Bipolar transurethral resection of prostate: risk factors for perioperative complications. A literature review

Introduction: Regardless of the technique used, either bipolar or monopolar, transurethral resection of the prostate (TURP) is considered the cornerstone of surgical management for low urinary tract symptoms (LUTS), and benign prostatic obstruction (BPO). Objective: To review the available literature regarding the frequency of bipolar TURP (B-TURP) complications and the risk factor associated with them. Results: The search was conducted using Medline and studies addressing the research question published between 1996 and 2017 were retrieved. Seventy six article were screened and 50 were included. Those papers reported that B-TURP was associates with good long-term outcomes. According to Clavien-Dindo classification, a high proportion of complications were grade I, and the most frequent ones were: retrograde ejaculation, urine retention, urinary tract infection, bleeding and urethral stricture. Risk factors most commonly associated with these complications were: patient’s medical status before surgery, the extent of disease at the time of the procedure, skills and technique of the surgeon, amongst other. Discussion: The majority of the surgical complications associated with B-TURP are mild, and identifying the best moment to conduct the procedure and intervening on modifiable risk factors before surgery, may contribute to improve outcomes of the B-TURP

Risk factors for perioperative complications in the transurethral resection of the prostate in patients of a Colombian institution

RESUMEN: Objetivo: Determinar la tasa de complicaciones y los factores de riesgo para complicaciones perioperatorias tempranas de la Resección Transuretral de Próstata con bipolar (RTUP-B) en una institución prestadora de servicios de salud de Colombia. Materiales y métodos: Se realizó un estudio de cohortes mixta en el cual se incluyeron 340 pacientes con diagnóstico de Hiperplasia Prostática Benigna (HPB) que fueron llevados a RTUP-B entre el año 2012 y 2019. Se recolectaron datos sobre las características basales y perioperatorias y se determinó la tasa de complicaciones hasta los 30 días postoperatorio. Resultados: 67 pacientes (19.45%) presentaron complicaciones perioperatorias de las cuales 17 (25,37%) fueron intrahospitalarias. Según la clasificación Clavien Dindo el 14,79% fueron complicaciones grado I y II: la hematuria secundaria fue la complicación más reportada en (5,22%), seguida de infecciones del tracto urinario (4,64%) y disfunción de la sonda uretrovesical (1,76%). Los factores de riesgo fueron: estancia hospitalaria previo a la cirugía por cualquier causa (RR: 2,23, IC95%: 1,14 – 4,39), aumento del valor del INR por unidad (RR: 7,59, IC95%: 4,63 – 12,44) y cada día adicional de irrigación vesical (RR: 1,32, IC95%: 1,22 – 1,42) y sonda vesical (RR: 1,04, IC95%: 1,02 – 1,05). Conclusiones: En este estudio, la tasa de complicaciones después de la RTUP con bipolar fue de menor del 20%, siendo las complicaciones grados I y II las más frecuentes. Los factores de riesgo encontrados son modificables lo que podría reducir la morbilidad postoperatoriaABSTRACT: Objective: To determine the complications rate and the risk factors associated with early operative and postoperative complications with a Bipolar Transurethral Resection of the Prostate (B- TURP) at a health service provider institution inColombia. Materials and methods: A mixed cohort study was conducted involving 340 patients diagnosed with Benign Prostatic Hyperplasia (BPH) who were taken to RTUP-B between 2012 and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate of complications determined up to 30 postoperative days. Results: A total of 67 patients (19.45%) presented perioperative complications of which 17 (25.37%) were in- hospital. According to the Clavien Dindo classification, 14.79% were grade I and II complications: secondary hematuria was the most reported complication in 18 patients 5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). Risk factors were intrahospital surgery (RR: 2.23, 95% CI: 1.14 – 4.39), INR (RR: 7.59, IC95%: 4.63 – 12.44), duration in days of cystoirrigation (RR: 1.32, C95%: 1.22 – 1.42) and bladder probe (RR: 1.04, IC95%: 1.02 – 1.05). Conclusions: In this study, the complication rate after bipolar TURP was less than 20%, with grade I and II complications being the most frequent. The risk factors found are modifiable, which could reduce postoperative morbidityIntroducción, Métodos, Resultados, Discusión, Conclusiones, Bibliografía, Tablas