Department of Urology, Shintoshi Hospital, Iwata, Japan.
J Endourol. 2012 Aug;26(8):1053-8. doi: 10.1089/end.2011.0592. Epub 2012 Mar 19.
We compared the in-hospital outcomes between bipolar and monopolar transurethral resection of the prostate (B-TURP and M-TURP, respectively) on a real-world practice using a large database.
Patients who underwent TURP were extracted from the Diagnosis Procedure Combination database, which is a case-mix administrative claims database in Japan. TURP procedures were classified into M-TURP and B-TURP groups according to intraoperative use or nonuse of D-sorbitol solution, respectively, which is the only nonelectrolyte bladder irrigation fluid for M-TURP available in Japan. To exclude causality among autologous and homologous transfusion events, we confined eligible hospitals to those in which no autologous blood preparation was undertaken for TURP and whose annual surgical caseloads were 15 cases or more. Multivariate analyses were conducted for homologous transfusion, postoperative complications, operative time, postoperative length of stay, and total costs.
There were 5155 M-TURP and 1531 B-TURP patients identified. The results for M-TURP vs B-TURP (effect sizes were evaluated with reference to M-TURP) were 2.3% vs 1.3% for transfusion (odds ratio [OR]=0.54; P=0.013), 3.3% vs 1.7% for postoperative complications (OR=0.46; P<0.01), 98 vs 116 minutes for operative time (20.5% increase; P<0.001), 8.65 vs 8.45 days for postoperative stay (3.6% reduction; P=0.003), and $6103 vs $6062 for cost (1.7% reduction; P=0.018).
B-TURP had significantly lower rates of transfusion and postoperative complications, but a longer operative time. The impacts of B-TURP on shortening the hospital stay and lowering the costs were of little clinical significance.
本研究通过使用大型数据库，在真实世界实践中比较双极和单极经尿道前列腺切除术（分别为 B-TURP 和 M-TURP）的住院期间结局。
从日本诊断程序组合数据库中提取接受 TURP 治疗的患者。根据术中是否使用 D-山梨醇溶液（M-TURP 中唯一可用的非电解质膀胱冲洗液）将 TURP 手术分为 M-TURP 和 B-TURP 组。为了排除同源输血事件之间的因果关系，我们将合格医院限定为那些不进行 TURP 自体血准备且每年手术例数为 15 例或更多的医院。对同源输血、术后并发症、手术时间、术后住院时间和总费用进行多变量分析。
共确定了 5155 例 M-TURP 和 1531 例 B-TURP 患者。M-TURP 与 B-TURP 的结果（以 M-TURP 为参照评估效应大小）为输血率分别为 2.3%和 1.3%（优势比[OR] = 0.54；P=0.013）、术后并发症发生率分别为 3.3%和 1.7%（OR = 0.46；P<0.01）、手术时间分别为 98 分钟和 116 分钟（增加 20.5%；P<0.001）、术后住院时间分别为 8.65 天和 8.45 天（减少 3.6%；P=0.003）和费用分别为 6103 美元和 6062 美元（减少 1.7%；P=0.018）。
B-TURP 的输血率和术后并发症发生率显著降低，但手术时间较长。B-TURP 对缩短住院时间和降低成本的影响临床意义不大。
