Monopolar and holmium enucleation in treatment of benign prostatic hyperplasia
Patients and methods. In the period from December 2014 till now, 40 monopolar electro-enucleations of BPH were performed in the urology clinic of I.M. Sechenov First Moscow Medical University. The patients' mean age was 72.4 ± 3.8 years, volume of the prostate - 70.3 ± 14.8 cm3, IPSS/Qol - 23.6 ± 3.2 / 5.2 ± 1.0 scores; maximal urine flow rate - 7.1 ± 2.2 ml/s. The control group comprised 40 patients (mean age 65.4 ± 7.01 years), comparable by the basic parameters, who underwent laser enucleation of the prostate. These patients in the pre-operative period received similar complex clinical and laboratory examination. In surgery, the resectoscope 26 Сh with continuous irrigation, hook electrode, pusher electrode, and also standard electrode kits for mono- and bipolar surgery were utilised. Enucleated adenomatous nodes were either resected in the course of mono- or bipolar transurethral resection and washed with a Reiner-Alexander syringe or morselled. Results. As has been found by a comparative analysis of the outcomes of different surgical treatments of prostatic hyperplasia (laser and monopolar enucleation), the incidence of complications in both groups was comparable and low in general. In the control group, 1 case of acute prostatitis was recorded and 2 cases of bleeding with subsequent tamponade of the urinary bladder that necessitated repeat surgery in the remote post-operative period. In the basic group, 1 patient needed blood transfusion, urethrocystoscopy, revision of the bed of the removed prostatic hyperplasia, in one more patient the volume of operative intervention was enhanced due to a urethral stricture. In 1 case, stress urinary incontinence was noted. One month after surgery the prostate volume was similar in both groups, which permits to state high radicality of both monopolar enucleation and HoLEP. Conclusion. The first results we obtained by transurethral monopolar enucleation of the prostate give reason to consider this method to be radical, safe and cost-efficient.