1992 SINGLE PORT TRANSVESICAL PROSTATECTOMY FOR BPH TREATMENT OF LARGE PROSTATES

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (II)1 Apr 20131992 SINGLE PORT TRANSVESICAL PROSTATECTOMY FOR BPH TREATMENT OF LARGE PROSTATES Marcelo Hisano, Fábio Carvalho Vicentini, Túlio Agresta, Marco Antonio di Napoli, Priscila Kuriki, Carlos Watanabe, Cláudio Bovolenta Murta, and Joaquim Francisco de Almeida Claro Marcelo HisanoMarcelo Hisano São Paulo, Brazil More articles by this author , Fábio Carvalho VicentiniFábio Carvalho Vicentini São Paulo, Brazil More articles by this author , Túlio AgrestaTúlio Agresta São Paulo, Brazil More articles by this author , Marco Antonio di NapoliMarco Antonio di Napoli São Paulo, Brazil More articles by this author , Priscila KurikiPriscila Kuriki São Paulo, Brazil More articles by this author , Carlos WatanabeCarlos Watanabe São Paulo, Brazil More articles by this author , Cláudio Bovolenta MurtaCláudio Bovolenta Murta São Paulo, Brazil More articles by this author , and Joaquim Francisco de Almeida ClaroJoaquim Francisco de Almeida Claro São Paulo, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2411AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditionally, large prostates (more than 80g) associated to LUTS and requiring surgical treatment are managed by open adenomectomy; laparoscopic access remains as a minimally invasive option. We present our series of adenomectomy through a transvesical single port (TLESS) access for large prostates. METHODS We prospectively performed TLESS adenomectomy in 21 patients with BPH and LUTS. Of these patients, 4 were on urinary retention and one had bladder stones. Patient's demographics and perioperative data were recorded and statistically analyzed. Under general anesthesia, patient is positioned in the Trendelenburg position (30°); the bladder is filled with saline solution until the maximum capacity. A 2cm longitudinal incision is performed 2cm below the vesical dome; the bladder is opened and its walls are secured at the skin with stitches. The single-port device (GelPoint®) is introduced into the bladder and a pneumovesicum at 12 to 15mmHg is established. Standard laparoscopic instruments and a 30 degree lens are used. Bladder neck is incised to reach the adenoma plane, followed by enucleation. Hemostasia is performed under direct vision. An irrigation catheter is placed into the bladder and its wall is closed. Patients are followed each 4 months. RESULTS Mean age was 68.5 years old, median body max index was 27.18 Kg/m2. Median prostate weight was 80g on digital rectal exam and 123g on sonography. Preoperative median AUA symptom score was 26, mean quality of life index (QL) was 4.93 and median maximum urinary flow rate (Qmax) was 8mL/s. Mean operative time was 98 minutes (60-180 min) and mean estimated blood loss was 304 mL. Median irrigation time was 48 hours (24-144h), median hospital stay was 2.5 days. Median decrease of serum hemoglobin level was 2.6 g/dL; there was no transfusion. Mean weight of the enucleated adenoma was 74.9g (40-175g). There were 8 complications: 3 patients had capsule perforation, requiring suturing (Clavien I) and one of them developed urinary fistula, requiring surgical correction (Clavien IIIb); 2 patients had clot retention, requiring bed-side evacuation (Clavien II); another 2 patients had intraoperative vagal response with bradycardia, both reverted without complications. Median follow-up was 11 months (4 to 21 months). All patients were voiding spontaneously. Post-operative median AUA symptom score was 6 (p<0.05), mean QL was 0.23 (p<0.05) and median Qmax was 24 mL/s(p<0.05). CONCLUSIONS Single port transvesical adenomectomy is technically feasible, safe and efficient in short term follow-up and can be an option for surgical treatment of large prostates. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e818 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcelo Hisano São Paulo, Brazil More articles by this author Fábio Carvalho Vicentini São Paulo, Brazil More articles by this author Túlio Agresta São Paulo, Brazil More articles by this author Marco Antonio di Napoli São Paulo, Brazil More articles by this author Priscila Kuriki São Paulo, Brazil More articles by this author Carlos Watanabe São Paulo, Brazil More articles by this author Cláudio Bovolenta Murta São Paulo, Brazil More articles by this author Joaquim Francisco de Almeida Claro São Paulo, Brazil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...