Perioperative Complications in Monopolar Transurethral Resection of Prostate: Single Center Retrospective Evaluation of 942 Cases

Aims: To describe the perioperative complications in monopolar transurethral resection of prostate (M-TURP) among the patients who underwent M-TURP for benigh prostate enlargement or palliative “channel” TURP in the hospital from the year 2010 to 2019.

Study Design: Retrospective single center study.

Place and Duration of Study: Department of Urology, B and B Hospital, Gwarko, Lalitpur, Nepal, between January 2010 and December 2019.

Methodology: Hospital based electronic records were retrieved for all M-TURP done during the above mentioned period. Variables considered were age, presenting symptoms, comorbidities, diagnosis, anesthesia type, operative duration, amount of prostatic tissue resected and any perioperative complication. Multinominal logistic regression model was used to calculate adjusted odds ratio of complications between different subgroups and P value < .05 was considered significant.

Results: The overall perioperative morbidity and mortality rate was 10.3% and 0.11% respectively. Most common complications were clot retention requiring bladder wash (3.29%), urinary tract infection (2.87%) and transurethral resection syndrome (1.06%). Incontinence, bladder injury and iatrogenic urethral injury occurred in 0.96%, 0.53% and 0.53% respectively. Single case of conversion to open surgery was recorded (0.11%). Average prostatic tissue resected was 35.4 ± 15.6 grams. Operative duration more than 90 minutes was significantly associated with complication with adjusted odds ratio 2.34 (95% CI 1.17-4.66, P value .02). Factors such as age, preoperative urinary retention, predominantly storage or voiding lower urinary tract symptoms, comorbidities, anti-platelet therapy, anesthesia, amount of prostate tissue resected did not show significant association.

Conclusions: Monopolar TURP has acceptable morbidity and mortality rates which can be further minimized by limiting the duration of surgery to 90 minutes.