Re: Early postoperative outcome of bipolar transurethral enucleation and resection of the prostate.

To the Editor—I enjoyed the article by Cho et al1 titled, “Early postoperative outcome of bipolar transurethral enucleation and resection of the prostate,” published in the December 2015 issue of Hong Kong Medical Journal. I noted with interest that the authors reported no urethral stricture, meatal stenosis, or bladder neck contracture at 3 months despite the larger prostates and more difficult procedures (mean preoperative transrectal ultrasonography prostate volume of 71.9 cm3 and mean operating time of 86.1 minutes). Komura et al2 recently published the results of their randomised trial of monopolar (abbreviated M-TURP) versus bipolar transurethral resection of the prostate (abbreviated TURis) in the April 2015 issue of the BJU International. They reported “a significant difference in postoperative urethral stricture rates between groups was detected (6.6% in M-TURP vs 19.0% in TURis; P=0.022). After stratifying patients according to prostate volume, there was no significant difference between the two treatment groups with regard to urethral stricture rates in patients with a prostate volume of ≤70 mL (3.8% in M-TURP vs 3.8% in TURis), but in the TURis group there was a significantly higher urethral stricture rate compared with the M-TURP group in patients with a prostate volume >70 mL (20% in TURis vs 2.2% in M-TURP; P = 0.012).” The difference was also noted by Tang et al3 who suggested “the risk factors for B-TURP (to result in more urethral strictures) included a larger resectoscope diameter, higher ablative energy, and longer procedure time” in their review and meta-analysis published in the September 2014 issue of the Journal of Endourology. My personal experience is more in line with the previously reported experiences in that I appear to have less bleeding with the bipolar technique and less worry about transurethral resection syndrome. Hence I resect more, operate for longer, and end up with at least 3 times more strictures after switching from the monopolar to the bipolar technique, despite routinely performing preoperative urethral dilatation. I am interested to find out how the incidence of urethral strictures will now compare with results of monopolar TURP in Cho et al’s ongoing series after they have operated on more patients, and whether the authors perform routine preoperative urethrotomy or other prophylaxis against urethral stricture. Hong Kong Med J 2016;22:188–9 DOI: 10.12809/hkmj164831