The PIVOTAL trial established the non-inferiority of narrow-margin bipolar TURP compared to standard monopolar TURP. Bipolar TURP uses isotonic saline as irrigant primarily to avoid:

• A TURP syndrome (dilutional hyponatraemia from hypotonic glycine absorption) ✓
• B Haemolytic reaction
• C Urinary tract infection
• D Retrograde ejaculation

Explanation

TURP syndrome occurs when hypotonic irrigating fluids (glycine 1.5%, sorbitol, mannitol) are absorbed through open venous sinuses, causing dilutional hyponatraemia, cerebral oedema, visual disturbances, and cardiovascular instability. Bipolar TURP uses isotonic saline as irrigant, completing the circuit between electrode poles within the tissue rather than through the patient's body, thus eliminating the need for non-conducting (hypotonic) fluids and preventing TURP syndrome.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.