWS. A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline (TURIS) system. Eur Urol. 2007;52:517-24.

Mamoulakis C. Midterm results from an international multicentre randomized controlled trial comparing bipolar with monopolar transurethral resection of the prostate. Eur Urol. 2013;63:667-76.

Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)-incidence, management, and prevention. Eur Urol. 2006;50:969-79.

Hawary A, Mukhtar K, Sinclair A, Pearce I. Transurethral resection of the prostate syndrome: Almost gone but not forgotten. J Endourol. 2009;23:2013-232.

Mamoulakis C, Trompetter M, de la Rosette J. Bipolar transurethral resection of the prostate: The "golden standard" reclaims its leading position. Curr Opin Urol. 2009;19:26-32.

Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P et al Morbidity, mortality and early outcome of transurethral resection of the prostate: A prospective multicenter evaluation of 10,654 patients J Urol. 2008;180:246-9.

Reich O. Bipolar transurethal resection of the prostate: What did we learn, and where do we go from here? Eur Urol. 2009;56:796-7.

Shah AK, Srivastava A, Karan S C. Medical management of patients with benign prostatic hyperplasia: A study in Indian population. J Mar Med Soc. 2018;20(2):104.

Raghuvanshi K, Raval A, Jain DK, Vartak KP, Patil S, Iqbal S et al. Comparative assessment of monopolar versus bipolar transurethral resection of prostate for the management of benign prostatic enlargement. Urol Sci. 2019;30:262-5.

Kumar A, Vasudeva P, Kumar N, Nanda B, Jha SK, Mohanty N. A prospective randomized comparative study of monopolar and bipolar transurethral resection of the prostate and photoselective vaporization of the prostate in patients who present with benign prostatic obstruction: A single center experience. J Endourol. 2013;27:1245-53.

Madduri VK, Bera MK, Pal DK. Monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: Operative outcomes and surgeon preferences, a real-world scenario. Urol Ann. 2016;8:291-6.

Agarwal V, Singh S. A Prospective Study of Subjective Symptoms-Ipss and Uroflowmetry Before and after Turp of BPH Patients. Int J Contemp Surg. 2020;8(1):67-70.