TUR-P VE BİPOLEP UYGULANAN HASTALARIN POST OPERATİF AĞRI AÇISINDAN KARŞILAŞTIRILMASI

Year 2024, Volume: 31 Issue: 1, 39 - 43, 18.03.2024

Kadir Eryılmaz , Mücahit Baltik , Osman Ergün , Taylan Oksay

https://doi.org/10.17343/sdutfd.1379409

Abstract

Amaç
Transüretral prostat rezeksiyonu (TUR-P), bening
prostat hiperplazisin (BPH)’de uzun yıllardır kullanılan
altın standart cerrahi tedavidir. Bipolar prostat
enükleasyonu (BipolEP); son yıllarda BPH tedavisinde
TUR-P operasyonuna önemli bir alternatif yöntem
haline gelmiştir. Çalışmamızda bu iki yöntemin post
operatif hasta konforu, ağrısı ve ağrı kesici ilaç kullanımı
açısından karşılaştırmayı hedefledik.
Gereç ve Yöntem
Mayıs 2022 ve Mayıs 2023 tarihleri arasında kliniğimizde
TUR-P ve BipolEP cerrahisi yapılan 40 hastanın
verileri tarandı. TUR-P grubunda 20 hasta, BipolEP
grubunda 20 hasta mevcuttu. Hastaların; pre,
intra ve post operatif özellikleri değerlendirildi. Hastalara
pre ve post operatif 6 saat aralıklarla ağrı Vizüel
Analog Skala(VAS) skorları sorularak kaydedildi. Post
operatif alınan cevaplarda en yüksek VAS skoru kayıt
altına alınmıştır. Cevaplara uygun ağrı kesici ilaçlar
verilmiş ve adetleri kaydedilmiştir.
Bulgular
Post operatif VAS ağrı skoru ortalaması TUR-P ve BipolEP
gruplarında sırasıyla 2,9 ve 3,2 olarak bulundu
ve aralarında anlamlı fark yoktu (p: 0,684). Post
operatif ağrı kontrolü için kullanılan NSAİD, tramadol,
parasetemol ve hiyosin-N- Butil Bromür sayıları açısından
da anlamlı fark izlenmedi (sırasıyla p=1; p=1;
p=0,29; p=0,221). TUR-P ve BipolEP yöntemlerinin
post operatif ağrı ve medikasyon gerekliliği açısından
benzer olduğu görüldü.
Sonuç
Çalışmamızda her iki yöntem arasında post operatif
ağrı ve gerekli medikasyon açısından bir fark izlenmemiştir.
Birbirine yakın ekipmanlar ile yapılmaları,
cerrahi endikasyonları aynı olan yöntemler olması ve
benzer hasta gruplarına uygulanmasından dolayı iki
grup arasında ağrı açısından fark olmadığını düşünmekteyiz.

Keywords

TUR-P, BipolEP, Ağrı, VAS skoru

COMPARISON OF PATIENTS UNDERWENT TUR-P AND BIPOLEP IN TERMS OF POST OPERATIVE PAIN

Abstract

Objective
Transurethral resection of the prostate (TUR-P)
has been considered as the gold standard surgical
treatment of BPH for many years. Over the past years,
Bipolar Prostate Enucleation (BipolEP) has became
an important alternative method compared to TUR-P
for BPH treatment. In our study, we aimed to compare
these two methods in terms of postoperative patient
comfort, pain and analgesic use.
Material and Method
The data of 40 patients who underwent TURP and
BipolEP procedures in our clinic between May 2022
and May 2023 were scanned. There were 20 patients
in the TUR-P group and 20 patients in the BipolEP
group. Pre-, intra- and postoperative features of the
patients were evaluated. Pain assessments were
recorded using the Visual Analogue Scale (VAS)
by asking patients at 6- hour intervals pre and postoperatively.
The highest VAS score was recorded
during the post-operative responses. According to the
answers, the most appropriate painkillers were given
and their quantities were recorded.
Results
The mean post-operative VAS pain score was 2.9 and
3.2 in the TUR-P and BipolEP groups, respectively, and
there was no significant difference between them (p=
0.684). Also, no significant difference was observed in
the quantities of NSAIDs, tramadol, parasetemol and
hyoscine-N-Butyl Bromide used in postoperative pain
control (p=1; p=1; p=0,29; p=0,221, respectively). It
was found that TUR-P and BipolEP methods were
similar in terms of postoperative pain and medication
requirement.
Conclusion
In our study, no differences were observed between
the two methods in terms of postoperative pain and
necessary medications.We believe that this outcome
is due to the fact that they are both performed with
similar equipments and since they have the same
surgical indications they are performed on similar
patient groups.

Keywords

TUR-P, BipolEP, pain, VAS scores

References

• 1. Oelke M, Bachmann A, Descazeaud A, et al. Guidelines for the management of benign prostatic male lower urinary tract symptoms obstruction (BPO). European Association of Urology 2012;64:118–140. https://doi.org/10.1016/j.eururo.2013.03.004
• 2. Ryang SH, Ly TH, Tran AV, Oh SJ, Cho SY. Bipolar enucleation of the prostate-step by step. Andrologia. 2020;52(8):13631. doi: 10.1111/and.13631.
• 3. Hiraoka Y, Akimoto M. Transurethral enucleation of benign prostatic hyperplasia. J Urol 1989;142:1247–1250
• 4. Neill MG, Gilling PJ, Kennett KM, et al. Randomized trial comparing holmium laser enucleation of the prostate with plasmakinetic enucleation of the prostate for the treatment of benign prostatic hyperplasia. Urology 2006;68:1020–1024. https://doi. org/10.1016/j.urology.2006.06.021z
• 5. Geavlete B, Stanescu F, Iacoboaie C, et al. Open prostatectomy versus bipolar plasma enucleation of the prostate in large cases of benign prostatic hyperplasia a medium-term, prospective, randomized comparison. BJU Int 2013;11:793–803. https:// doi.org/10.1111/j.1464-410X.2012.11730.x
• 6. Geavlete B, Stanescu F, Iacoboaie C, et al. Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases a medium term, prospective, randomized comparison. BJU Int 2013;111(5):793-803. doi: 10.1111/j.1464-410X.2012.11730.x.
• 7. Pallauf M, Kunit T, Ramesmayer C, et al. Endoscopic enucleation of the prostate (EEP). The same but different-a systematic review. World J Urol 2021;39(7):2383-2396. doi: 10.1007/ s00345-021-03705-6.
• 8. Herrmann TR. Langzeitergebnisse nach endoskopischer Enukleation der Prostata: Von der monopolaren Enukleation zu Ho- LEP und EEP [Long-term outcome after endoscopic enucleation of the prostate: From monopolar enucleation to HoLEP and from HoLEP to EEP]. Urologe A 2016;55(11):1446-1454. doi: 10.1007/s00120-016-0245-8.
• 9. Elkoushy MA, Elhilali MM. Management of benign prostatic hyperplasia larger than 100 ml: simple open enucleation versus transurethral laser prostatectomy. Curr Urol Rep 2016;17(6):44. doi: 10.1007/s11934-016-0601-7.
• 10. Li M, Qiu J, Hou Q, Wang D, Huang W, Hu C, et al. Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS One 2015;31;10(3):e0121265. doi: 10.1371/ journal.pone.0121265.
• 11. Lin Y, Wu X, Xu A, et al. Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol 2016;34(9):1207-19. doi: 10.1007/s00345-015-1735-9.
• 12. Zhang Y, Yuan P, Ma D, et al. Efficacy and safety of enucleation enucleation vs. resection of prostate for treatment of benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. Prostate Cancer Prostatic Dis 2019;22(4):493-508. doi: 10.1038/s41391-019-0135-4.
• 13. Arcaniolo D, Manfredi C, Veccia A, et al. EAU Section of Uro-Technology (ESUT) Research Group. Bipolar endoscopic enucleation versus bipolar transurethral resection of the prostate: an ESUT systematic review and cumulative analysis. World J Urol 2020;38(5):1177-1186. doi: 10.1007/s00345-019-02890-9.
• 14. Tyritzis SI, Stravodimos KG, Vasileiou I, et al. Spinal versus general anaesthesia in postoperative pain management during transurethral procedures. ISRN Urol 2011;2011:895874. doi: 10.5402/2011/895874.
• 15. Blichfeldt-Eckhardt MR, Jensen JM, Møller JF. Treating post-operative pain. Ugeskr Laeger 2017;26;179(26).
• 16. Breivik H. Fifty years on the Visual Analogue Scale (VAS) for pain-intensity is still good for acute pain. But multidimensional assessment is needed for chronic pain. Scand J Pain 2016;11:150-152. doi: 10.1016/j.sjpain.2016.02.004.
• 17. Ueland W, Plymale MA, Davenport DL, Roth JS. Perioperative factors associated with pain following open ventral hernia repair. Surg Endosc 2019;33(12):4102-4108. doi: 10.1007/s00464- 019-06713-1.
• 18. Ryang SH, Ly TH, Tran AV, Oh SJ, Cho SY. Bipolar enucleation of the prostate-step by step. Andrologia 2020;52(8):13631. doi: 10.1111/and.13631.