To compare the mean perioperative blood loss in monopolar transurethral resection of prostate with bipolar transurethral resection in patients with BPH.
Introduction:
BPH (benign prostatic hyperplasia) is an ailment of old age males. Symptoms of the lower urinary tract are brought on by the growth of smooth muscle and epithelial cells in the Lower urinary tract symptoms (LUTS).Men aged 40–50 have a 20% increased risk of developing BPH, men aged 50–60 a 50% increased risk, and men aged 80+ have a 90% increased risk. Goal of therapy is around three features : eradicate the LUTS, hinder disease development, and to decrease complications. Surveillance, medication therapy, and surgical management are all viable options for treating BPH.
Moderate to severe LUTS and individuals who have acquired problems owing to BPH are evaluated for surgical treatment. In view of long-term findings from randomised control studies, transurethral monopolar resection of the prostate has become the gold standard for the surgical care of BPH. The diathermy unit is used endoscopically to remove the inner prostate gland. Transurethral resection syndrome, urinary incontinence, erectile dysfunction, retrograde ejaculation, and peri- and post-operative bleeding are among complications that might arise from this procedure despite its usefulness in enhancing urine flow rate, symptom score, and other metrics.
Many minimally invasive techniques, such as plasma kinetic bipolar loop resection, holmium laser enucleation of the prostate, holmium laser ablation of the prostate, photosensitive vaporisation, and others, have been introduced in recent years in an effort to reduce the risks of complications associated with transurethral resection of the prostate (TURP). These techniques are comparable to monopolar but have a different rate of complications. In the procedure known as bipolar resection of the prostate gland, a particular resectoscope loop is utilised. This loop comprises both active and return electrodes, and the pattern of current flow that results from its use mitigates the potentially damaging effects of continuous current flow.
Normal saline, which has the potential benefit of reducing TUR syndrome and decreasing blood loss, is used as the irrigation fluid in bipolar. Monopolar TURP has historically suffered from severe bleeding, necessitating frequent blood transfusions. Many studies have highlighted the fact that bipolar people lose less blood than monopolar people.10 Bipolar TURP has been shown to have lower intraoperative blood loss compared to monopolar TURP in one research. (238.5±69.43ml vs. 289.6±89.47ml). In another study, Bipolar TURP associated with significantly less blood loss than monopolar TURP (300.0±2.47ml vs. 349.0±43.5ml).
Since its inception, Bipolar TURP has acquired international popularity and challenges monopolar TURP as the Gold standard in terms of decreased perioperative blood loss, yet there is no data available about comparison of the quantity of blood loss between these two methods. The purpose of the research is to determine if there is a substantial difference in blood loss among those who suffer from bipolar disorder. If we are successful in demonstrating this, then bipolar TURP might be an option for patients who would experience a higher risk of bleeding with monopolar diathermy. Treatment of benign prostatic hyperplasia (BPH) might benefit from the identification of a function for bipolar diathermy in reducing perioperative bleeding after TURP. Specifically, we would be able to manage bleeding, a major risk factor for complications after monopolar TURP.

Study Design :
Randomized control Trial.
Setting: 
Department of Urology & Renal transplantation, DHQ hospital Gujranwala
Duration of Study:
6 months 
Sample Size:
Sample size of 80 patients (40 patients in each group) was estimated by using 95% confidence internal with 80% power of test and taking expected mean blood loss 238.5 + 69.43ml with bipolar TURP and 289.6£89.47ml with monopolar TURP.11
Sampling Technique: 
Non-probability consecutive sampling
Sample selection:
Inclusion Criteria:
Age 55 to 75 years male patients having BPH (as per operational definition)
Exclusion Criteria:
Bleeding Disorder (Pt, INR > 1.5 times deranged)
Chronic liver disease (ALT & AST>40IU/L)
Patient with uncontrolled hypertension (≥140/90) and diabetes mellitus (240 FBS).
Data Collection Procedure:
After approval of the synopsis, one hundred patients fulfilling inclusion criteria was selected from outpatient urology department, DHQ Hospital Gujranwala. Informed consent about the study was taken from the patient. Prior to study 80 patients (sample size) was divided into two equal groups by computer random number generated. 40 consecutive patients were allotted to each group associated to their random number. Each of the group containing 40 patients were in group A (monopolar diathermy), and group B (bipolar diathermy). Demographic data/information was recorded. Investigations including complete blood picture, urine complete and ultrasonography abdomen and pelvis was done. Preoperative hematocrit of each Study patient was recorded. Two groups (A and B) each containing 40 patients. Patients were followed up after 24 hours of surgery in which hematocrit level was estimated. Blood loss was calculated by recording preoperative and postoperative (after 24 hours) hematocrit level. Data was collected by the researcher himself on the approved proforma.
Data Analysis Procedure:
Data was tabulated and analyzed by SPSS version 23. The quantitative data like age, duration of BPH, size of prostate and blood loss was presented in the form of mean + SD. Preoperative blood loss in both group was composed through t-test taking p-value < 0.05 as significant. Data was stratified for age, duration BPH and size of prostates. Post-stratification t-test was used taking p-value < 0.05 as significant.

In this study perioperative blood loss was significantly higher among patients who underwent mono-polar diathermy as compared to those patients who were treated with bipolar diathermy i.e. Mono-polar 325.22 vs. Bipolar: 240.0, p-value=0.0001. Stratification of age and size of prostate showed the similar findings that bipolar TURP had significantly less perioperative blood loss.

Mean age of patients in Group-A and in Group-B was 62.42±5.27 and 62.27±4.86 years. Mean duration of BPH in Group-A and in Group-B was 3.28±1.66months and 3.70±1.84months. Mean prostate size in Group-A and in Group-B patients was 39.45±3.80 and 38.40±3.93. Mean postoperative hematocrit in Group-A and in Group-B patients was 35.77±1.65 and 35.62±1.51. Group-B patient had less perioperative blood loss as compared to Group-A patients. i.e. Group-A: 325.22 vs. Group-B: 240.0, p-value=0.0001. In all age groups patients mean perioperative blood loss was significantly lower for Group-B patients as compared to Group-A patients.  In both duration groups i.e. 1-3months and 4-6months, the difference between both groups was statistically significant and group A showed more perioperative blood loss than group B. Significant difference was seen for mean perioperative blood loss between the treatment groups in relation to prostate size.

Results of this study highlighted a significant difference in perioperative blood loss with bipolar TURP in patients with BPH.