Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting

What's known on the subject? and What does the study add? The effect of TURP on overall sexual function and particularly erectile function (EF) is controversial with conflicting results based on a low level of evidence. The effects of monopolar and bipolar TURP (M‐TURP and B‐TURP, respectively)...

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Bibliographic Details
Published in:BJU international 2013-07, Vol.112 (1), p.109-120
Main Authors: Mamoulakis, Charalampos, Skolarikos, Andreas, Schulze, Michael, Scoffone, Cesare M., Rassweiler, Jens J., Alivizatos, Gerasimos, Scarpa, Roberto M., Rosette, Jean J.M.C.H.
Format: Article
Language:English
Subjects:
Aged
benign prostatic hyperplasia
Biological and medical sciences
Clinical trials
Double-Blind Method
electrosurgery
Equipment Design
erectile dysfunction
Follow-Up Studies
Gynecology. Andrology. Obstetrics
Humans
Male
Male genital diseases
Medical sciences
Nephrology. Urinary tract diseases
Penile Erection - physiology
Prostate
Prostatic Hyperplasia - physiopathology
Prostatic Hyperplasia - psychology
Prostatic Hyperplasia - surgery
randomized controlled trial
Retrospective Studies
Sexual Behavior - physiology
sexual dysfunction
Surveys and Questionnaires
Transurethral Resection of Prostate - instrumentation
Treatment Outcome
Tumors
Tumors of the urinary system
TURP
Urinary tract. Prostate gland
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Summary:What's known on the subject? and What does the study add? The effect of TURP on overall sexual function and particularly erectile function (EF) is controversial with conflicting results based on a low level of evidence. The effects of monopolar and bipolar TURP (M‐TURP and B‐TURP, respectively) on EF are similar, as has been shown in a few non‐focused randomized control trials (RCTs). For the first time, the present study offers focused results of a comparative evaluation of the effects of B‐TURP and M‐TURP on overall sexual function, as quantified with the International Index of Erectile Function Questionnaire (IIEF‐15) in an international, multicentre, double‐blind RCT setting. Objective To compare monopolar and bipolar transurethral resection of the prostate (M‐TURP and B‐TURP, respectively) using a true bipolar system, for the first time in an international multicentre double‐blind randomized controlled trial focusing on the overall sexual function quantified with the International Index of Erectile Function Questionnaire (IIEF‐15). Other baseline/perioperative parameters potentially influencing erectile function (EF) after TURP were secondarily investigated. Materials and Methods From July 2006 to June 2009, consecutive TURP candidates with benign prostatic obstruction were prospectively recruited in four academic urological centres, randomized 1:1 into M‐TURP/B‐TURP arms and followed up at 6 weeks, 6 and 12 months after surgery. In all, 295 eligible patients were enrolled. Overall sexual function was quantified using self‐administered IIEF‐15 at baseline and at each subsequent visit. Total IIEF/domain scores were calculated and EF score classified erectile dysfunction severity. Differences in erectile dysfunction severity at each visit compared with baseline (EF evolution), classified patients into ‘improved’, ‘stable’ or ‘deteriorated’. Pre‐postoperative IIEF/domain scores and differences in the distribution of EF evolution were compared between arms throughout follow‐up. Results In all, 279 patients received the allocated intervention; 218/279 patients (78.1%) provided complete IIEF‐15 data at baseline and were considered in sexual function analysis. Complete IIEF‐15 data were available from 193/218 (88.5%), 186/218 (85.3%) and 179/218 (82.1%) patients at 6 weeks, 6 months and 12 months, respectively. Sexual function did not differ significantly between arms during follow‐up (scores: IIEF, P = 0.750; EF, P = 0.636; orgasmic function, P = 0.868; sex
ISSN:1464-4096
1464-410X
DOI:10.1111/j.1464-410X.2012.11662.x