Abstract: PD23-01
Sources of Funding: None

Introduction

Compare the different impact of monopolar and bipolar TURP (Trans-urethral resection of the prostate) on the sexual function of male patients with LUTS (Lower urinary tract symptoms) by the use of IIEF ( International index of erectile function ) and to identify statistical risk factors associated with development of post-operative ED (Erectile dysfunction).

Methods

This study was a comparative prospective study between monopolar and bipolar TURP regarding their effect on the sexual function of male patients with LUTS by the use of IIEF. It was taken into consideration age, associated comorbidities, preoperative medications, smoking, assisted methods to obtain erection, duration of the operation, weight of the specimen and intraoperative complications (e.g. perforation (.The IIEF scores were compared one day before the surgery and 3 and 6 months after the surgery in the two limbs of the study monopolar vs. bipolar. The study design is a nonrandomized clinical trial that was carried out on a total number of 98 consecutive Egyptian patients who underwent TURP, 58 patients by the monopolar technique, 40 patients by the bipolar technique for the treatment of symptomatic benign prostatic hyperplasia. The study was done at the Department of Urology, Cairo University, between April 2014 and April 2015. An informed consent was obtained from all patients prior to enrollment in the study. Patients had to have stable sexual partners for 6 months before surgery and for 6 months postoperatively until follow-up.

Results

Patients were classified into two groups: patients experienced change in the EF score by less than 4 and patients experienced change in the EF score by ? 4. Change in the EF score by ? 4 was defined as the minimal clinically importance difference that is clinically perceived by the patient as a change in his erection. The incidence of ED after monopolar TURP was 22.4%, the incidence of ED after bipolar TURP was 30% and the overall incidence of post-operative ED was 25.5%. There was no statistically reported difference between monopolar and bipolar TURP on developing post-operative ED (p value 0.33 at the 3rd month and 0.397 at the 6th month). The risk factors that have been statistically associated with high incidence of post-operative ED in the whole population of study were DM (P value0.001), intraoperative capsular perforation (P value 0.0001) and preoperative use of PDE5I (P value0.004). In the monopolar group DM (P value0.002) and Intra-operative capsular perforation (P value0.00001) were the statistically significant factors associated with high incidence of post-operative ED. In the bipolar group there were no significant risk factors associated with high incidence of post-operative ED, and that were explained by the smaller sample size in the bipolar arm of the study. Other factors which were the age, the operative time, the weight of the specimen, preoperative EF score, preoperative IIEF score, smoking, COPD, cardiovascular disorders, preoperative use of alpha blocker and intraoperative or postoperative bleeding which were studied in our study showed no statistically significant impact on developing postoperative ED either in the monopolar or the bipolar arm.

Conclusions

TURP carries a risk of post-operative ED around 25.5% and the patient should be aware of this degree of ED. The most commonly affected domain of the 5 IIEF domains by TURP is the orgasmic domain (retrograde ejaculation) and the patient should be consented on this before the operation. Generally there is no difference between the monopolar TURP and the bipolar TURP in developing post-operative ED. DM, intraoperative capsular perforation and pre-operative use of PDE5I are important risk factors for developing post-operative ED. Larger number of patients should be included in future studies to validate these results.

Funding

None