Stray radiofrequency current as a cause of urethral strictures after transurethral resection of the prostate

Purpose: This study was designed to define the pattern and significance of stray currents induced by two electrosurgical generators (ESGs) in relation to urethral strictures forming after transurethral resection of the prostate (TURP). Materials and Methods: A 24F resectoscope irrigated with glycine was activated at various power outputs in different modes, with intact loops and loops with faulty insulation, simulating TURP. The Valleylab and ERBE ESGs were compared for inducing capacitance. An ESG analyzer simulated tissue impedance and recorded the stray currents induced along the resectoscope sheath. A fresh pig liver was used for assessment of tissue damage caused by the currents. Results: In the cutting mode, the ERBE ESG produced a mean stray current of 70 mA with an intact loop and 144 mA with a loop having faulty insulation. The Valleylab ESG produced 150 mA and 161 mA, respectively. In the coagulation mode, the ERBE ESG produced an average leakage current of 35 mA, and with a loop with faulty insulation, 40 mA. The Valleylab ESG produced 148 mA and 151 mA, respectively. Conclusions: Electrical injury may represent a significant cause of urethral stricture after transurethral electrosurgery. The critical power density of 7.5 W/cm² (which is likely to cause a urethral burn) may be reached, especially with the use of loops with faulty insulation or nonconductive lubricating gel. The ERBE ESG produced significantly less capacitance, decreasing the risk of urethral electrical burn. Conductive gel prevents dangerous current concentration.