Bipolar Transurethral Resection of the Prostate (TURP) is a modern, minimally invasive surgical technique used to treat an enlarged prostate, a condition known as Benign Prostatic Hyperplasia (BPH). This procedure utilizes specialized electrical energy delivered through a thin instrument to remove excess prostate tissue that obstructs the flow of urine. Bipolar TURP is an advancement of the traditional TURP method. The following sections explain the reasons for this procedure, the mechanics of the bipolar system, the patient experience, and its benefits over older techniques.
Why the Procedure is Necessary
The need for Bipolar TURP arises from Benign Prostatic Hyperplasia, where the prostate gland grows larger and presses on the urethra. This compression creates a physical obstruction that interferes with urination, leading to lower urinary tract symptoms. Symptoms include a weak or intermittent urinary stream, difficulty starting urination, the need to strain, and a frequent, urgent need to urinate, especially at night.
While many men initially manage these symptoms with oral medications, surgery becomes necessary when drug therapy fails or when complications occur. Complications may include acute urinary retention, recurrent urinary tract infections, bladder stones, or damage to the kidneys. Surgical intervention is then required to remove the obstructing tissue and restore proper urinary flow.
Understanding the Bipolar Mechanism
The defining feature of Bipolar TURP is the way it uses electrical current to cut and cauterize prostate tissue, which is a significant difference from the older monopolar method. In the bipolar system, the electrical circuit is contained entirely at the tip of the resectoscope, flowing between two closely spaced electrodes. This localized energy creates a plasma corona effect, which vaporizes and cuts the tissue with minimal thermal damage to surrounding areas.
This contained current flow allows the surgeon to use sterile, isotonic saline solution as the irrigation fluid during the procedure. In contrast, the traditional monopolar system required a non-electrolyte fluid like glycine because the current had to pass through the patient’s body to a grounding pad. The use of saline eliminates the primary risk associated with the older procedure, allowing for safer, longer operation times when treating larger prostates.
The Patient Experience During and After Surgery
The Bipolar TURP procedure is performed under general or spinal anesthesia. The surgeon inserts a resectoscope—a thin instrument containing a light, lens, and the bipolar cutting loop—through the urethra to access the prostate. There are no external incisions required, as the entire operation is performed transurethrally.
The electrical loop on the resectoscope shaves away the excess prostate tissue, and these fragments are then flushed into the bladder and removed. A catheter is temporarily placed into the bladder, often connected to a continuous bladder irrigation (CBI) system, which flushes the bladder with fluid to prevent blood clots from forming. Most patients remain in the hospital for a short stay, typically one to three days, until the urine clears and the catheter can be safely removed.
Immediately following the procedure, patients may see blood in their urine, which gradually improves. Temporary side effects can include a burning sensation during urination or an increased urge to urinate as the bladder adjusts to the removal of the obstruction. The bladder may take up to three months to fully adjust, leading to a gradual improvement in symptoms over time.
Superior Outcomes and Reduced Risk Profile
The primary advantage of Bipolar TURP over the traditional monopolar method is the reduced risk of Transurethral Resection (TUR) Syndrome. This complication occurs when the non-electrolyte irrigation fluid used in monopolar surgery is absorbed into the bloodstream, causing a drop in blood sodium levels (hyponatremia). By using safe, isotonic saline solution, the bipolar system virtually eliminates this risk.
Bipolar TURP is also associated with less bleeding because the contained current provides better coagulation and sealing of blood vessels. This reduction in blood loss can lower the need for blood transfusions. Bipolar TURP results in a shorter duration of catheterization and a shorter overall hospital stay. Both monopolar and bipolar procedures offer similar long-term relief from BPH symptoms.