Variables Grade 2-4 5-7 8-10 Variables Table IX. Complications TUR syndrome Clot retention Urinary retention 5 (15) Monopolar TURP N (%) 1 (3) 8 (28) 20 (69) Monopolar TURP N (%) 0 (0) 2 (6) Bipolar TURIS N (%) 1 (3) 3 (9) 29 (88) Bipolar TURIS N (%) 0 (0) 5 (12) 11 (27) TURP – transurethral resection of prostate, TURIS – transurethral resection of prostate in saline, N – number TURP – transurethral resection of prostate, TURIS – transurethral resection of prostate in saline, TUR – transurethral resection repeated surgery [12]. Mazur and Thompson report a success rate of 79% [12]. In our study a success rate of 77% was achieved. Palliative endoscopic resection failed in 16 patients (23%), demanding a long-term suprapubic or transurethral catheter as a final solution. Our re-operation rate was 6%. A factor in re- intervention was a reoccurring obstruction due to ongoing local tumour progression. Crain et al. reported 29% of patients requiring additional procedures [13], including surgical intervention for haemorrhage and clot retention. Our incidence of clot retention was 9.3%, but all cases could be managed conservatively. A potential drawback of palliative endoscopic transurethral resection of a malignant gland is that this is technically more difficult. The prostatic urethra may be rigid and both the verumontanum and external sphincter hard to identify. This leads to a higher risk of incontinence. External radiotherapy that had been applied in some patients causes radiation effects that may contribute to the complication rate. Palliative endoscopic resections have been criticized by Engelhardt and Riedl [14], as resection and venous propagation of tumour cells may enhance further dissemination of the disease. Such a possible negative impact on progression has been demonstrated in several studies. Fadlon et al. detected circulating prostate cancer cells in the serum of patients after prostate manipulations [15]. Clinical observations in patients with high grade cancer or progressive cancer showed higher Total N (%) 2 (3) 11 (18) 49 (79) p 1.000 0.565 0.292 postoperative rates of metastasis [16-19]. Further- more, some survival benefit was observed when palliative endoscopic resection was avoided [14]. Therefore, Hübner et al. promotes intraprostatic stenting in locally advanced prostate cancer and urinary obstruction [20]. Our personal experience with prostatic stenting is disappointing and corresponds with the results and the high rates of complications reported in the literature [21]. Our goal in hormonal refractory prostate cancer patients is for improved quality of life rather than for quantity of months of survival. Transurethral resection of the prostate with conventional monopolar loops remains the gold standard for treatment of symptomatic obstructive prostatic hypertrophy [22]. The current passes from the active electrode on the monopolar resectoscope through the patient's body to the return plate. This can provoke deep tissue heating, stimulation of underlying nerves or muscles, burning wounds at the site of the return electrode and malfunction of cardiac pacemakers [23]. The risk of complications such as bleeding and absorption of irrigation fluid with possible TUR syndrome cannot be ignored. With bipolar systems, one tries to counter the problems associated with conventional monopolar systems by allowing resection in an iso-osmotic saline solution and obviating the use of a return electrode applied to the skin because the active and return electrode are placed on the same axis on the resectoscope. Many studies have reported the advantages and disadvantages of bipolar resection in BPH patients [24-33]. Our group compared the Olympus TURIS device over conventional monopolar resections in 238 BPH patients [23]. In the bipolar resection group there were only 4 clot retentions (3.4%) and no occurrence of TUR syndrome. But staff members as well as trainees needed more operative time with the bipolar system. We do not discard the importance of the learning curve, but prolonged operative time was also related to specific TURIS characteristics such as the size of the resection loop and smaller endoscopes [33]. To date, no studies have analysed the advantages and disadvantages of bipolar resection in prostate cancer patients. Therefore, we re- analysed our data retrospectively. Two important factors were investigated. Did bipolar resection have a positive influence on the electrolyte balance in this older and debilitated patient group, and was bipolar resection associated with less prostate bleeding after the procedure? In the present study we did not observe statistically significant changes in the electrolyte balances, although this advantage was clear in BPH patients. Possible explanations for this are the smaller study groups, the shorter operation times Dirk P.J. Michielsen, Danny Coomans, Benedikt Engels, Johan G. Braeckman Table VIII. Histological data after endoscopic resec- tion 784 Arch Med Sci 5, October / 2010