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Abstract

We really appreciate the editorial comment on our report regarding the intermediate-term functional outcomes of single-port transvesical enucleation of the prostate (STEP) for voluminous benign prostatic hyperplasia (BPH). Our study clearly shows that STEP can be performed safely in selected voluminous BPH patients, with a favorable functional efficacy in terms of Qmax, International Prostate Symptom Score and Quality of Life Index at 12 months postoperatively. STEP is still a technically demanding and challenging procedure. A precise dissection and management of the apex is one of the most difficult surgical maneuvers to perform during STEP. The visibility can be to some extent improved by a stitch retraction, and we believe the digital assistance to reach the apex is useful. The STEP procedure still needs further refinements on instrumentation and surgical techniques. A combination of transurethral techniques or robotic assistance will ensure an adequate enucleation of the adenoma. Nevertheless, the point at which the advantages of STEP justify the increased overall cost (the TriPort, articulating instruments, robotic surgical system, etc.) should be evaluated in future study. Editorial CommentUrologyVol. 80Issue 2PreviewThe type of surgical treatment for benign prostatic hyperplasia is largely dependent on gland volume. This includes enucleation (open or Holmium [HoLEP]), transurethral resection of the prostate, or energy-based ablation. For larger glands, the enucleation procedures offer greater adenoma reduction with consequent long-term durable outcomes. Both single- and multi-port, transvesical and extravesical laparoscopic and robotic procedures have been reported as minimally invasive alternatives to open simple prostatectomy with encouraging results. Full-Text PDF