Effect of Monopolar Versus Bipolar Transurethral Resection of The Prostate on Erectile Function: A Randomized Controlled Trial with Phosphodiesterase-5 Inhibitors Users Subgroup Analysis
Urology Journal,
Vol. 22 No. 05 (2025),
11 November 2025
,
Page 250-254
https://doi.org/10.22037/uj.v22i.8234
Abstract
Purpose: Men with lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) often experience erectile dysfunction (ED). While transurethral resection of the prostate (TURP) can improve ED, new onset ED remains a concern. This study compares monopolar (M TURP) and bipolar (B TURP) techniques, with a subgroup analysis based on phosphodiesterase 5 inhibitor (PDE5i) use.
Materials and Methods: This randomized clinical trial included candidates for TURP aged over 50 years. Patients were divided into M TURP and B TURP groups. Erectile function was assessed using the International Index of Erectile Function 15 (IIEF 15) at baseline, six weeks, and six months post surgery.
Results: A total of 205 patients were analyzed (102 M TURP, 103 B TURP). Baseline characteristics, perioperative findings, and surgical complications were similar. IIEF 15 scores were comparable between groups at all time points. In the PDE5i user subgroup, M TURP showed a slight short term decline in erectile function and total scores at 6 weeks, but both groups demonstrated no significant long term changes at 6 months.
Conclusion: No significant difference was observed between M TURP and B TURP on erectile function during medium term follow up. Patients with prior PDE5i use may experience fewer short term adverse effects on erectile function from B TURP.
- Transurethral resection of prostate
- Phosphodiesterase-5 inhibitors
- Erectile dysfunction
- sexual dysfunction
How to Cite
References
Foster HE, Dahm P, Kohler TS, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2019. J Urol. 2019;202:592-8.
Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006;50:969-80.
Yu X, Elliott SP, Wilt TJ, McBean AM. Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies. J Urol. 2008;180:241-5.
Taher A. Erectile dysfunction after transurethral resection of the prostate: incidence and risk factors. World J Urol. 2004;22:457-60.
Khorrami MH, Gholipour F, Zargham M, et al. Electrocoagulation accounts for a significant portion of discrepancy between preoperative ultrasonography prostate size estimation and resected tissue weight. J Endourol. 2020;34:671-5.
Pederzoli F, Campbell JD, Matsui H, Sopko NA, Bivalacqua TJ. Surgical Factors Associated With Male and Female Sexual Dysfunction After Radical Cystectomy: What Do We Know and How Can We Improve Outcomes? Sex Med Rev. 2018;6:469-81.
Salonia A, Adaikan G, Buvat J, et al. Sexual Rehabilitation After Treatment for Prostate Cancer-Part 1: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med. 2017;14:285-96.
Walz J, Epstein JI, Ganzer R, et al. A Critical Analysis of the Current Knowledge of Surgical Anatomy of the Prostate Related to Optimisation of Cancer Control and Preservation of Continence and Erection in Candidates for Radical Prostatectomy: An Update. Eur Urol. 2016;70:301-11.
Taher A. Erectile dysfunction after transurethral resection of the prostate: incidence and risk factors. World J Urol. 2004;22:457-60.
Akman T, Binbay M, Tekinarslan E, et al. Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int. 2013;112:240-8.
Kumar N, Vasudeva P, Kumar A, Singh H. Prospective randomized comparison of monopolar TURP, bipolar TURP and photoselective vaporization of the prostate in patients with benign prostatic obstruction: 36 months outcome. LUTS. 2018;10:17-20.
Mamoulakis C, Schulze M, Skolarikos A, et al. Bipolar versus monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int. 2013;112:109-20.
El Shorbagy G, El Ghoneimy M, El Feel A, et al. Comparison of impact of monopolar versus bipolar resection of the prostate on erectile function in patients with benign hyperplasia of the prostate. Afr J Urol. 2018;24:216-20.
Nesbit RM. Transurethral prostatic resection: a discussion of some principles and problems. J Urol. 1951;66:362-72.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822-30.
Rosen RC, Allen KR, Ni X, Araujo AB. Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. Eur Urol. 2011;60:1010-6.
Autorino R, De Sio M, D'Armiento M. Bipolar plasmakinetic technology for the treatment of symptomatic benign prostatic hyperplasia: evidence beyond marketing hype? BJU Int. 2007;100:983-5.
Erturhan S, Erbagci A, Seckiner I, Yagci F, Ustun A. Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1-year follow-up. Prostate Cancer Prostatic Dis. 2007;10:97-100.
Muslumanoglu AY, Yuruk E, Binbay M, Akman T, Tefekli A. Transurethral resection of prostate with plasmakinetic energy: 100 months results of a prospective randomized trial. BJU Int. 2012;110:546-9.
Tefekli A, Muslumanoglu AY, Baykal M, et al. A hybrid technique using bipolar energy in transurethral prostate surgery: a prospective, randomized comparison. J Urol. 2005;174:1339-43.
Zhao Z, Ma W, Xuan X, et al. Impact of plasmakinetic enucleation of the prostate (PKEP) on sexual function: results of a prospective trial. J Sex Med. 2012;9:1473-81.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822-30.
Tscholl R, Largo M, Poppinghaus E, Recker F, Subotic B. Incidence of erectile impotence secondary to transurethral resection of benign prostatic hyperplasia, assessed by preoperative and postoperative Snap Gauge tests. J Urol. 1995;153:1491-3.
Issa MM. Technological advances in transurethral resection of the prostate: bipolar versus monopolar TURP. J Endourol. 2008;22:1587-95.
Rassweiler J, Schulze M, Stock C, Teber D, de la Rosette J. Bipolar transurethral resection of the prostate‐technical modifications and early clinical experience. Minim Invasive Ther Allied Technol. 2007;16:11-21.
Faul P, Schlenker B, Gratzke C, et al. Clinical and technical aspects of bipolar transurethral prostate resection. Scand J Urol Nephrol. 2008;42:318-23.
Lynch MJ. Transurethral resection of the prostate stands accused of causing impotence in patients: should it be found culpable? BJU Int. 2010;106:614-9.
Ko R, Tan AH, Chew BH, Rowe PE, Razvi H. Comparison of the thermal and histopathological effects of bipolar and monopolar electrosurgical resection of the prostate in a canine model. BJU Int. 2010;105:1314-7.
Mamoulakis C, Ubbink DT, de la Rosette JJ. Bipolar versus monopolar transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol. 2009;56:798-809.
Derby CA, Araujo AB, Johannes CB, Feldman HA, McKinlay JB. Measurement of erectile dysfunction in population-based studies: the use of a single question self-assessment in the Massachusetts Male Aging Study. Int J Impot Res. 2000;12:197-204.
- Abstract Viewed: 462 times
- 8234/pdf Downloaded: 196 times