Impact of surgical technique on histopathological specimen quality: Transurethral resection of the prostate versus bipolar enucleation of the prostate

Abstract

This study examines the effects of Transurethral Resection of the Prostate (TURP) and Bipolar Enucleation of the Prostate (BipoLEP) techniques on the histopathological quality of specimens in benign prostatic hyperplasia surgery. A retrospective analysis was conducted on 200 patients (100 TURP, 100 BipoLEP) treated at a single center between January 2021 and January 2023. Specimens were systematically evaluated for artifacts, including fragmentation, thermal, telescoping, sectioning, processing, and staining artifacts. The relationship between surgical technique and artifact types was analyzed using independent samples t-tests, while pathological diagnoses were compared using the chi-square test. Additionally, a pilot group of 10 patients (5 TURP, 5 BipoLEP) underwent immunohistochemical analysis with p63, p27, and androgen receptor to assess antigen preservation. Fragmentation was significantly higher in the BipoLEP group (87 %) compared to the TURP group (6 %) (p < 0.001). Conversely, thermal artifacts were notably more frequent in TURP specimens (97 %) than in BipoLEP (22 %) (p < 0.001). Sectioning artifacts were observed more often after TURP (24 %) compared to BipoLEP (4 %) (p < 0.001), while telescoping artifacts were also more prevalent in BipoLEP (90 %). No significant differences were detected between groups regarding processing or staining artifacts. Both techniques provided comparable diagnostic adequacy and rates of incidental prostate cancer detection. In conclusion, the choice of surgical technique substantially influences the type and frequency of histological artifacts. Therefore, awareness of the surgical method is vital for pathologists to ensure accurate interpretation and optimal patient management.