When medication is no longer effective in managing urinary symptoms caused by an enlarged prostate, surgery becomes necessary to restore proper flow. This condition, Benign Prostatic Hyperplasia (BPH), involves the non-cancerous growth of the prostate gland, which presses against the urethra and obstructs the bladder outlet. Surgical intervention removes the excess tissue causing this blockage, relieving difficult urination, frequent nighttime waking, and other lower urinary tract symptoms. A modern approach to this problem is the Bipolar Transurethral Resection of the Prostate (Bipolar TURP).
Understanding Bipolar TURP
Bipolar Transurethral Resection of the Prostate (TURP) is a minimally invasive procedure designed to alleviate the obstruction caused by BPH. It involves accessing the prostate through the natural urinary channel, the urethra, without making any external incisions.
The procedure is considered the surgical standard for treating BPH symptoms that have not responded to medical therapy. Its effectiveness comes from physically removing the obstructing tissue, which provides a long-lasting and significant improvement in a patient’s ability to urinate. The defining feature of this technique is the use of a specialized electrical current, which allows for both cutting and sealing of tissue.
The “Bipolar” designation refers to the configuration of the electrical current used for resection. Unlike older technology, the bipolar system contains both the active and return electrodes within the surgical instrument itself. This design confines the electrical energy to the immediate area of the tissue being treated, creating a highly efficient cutting and coagulating effect. This localized energy field enables the use of a safer irrigation fluid during the operation.
How the Procedure is Performed
The Bipolar TURP procedure is performed under general or spinal anesthesia, beginning with the insertion of a specialized instrument called a resectoscope. The resectoscope is passed through the urethra and guided to the prostate gland. It contains an optical system, a light source, and channels for irrigation fluid and the working electrode, allowing the surgeon to visualize the internal anatomy on a monitor.
The surgeon uses the working element of the resectoscope, which features a wire loop or similar electrode, to shave away the obstructing prostate tissue piece by piece. Tissue removal starts from the bladder neck and moves toward the external sphincter. The electrical current passing through the loop vaporizes and cuts the tissue, effectively widening the channel that passes through the prostate.
As the tissue is cut, the bipolar energy simultaneously cauterizes the small blood vessels it encounters, controlling bleeding throughout the procedure. The excised tissue fragments, called “chips,” are carried by the continuous flow of irrigation fluid into the bladder. Once the resection is complete, these prostate chips are flushed out of the bladder.
Key Advantages of Bipolar Technology
The main difference between Bipolar TURP and older Monopolar TURP technology is the type of irrigation fluid used during the surgery. Traditional monopolar TURP requires a non-conductive fluid, such as glycine, to prevent the electrical current from dispersing dangerously through the body. If the body absorbs too much of this fluid through open blood vessels, it can lead to Transurethral Resection (TUR) Syndrome, which involves a dangerous drop in the body’s sodium levels (hyponatremia).
Bipolar technology eliminates this risk because the electrical circuit is completed locally within the instrument, allowing the surgeon to use physiological saline solution for irrigation. Saline is an isotonic, or salt-containing, solution that the body can tolerate if absorbed, virtually eliminating the risk of TUR Syndrome. This enhanced safety profile means that surgeons can safely perform longer procedures, which is especially beneficial for men with larger prostates that require extended resection time.
The localized energy delivery of the bipolar system also offers superior hemostasis, or control of bleeding, compared to its predecessor. By confining the current, the bipolar system creates a more efficient and focused coagulation effect on the blood vessels. This improved ability to seal off bleeding vessels can lead to less blood loss during the operation and a clearer surgical field for the surgeon. Ultimately, the use of bipolar energy and saline irrigation makes the procedure safer and more adaptable for a wider range of patients.
Recovery and Follow-Up
Following a Bipolar TURP, most patients remain in the hospital for an overnight stay, though some may be discharged the same day. A urinary catheter is typically placed into the bladder at the end of the procedure to allow the bladder to rest and to flush out any remaining blood or clots. The catheter usually remains in place for one to a few days and is removed once the urine is clear of significant bleeding.
Patients should expect some temporary side effects as they recover, most notably the presence of blood in the urine, known as hematuria, which can persist intermittently for up to a month. It is also common to experience urinary urgency or mild burning during urination as the bladder adjusts to the removal of the obstruction. Patients are advised to avoid strenuous activity and heavy lifting for about four to six weeks to allow the prostatic bed to heal completely.
The long-term success rate of Bipolar TURP in relieving BPH symptoms is very high, often providing effective relief for 15 years or more. A common side effect, however, is retrograde ejaculation, where semen flows backward into the bladder during orgasm instead of out through the penis, though sexual sensation is preserved. While tissue regrowth can occur over many years, the procedure remains a reliable treatment for severe urinary symptoms caused by an enlarged prostate.