The gold standard in the treatment of prostate adenoma

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Prostate Adenoma – Today, bipolar TUR (Transurethral Resection) is recognized worldwide as the gold standard in the treatment of prostate adenoma.

TUR is not new to Georgia either. We’ve heard the term for a long time – “he had TUR,” “they did a TUR,” – but many people don’t actually know what this procedure means, how monopolar TUR differs from bipolar TUR, and how the surgery is generally performed.

TUR, in general, stands for Transurethral Resection, a procedure where, using special endoscopic equipment, the pathological tissues are removed through the urethra (the urinary passage).

This type of surgery — TUR — can be performed on the urethra, prostate, or urinary bladder, depending on the condition

TUR is performed using a transurethral resectoscope (“resection” means removal, and “skopeo” means to see), which is a special, thin-diameter instrument that can easily pass through the urethra.

At its end, it has an optical component, which is connected to a video camera, allowing the image to be transmitted to a monitor.

The design of the instrument allows for maximum tissue removal and provides excellent visualization, which is crucial during complex surgical procedures.

At the end of the instrument, a special loop, known as an electrode or electrosurgical loop, is attached. This is used to cut and remove the tissue.

It is important to note that at Karazanashvili Robotic Center – within Guram Kharazanashvili’s Urology Hub – the treatment of prostate adenoma is performed using equipment from the “Olympus” system, a world-leading Japanese company known for its advanced medical technologies. This system offers exceptional precision and top-level visualization.

At this clinic, highly qualified specialists with extensive practical experience use bipolar TUR, rather than the traditional monopolar method!

Let’s take a look at how these two types of TUR differ.

Monopolar TUR and Its Disadvantages

In monopolar TUR, a standard monopolar electrode is used. In this system, the electrode acts as one pole, while the patient’s body (usually grounded) serves as the second pole.

Essentially, the electric current flows between the electrode and the patient’s body, and this is what allows the tissue to be cut or removed.

To transmit electrical impulses, it is necessary to create a conductive environment between the electrode and the body. For this purpose, a special fluid—an isotonic solution of sorbitol—is introduced through the instrument and continuously circulated during the procedure.

This fluid fills the urethra, prostate, and bladder area. It serves two main purposes:

By filling these areas, it expands the visual field, helping the surgeon see the target tissues more clearly for precise removal.
It also acts as a conductor for the electric current.

Karazanashvili Robotic Center – Guram Kharazanashvili’s Urology Hub combines modern, state-of-the-art technology with highly qualified specialists—all at your service.

During monopolar TUR, a fluid containing sorbitol (an isotonic solution) is used. While this fluid is considered “acceptable” for the body in proper concentrations, it has a major downside. Over time, if absorbed into the body through open blood vessels, it can lead to serious complications, specifically TUR syndrome. This condition is characterized by hypervolemia, heart dysfunction, shortness of breath, and other severe issues.

The greatest disadvantage of monopolar TUR is exactly this fluid. Due to the potentially harmful effects of sorbitol, monopolar TUR is not recommended to last longer than one hour.

Otherwise, during the operation, when tissue is being removed and veins are exposed, the fluid can enter the bloodstream under high pressure, causing serious complications.

Therefore, performing surgery using monopolar TUR is time-limited. This is exactly why modern clinical guidelines recommend using monopolar TUR only in cases where the prostate weighs less than 80 grams.

Naturally, operating on larger adenomas—or manipulating larger prostates—requires more time. As a result, there is a higher risk that a significant amount of the fluid will be absorbed into the body, increasing the chance of developing TUR syndrome.

One of the disadvantages of monopolar TUR is the risk of bleeding. This potential complication is much lower in bipolar TUR, making it a significantly more optimal choice.

With increased bleeding, the visual field becomes obscured by blood, and the surgeon may have difficulty identifying the area, which prolongs the operation. This can lead to incorrect manipulation and damage to healthy tissues, which often results in a need to stop the surgery or delay the procedure.

At Karazanashvili Robotic Center – Guram Kharazanashvili’s Urology Hub, specialists do not encounter these complications! Here, surgeries are performed using cutting-edge technology with modern, high-quality equipment that meets world standards. This clinic boasts a team of experienced professionals!

At Karazanashvili Robotic Center – Guram Kharazanashvili’s Urology Hub, prostate adenoma is treated with bipolar TUR, plasma vaporization, and enucleation methods.

Prostate Adenoma – Bipolar TUR and Its Advantages

Bipolar TUR is fundamentally a new, more advanced, and highly refined technology. It combines vaporization and enucleation methods, offering an improved solution compared to monopolar TUR, addressing all issues with greater efficiency.

Prostate Adenoma – What Does Bipolar TUR Involve?

The operation is technically very similar to monopolar TUR, where the approach is still transurethral, meaning it is performed through the urethra using endoscopic equipment. The key difference, however, is the electrical discharge during bipolar TUR, which occurs between two poles of the electrode (instead of between the electrode and the body, as in monopolar TUR). This difference leads to the development of higher temperatures, which ensures effective coagulation. As a result, the likelihood of bleeding is much lower, which is essential for reducing complications. Instead of using isotonic saline, physiological solutions are used, which are much safer for the body, meaning that even in the case of large volumes of blood being lost, no damage is done to the body. The kidneys will continue to function normally, and the procedure can be completed without issues.

Considering all these factors, bipolar TUR has a major advantage – the surgeon is not limited by time and can safely perform the procedure for more than an hour, even when operating on larger (heavier) prostates. During bipolar TUR, coagulation and visualization are significantly better than in monopolar TUR.

As a result, tissue removal and bleeding control (coagulation) happen simultaneously and efficiently, allowing the surgeon to work in an almost bloodless environment, which greatly improves precision and safety.

It is precisely because of these advantages that bipolar TUR is now recognized worldwide as the gold standard for the treatment of prostate adenoma. It has significant advantages over cryodestruction, laser therapy, high-frequency ultrasound, radiofrequency ablation, and other types of ablation techniques.

Bipolar TUR is successfully used not only for benign prostatic hyperplasia (BPH) but also for the removal of upper bladder tumors (growing into the bladder cavity). Additionally, it is widely used in gynecological practice, in the form of hysteroscopic resection, to remove uterine cavity fibroids (myomas).

So, visit a hospital equipped with modern technologies!
Receive highly qualified care, and undergo treatment that meets international medical standards!
Karazanashvili Robotic Center – Guram Karazanashvili Urology Hub is a leading and distinguished clinic in its field!

Prostate Adenoma – What is Plasma Vaporization?

Vaporization is an advanced development of bipolar TUR (Transurethral Resection). This technology also uses an electrosurgical tool, but with a different type of electrical discharge. During vaporization, the tip of the electrode becomes so hot that it creates plasma (similar to a flame), which breaks down the tissue into water and carbon dioxide. Essentially, the pathological tissue is vaporized and dissolves into the circulating physiological saline.

Vaporization can be used independently or in combination with bipolar TUR and enucleation.

It is especially effective during surgeries with significant bleeding, such as:

When a patient has impaired coagulation (blood clotting) or is taking high doses of anticoagulant medications for various reasons.
In cases of prostate cancer, when radical (open) surgery is not possible and a palliative procedure is needed. (Unlike adenoma, prostate cancer tissue is much more prone to bleeding, making coagulation particularly difficult.)

Vaporization is also irreplaceable in cases of multifocal bladder tumors, when the bladder contains numerous small lesions. In such cases, removing each one individually is very difficult, and it’s more practical to vaporize them without bleeding.

Prostate Adenoma – What is Enucleation?

Enucleation essentially replicates what is done during open surgery. In this case, the electrode used in the resectoscope (designed for TUR procedures) is replaced with a special double-loop device. One loop functions as a bipolar electrode, while the other serves a mechanical purpose.

A skilled and experienced surgeon inserts the electrode precisely into the correct tissue plane – between the prostate capsule and the adenomatous tissue – and, using a coagulation-assisted mode, begins to gradually separate the tissues. This process effectively “peels out” or extracts the adenoma.

The procedure is often compared to peeling a ripe orange with your fingers: the orange peel represents the prostate capsule, which is actually the compressed normal prostate tissue, while the core of the orange represents the adenoma, or the hyperplastic (overgrown) tissue.

Prostate Adenoma – Bipolar Enucleation

The enucleated (removed) adenoma is then fragmented with a morcellator into smaller pieces and extracted. Enucleation is especially suitable for larger prostates, since multiple cuts during surgery on large adenomas increase the risk of damaging healthy tissue and breaching the prostate capsule. That’s why removing the entire adenoma from the capsule and then fragmenting it is considered a safer and more appropriate method.

Under good visualization and with effective coagulation, enucleation can be used to successfully treat adenomas of 120, 140, 190, or even 200 grams.

Prostate Adenoma – Bipolar Electrode

Thus, bipolar TUR (transurethral resection) enables the use of all three methods—resection, vaporization, and enucleation—in combination. With the help of modern technology, the surgeon has the freedom to manipulate as needed, selecting the most appropriate approach based on the size of the prostate, the patient’s condition, and intraoperative developments.

The surgeon can switch electrodes during the procedure, transition from one method to another, and even use all three technologies if necessary to remove the pathological tissue as precisely and completely as possible, without complications.

What’s most important is: