Management of prostate enlargement with acute urinary retention: Diode laser vaporization in combination with bipolar transurethral resection of the prostate

Objective: Transurethral resection of prostate (TURP) has long been the gold standard for the management of benign prostate enlargement (BPE). Over the years, laser techniques have been developed as major alternative treatment for BPE. Retrospectively, we compared the preoperative status and surgical outcomes of conventional TURP with those of high-intensity diode laser vaporization in combination with bipolar TURP (DV + bTURP) in patients with BPE who are suffering from refractory acute urinary retention. Materials and methods: This is a retrospective chart review study. A total of 60 patients with BPE who were suffering from refractory acute urinary retention were enrolled between July 2011 and July 2013. Thirty-four patients were included in the TURP group and 26 in the DV + bTURP group. Perioperative parameters, including operation time, hemoglobin decrease, length of hospital stay, and time for catheter removal, were all recorded. Patients were followed postoperatively with peak flow rate measurement, international prostate symptom scores, and postvoid residual volume, and all adverse events were also recorded. Results: DV + bTURP was superior to TURP in terms of hospital stay (3.1 d vs. 4.2 d), catheter removal time (1.3 d vs. 3.2 d), hemoglobin reduction (0.8 g/dL vs. 2.5 g/dL), and fewer adverse events. However, it was inferior to TURP in terms of operation time (93.2 min vs. 68.5 min). Complications are also comparable. No significant differences were observed in peak flow rates, international prostate symptom score, and postvoid residual volume between the two procedures. Conclusion: DV + bTURP is comparable with monopolar TURP for relieving acute urinary retention in men with BPE in terms of complications and functional outcomes. The combined technique can provide better intraoperative hemostasis and shorter catheterization time, with no significant postoperative irritative symptoms.