Large Volume Benign Prostatic Hyperplasia Research Articles

Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial.

We compared the perioperative and postoperative characteristics of thulium vapoenucleation and holmium laser enucleation of the prostate for the treatment of large volume benign prostatic hyperplasia. A total of 94 patients with benign prostatic hyperplasia and a median prostate size of 80 (IQR 46.75-100)cc were either randomized to thulium vapoenucleation or holmium laser enucleation of the prostate. Patients were assessed preoperatively, 1 and 6months postoperatively. The median operative time was 60 (IQR 41-79)min without significant differences between the groups. There were no significant differences between the groups regarding catheter time [2 (IQR 2-2)days] and postoperative stay [2 (IQR 2-3)days]. Clavien 1 (13.8%), 2 (3.2%), 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. At 6-month follow-up, median maximum flow rate (10.7 vs. 25.9ml/s), post-void residual urine (100 vs. 6.5ml), I-PSS (20 vs. 5), quality of life (4 vs. 1), PSA (4.14 vs. 0.71µg/l), and prostate volume (80 vs. 16ml) had improved significantly (p < 0.001) compared to baseline without significant differences between the groups. Median PSA decrease was 79.7% (58.8-90.6%) and prostate volume reduction was 74.5% (68.57-87.63%) without differences between the groups. The reoperation rate was zero at 6-month follow-up. Thulium vapoenucleation and holmium laser enucleation of the prostate are safe and effective procedures for the treatment of large volume benign prostatic hyperplasia. Both procedures give satisfactory micturition improvement with low morbidity and sufficient prostate volume reduction at 6-month follow-up.

A Novel Modification of Transurethral Enucleation and Resection of the Prostate in Patients With Prostate Glands Larger than 80 mL: Surgical Procedures and Clinical Outcomes

To evaluate the efficacy and safety of the modified transurethral enucleation and resection of the prostate (M-TUERP) vs the conventional bipolar transurethral resection of the prostate (B-TURP) for the treatment of prostates larger than 80 mL. From April 2012 to May 2014, 86 patients with a prostate volume of >80 mL were divided into 2 groups to undergo M-TUERP and B-TURP. In the M-TUERP group, we proposed combining the 12-mm trocar suprapubic cystostomy and using the techniques of "umbrella-shaped resection," "point resection," and "segmental enucleation" to modify the transurethral enucleation and resection of the prostate procedure. The perioperative clinical data were recorded and analyzed. There were no significant differences in preoperative characteristics between the 2 groups. Both groups were similar with the operative time. The M-TUERP group was significantly superior to the B-TURP group in terms of the weight of the resected tissue, the mean intraoperative bladder pressure, hemoglobin decrease, bladder irrigation duration, and urethral catheterization time. No transurethral resection syndrome and incontinence occurred in either group. Compared with the B-TURP group, none of the patients in the M-TUERP group suffered blood transfusion, clot retention, recatheterization, dysuria and reoperation. At the 3-year follow-up, patients who underwent M-TUERP had better international prostate symptom scores, maximum urinary flow rates, and quality of life scores. Our modification of the transurethral enucleation and resection of the prostate procedure is a safe and effective method for the surgical treatment of large-volume benign prostatic hyperplasia. It can simplify the surgical procedures, reduce complications, lower difficulties and shorten the learning curve. At 3-year follow-up, the M-TUERP shows a superior and durable clinical outcome than the B-TURP.

Prospective study comparing laparoscopic and open adenomectomy: Surgical and functional results

IntroductionOpen adenomectomy (OA) is the surgery of choice for large volume benign prostatic hyperplasia, and laparoscopic adenomectomy (LA) represents a minimally invasive alternative. We present a long-term, prospective study comparing both techniques. Patients and methodsThe study consecutively included 199 patients with benign prostatic hyperplasia and prostate volumes >80g who were followed for more than 12 months. The patients underwent OA (n=97) or LA (n=102). We recorded and compared demographic and perioperative data, functional results and complications using a descriptive statistical analysis. ResultsThe mean age was 69.2±7.7 years (range 42–87), and the mean prostate volume (measured by TRUS) was 112.1±32.7mL (range 78–260). There were no baseline differences among the groups in terms of age, ASA scale, prostate volume, PSA levels, Qmax, IPSS, QoL or treatments prior to the surgery. The surgical time (p<.0001) and catheter time (p<0.0002) were longer in the LA group. Operative bleeding (p<0.0001), transfusion rate (p=0.0015) and mean stay (p<0.0001) were significantly lower in the LA group. The LA group had a lower rate of complications (p=0.04), but there were no significant differences between the groups in terms of major complications (Clavien score≥3) (p=0.13) or in the rate of late complications (at one year) (p=0.66). There were also no differences between the groups in the functional postoperative results: IPSS (p=0.17), QoL (p=0.3) and Qmax (p=0.17). ConclusionsLA is a reasonable, safe and effective alternative that results in less bleeding, fewer transfusions, shorter hospital stays and lower morbidity than OA. LA has similar functional results to OA, at the expense of longer surgical times and longer catheter times.

Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis.

BackgroundProstate artery embolization (PAE) is emerging and is a promising minimally invasive therapy that improves lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). The purpose of this article was to evaluate the efficacy and safety of PAE on LUTS related to BPH.Materials and methodsA literature review was performed to identify all published articles of PAE for BPH. The sources included MEDLINE, EMBASE and Cochrane Library from 1980 to 2016. A systematic review and meta-analysis was conducted. The outcome measurements were combined by calculating the mean difference with 95% confidence interval. Statistical analysis was carried out using Review Manager 5.3.0.ResultsTwelve studies involving 840 participants were included. Compared with baseline, the International Index of Erectile Function (IIEF-5; International Prostate Symptom Score) scores, the quality of life scores, peak urinary flow rate (Qmax) and postvoid residual volume all had significant improvements during the 24-month follow-up (all P<0.00001). Both prostate volume (PV) and prostate-specific antigen had significant decrease during the 12-month follow-up (P<0.00001 and P=0.005, respectively), except postoperative 24 months (P=0.47 and P=0.32, respectively). The IIEF-5 short form scores had significant increase at postoperative 6 months (P=0.002) and 12 months (P<0.0001), except postoperative 1 month (P=0.23) and 24 months (P=0.21). For large volume (PV ≥80 mL) BPH, the results were similar. There were no life-threatening complications.ConclusionPAE is an effective, safe and well-tolerable treatment for LUTS related to BPH, including large volume (PV ≥80 mL) BPH, with a good short-term follow-up. Studies with large number of cases and longer follow-up time are needed to validate our results.

Curative effect of plasmakinetic enucleation of prostate in the treatment of large volume prostate

Objectives To evaluate the clinical effect of transurethral plasmakinetic enucleation of the prostate (PKEP) in treatment of large volume benign prostatic hyperplasia(BPH) (>80mL). Methods The clinical date of 80 patients with large volume BPH in the hospital from May 2012 to January 2015 were analyzed retrospectively. All patients were divided into PKEP group(n=37) and transurethral bipolar plasma kinetic prostatectomy (TUPKP group) (n=43) according to surgical ways. Perioperative indices, postoperative follow-up results of two groups were compared and ana- lysed. Results Bladder washing time (20.5 ± 6.7 )min, blood loss (120.5± 44.9 )mL, indwelling catheter time (4.4 ± 1.9)d, postoperative hospitalization (5.2 ±1.8)d in PKEP group were significantly lower than in TUPKP group and resection of the prostate weight (63.2± 21.5) g was significantly higher than TUPKP group (P 0.05). Qmax (22.4±4.7) mL/s in PKEP group was significantly higher than that in TUPKP group (19.5±4.0) mL/s (P 0.05), and the PSA values of the two groups were significantly decreased (P<0.05). The postoperative complication rate (62.16%) in the PKRP group was significantly lower than that in the TUPKP group (86.05%) and the difference was statistically significant (P<0.05). Conclusions PKEP has good clinical effect in the treatment of large volume BPH and TUPKP, it has the advantages of less bleeding, quick recovery and low complications. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate

Trends in Simple Prostatectomy for Benign Prostatic Hyperplasia.

The definitive treatment for symptomatic large volume (>80mL) benign prostatic hyperplasia (BPH) is simple prostatectomy (SP). This can be performed by utilizing a retropubic, suprapubic, or a combined approach. The latter two approaches allow for the management of concomitant bladder diverticulum or stones through the same incision. Each approach affords unique technical strengths and weaknesses that must be considered in light of patient characteristics and concomitant pathology. SP allows for removal of the entire prostatic adenoma while obviating some of the neurovascular and continence issues that can arise from radical prostatectomy. Concerns with SP include its relatively high perioperative morbidity, notably bleeding. Therefore, there is increasing interest in less invasive options, including enucleation procedures and minimally invasive SP. This review presents an update regarding trends and outcomes of SP, as well as the effectiveness and popularity of alternative treatments.

Estudio prospectivo comparativo entre adenomectomía laparoscópica y abierta: resultados operatorios y funcionales

IntroductionOpen adenomectomy (OA) is the surgery of choice for large volume benign prostatic hyperplasia, and laparoscopic adenomectomy (LA) represents a minimally invasive alternative. We present a long-term, prospective study comparing both techniques. Patients and methodsThe study consecutively included 199 patients with benign prostatic hyperplasia and prostate volumes>80g who were followed for more than 12 months. The patients underwent OA (n=97) or LA (n=102). We recorded and compared demographic and perioperative data, functional results and complications using a descriptive statistical analysis. ResultsThe mean age was 69.2±7.7 years (range 42-87), and the mean prostate volume (measured by TRUS) was 112.1±32.7mL (range 78-260). There were no baseline differences among the groups in terms of age, ASA scale, prostate volume, PSA levels, Qmax, IPSS, QoL or treatments prior to the surgery. The surgical time (P<.0001) and catheter time (P<.0002) were longer in the LA group. Operative bleeding (P<.0001), transfusion rate (P=.0015) and mean stay (P<.0001) were significantly lower in the LA group. The LA group had a lower rate of complications (P=.04), but there were no significant differences between the groups in terms of major complications (Clavien score≥3) (P=.13) or in the rate of late complications (at one year) (P=.66). There were also no differences between the groups in the functional postoperative results: IPSS (P=.17), QoL (P=.3) and Qmax (P=.17). ConclusionsLA is a reasonable, safe and effective alternative that results in less bleeding, fewer transfusions, shorter hospital stays and lower morbidity than OA. LA has similar functional results to OA, at the expense of longer surgical times and longer catheter times.

3:55 PMAbstract No. 115 - Comparative cost analysis of prostate artery embolization to modern surgical techniques in the treatment of symptomatic large volume benign prostatic hyperplasia

3:55 PMAbstract No. 115 - Comparative cost analysis of prostate artery embolization to modern surgical techniques in the treatment of symptomatic large volume benign prostatic hyperplasia

3:48 PM, Abstract No. 298 - FEATURED ABSTRACT, Comparative study of prostate artery embolization (PAE) in small volume (80cc) benign prostatic hyperplasia: feasibility, safety, and clinical efficacy

3:48 PM, Abstract No. 298 - FEATURED ABSTRACT, Comparative study of prostate artery embolization (PAE) in small volume (<50cc), midsize (50-80cc), and large volume (>80cc) benign prostatic hyperplasia: feasibility, safety, and clinical efficacy

Comparison of transurethral plasmakinetic and transvesical prostatectomy in treatment of 100–149 mL benign prostatic hyperplasia

To compare the safety and efficacy of transurethral plasmakinetic resection of the prostate (PKRP) versus transvesical prostatectomy (TVP) in the treatment of large-volume benign prostatic hyperplasia (LV-BPH) (100-149mL). Ninety-nine BPH patients who had a prostate volume of 100-149mL were divided into two groups to undergo PKRP or TVP. Preoperative clinical data were analyzed. Patients had follow-up appointments at 1 month, 3 months, 6 months, and 12 months postoperatively. Outcome measures included the International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and postvoid residual urine volume. Adverse effects were also recorded. A total of 96 patients completed the 12-month follow-up. The operative time was longer, but intraoperative blood loss was lower in the PKRP group. Despite a higher percentage of patients requiring a blood transfusion, there was an obvious advantage in gland removal rate in the TVP group. The duration of postoperative catheterization, bladder irrigation, and hospital stay was significantly shorter in the PKRP group. Outcome measures were significantly improved in both groups 1 month postoperatively. The improvement in lower urinary tract symptoms was maintained throughout the 12 months after surgery. There were no significant differences in International Prostate Symptom Score, quality of life, maximum urinary flow rate, and postvoid residual urine volume between the two groups. PKRP has the advantage over TVP of being minimally invasive in the treatment of LV-BPH while achieving the same postoperative outcomes.

经尿道等离子前列腺剜除术治疗高龄危重前列腺增生(附86例报告)

目的：探讨治疗高危且伴有前列腺增生症(BPH)患者安全、有效的手术方法。方法：对我院2010~2012年86例高龄重度前列腺增生且伴有全身重要脏器疾病的患者用经尿道等离子前列腺剜除术(TUERP)治疗。结果：切除组织重量30~110 g，平均60.8 g，手术时间35~105 min，平均87.5 min，术中无明显出血，无手术并发症病例。随访6~48个月，术后的IPSS、Qmax、残余尿改善明显(P 。结论：TUERP是治疗高危重度前列腺增生安全、有效的手术方法。 Objective: To investigate the safe and effective management of large volume benign prostatic hyperplasia (BPH) with high-risk factors. Methods: We analyzed retrospectively 86 old patients of severe BPH accompanied with complicated underlying diseases. The all cases were underwent TUERP in our hospital from 2010 to 2012. Results: The weight of resected tissue was 30 - 110 g. Time of operation was 35 - 105 min. There was little bleeding and no compli- cations happened in-operation or post-operation in this group. A1l patients were followed-up 6 to 48 Months, the IPSS and volume of urine retention had dropped, and Qmax had increased after operation obviously (P Conclusion: Transurethral resectoscope enucleation of prostate is safe and effective to treat high and large volume BPH accompa- nied with high-risk facts.

Electrosurgical Enucleation Versus Bipolar Transurethral Resection for Prostates Larger than 70 ml: A Prospective, Randomized Trial with 5-Year Followup

We compared the perioperative and postoperative characteristics of prostate PlasmaKinetic™ enucleation and bipolar transurethral resection for large volume benign prostatic hyperplasia. In this prospective, randomized, controlled trial 80 patients with benign prostatic hyperplasia and a prostate of larger than 70 ml were randomly assigned to prostate bipolar transurethral resection or PlasmaKinetic enucleation. Operative time, resected adenoma weight, changes in hemoglobin, catheterization time and postoperative hospital stay were recorded and compared. Patients were followed 1, 6, 12, 24, 36, 48 and 60 months after surgery. Greater resected prostate weight (mean ± SD 64.2 ± 19.0 vs 50.6 ± 20.0 gm, p = 0.03), less blood loss (mean 0.87 ± 0.42 vs 1.74 ± 0.63 gm, p <0.01), and shorter catheterization time (mean 35.5 ± 5.8 vs 60.1 ± 5.8 hours, p <0.01) and postoperative hospital stay (mean 3 vs 4 days, [corrected] p <0.01) were recorded in the enucleation group than in the resection group. The postoperative improvement in International Prostate Symptom Score, quality of life, maximal flow rate and post-void residual urine volume was similar in the 2 groups at 1, 6, 12 and 24 months but significantly better in the enucleation group at 36, 48 and 60 months. During the 5-year followup no patient in the enucleation group but 2 in the resection group experienced recurrence. For large volume benign prostatic hyperplasia PlasmaKinetic enucleation of the prostate is associated with less blood loss, shorter hospital stay and catheterization time than bipolar transurethral resection of the prostate. Moreover, PlasmaKinetic enucleation seems to be superior at long-term followup with fewer reoperations necessary.

Preperitoneal Single-port Transvesical Enucleation of the Prostate (STEP) for Large-volume BPH: One-year Follow-up of Qmax, IPSS, and QoL

To evaluate the 1-year efficacy and safety of single-port transvesical enucleation of the prostate (STEP) for voluminous benign prostatic hyperplasia (BPH). Nine patients with moderate- to large-volume (83.8 ± 19.9 mL) BPH (mean age 71.9 ± 6.39 years, body mass index [BMI] 21.5 ± 3.25 kg/m(2)) were preoperatively evaluated by abdominal and transrectal ultrasonography, uroflowmetry, International Prostate Symptom Score (IPSS) and Quality of Life Index (QoL). The STEP procedures were performed by a single surgeon. All patients were followed up for a minimum of 12 months postoperatively by ultrasonography, uroflowmetry, IPSS, and QoL. STEP was smoothly completed in 8 cases with 1 case of open conversion owing to failure of the single-port device insertion. The mean operative duration was 160.9 ± 30.24 minutes, and the estimated blood loss was 418.8 ± 282.76 mL. One intraoperative complication of bleeding occurred. Postoperative complications occurred for 2 patients, including one case each of acute epididymitis and urethral stricture. At the 12-month follow-up after surgery, the mean Q(max) of the entire cohort was 22.7 ± 4.62 mL/s (an increase of 12.9 mL/s), with an average postvoid residual volume of 36.1 ± 40.02 mL, an IPSS of 4.1 ± 1.36 (a decrease of 21 points), and a QoL of 1.4 ± 1.19 (a decrease of 3.2 points). No patients developed incontinence or bladder neck contracture. In selected patients with voluminous BPH, STEP is a safe, feasible, and efficacious procedure with a promising outcome at 1-year follow-up in terms of Q(max), IPSS, and QoL.

Editorial Comment

The 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. Both require a substantial learning curve, comparable with that required of the HoLEP procedure. Preperitoneal Single-port Transvesical Enucleation of the Prostate (STEP) for Large-volume BPH: One-year Follow-up of Qmax, IPSS, and QoLUrologyVol. 80Issue 2PreviewTo evaluate the 1-year efficacy and safety of single-port transvesical enucleation of the prostate (STEP) for voluminous benign prostatic hyperplasia (BPH). Full-Text PDF ReplyUrologyVol. 80Issue 2PreviewWe 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. Full-Text PDF

Robot-Assisted Simple Prostatectomy: Multi-Institutional Outcomes for Glands Larger Than 100 Grams

To present our experience with robot-assisted simple prostatectomy in patients with large gland adenoma (>100 g) that would not be amenable to transurethral treatments. From August 2009 to May 2011, 13 robot-assisted simple suprapubic prostatectomies were performed in patients with symptomatic large gland (>100 g) prostatomegaly on transrectal ultrasonography (mean 163 cc). Essential aspects of our technique include a transverse cystotomy just proximal to the prostatovesical junction and use of a robotic tenotomy grasper to aid in adenoma dissection. Mean operative time was 179 minutes (range 90-270 min), and mean estimated blood loss was 219 mL (range 50-500 mL). Mean hospital stay was 2.7 days (range 1-8 d), and the mean urethral catheterization time was 8.8 days (range 5-14 d). None of the patients needed blood transfusion. One patient had an intraoperative urinary leak after bladder closure that was managed with prolonged urethral catheterization (14 d). Histopathologic analysis confirmed benign prostatic hyperplasia (BPH) in all patients, and mean specimen weight on pathologic examination was 127 g (range 100-165 g). Mean follow-up duration was 7.2 months with all patients having a minimum of a 4-month follow-up. Significant improvements were noted in the International Prostate Symptom Score (preoperative vs postoperative 18.1 vs 5.3, p<0.001) and the maximum urine flow rate (preoperative vs postoperative 4.3 vs 19.1 mL/min, P<0.001). Minimally invasive robot-assisted simple prostatectomy is technically feasible in patients with large volume (>100 g) BPH and is associated with significant improvements in obstructive urinary symptoms. Surgeons with robotic expertise may consider using this approach for treatment of their patients with large volume BPH.

Transurethral Bipolar Plasmakinetic Resection Combined with 2 μm Continuous Wave Laser Vaporization: A New Method for the Treatment of Large Volume Benign Prostatic Hyperplasia

The aim of this study was to evaluate the safety and efficiency of transurethral bipolar plasmakinetic resection of the prostate (PKRP) combined with 2 μm laser vaporization in the management of large prostates (>80 mL). The safety and efficiency of transurethral vaporesection of the prostate with benign prostatic hyperplasia (BPH), using a 2 μm laser system, have been verified. However, this method does still not manage large volume prostates efficiently. From October 2009 to June 2010, 120 BPH patients with a median prostatic volume of 106.7 (±16.7) mL (range, 82.5-156.8 mL) were randomized for surgical treatment with PKRP combined with 2 μm laser vaporization (n=58) or PKRP only (n=62). All patients were preoperatively assessed with subjective symptoms score. Preoperative and perioperative parameters at 3-, 6-, and 9-month follow-up were also evaluated. All complications were recorded. PKRP combined with 2 μm laser vaporization was significantly superior to PKRP alone in terms of operative time, irrigation time, catheterization time, hospital stay, and hemoglobin decrease. The blood transfusion and urinary tract infection observed in the PKRP combined with 2 μm laser vaporization group was significantly less than that of the groups that received PKRP only. Both groups were similar with respect to resected tissue weight, transient incontinence, urethral stricture and retrograde ejaculation in the postoperative period. Both groups showed a significant improvement from baseline in terms of International Prostate Symptom Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and pulmonary vascular resistance unit (PVRU) values. However, no significant difference was found between them. PKRP combined with 2 μm laser vaporization, which combines the advantages of both PKRP and 2 μm laser, is superior for its shorter operation time, less bleeding, and better efficiency. It may be a safer and more effective method for the treatment of BPH in large prostates.

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia.

ObjectiveLaparoscopic simple prostatectomy for large volume benign prostatic hyperplasia (BPH) has been reported in the literature and may be a viable alternative to open surgery for large prostate glands. While previous publications have shown comparable outcomes between laparoscopic and open simple prostatectomy, there have been few publications describing improved laparoscopic operative technique to further improve these outcomes. The authors describe a novel technique of prostatic urethra preservation during laparoscopic simple prostatectomy.Materials and methodsFrom January 2006 to September 2009, laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 51 patients with symptomatic BPH. This technique included extraperitoneal insufflation of the retropubic space by balloon dilation, placement of five trocars in an inverted U shape, transverse prostatic capsular incision, development of a subcapsular plane, and removal of prostatic adenoma with preservation of the prostatic urethra followed by suturing of the prostatic capsule. Demographic, perioperative and outcome data were recorded.ResultsThe mean operative time was 126±51.98 min and the estimated blood loss was 232.55±199.54 mL. Significant improvements were noted in the International Prostate Symptom Score (IPSS), quality of life (QOL) questionnaires and maximum flow rate (Qmax) of patients three months after surgery. No incontinence was reported in any patient. Moreover, there was no significant difference in the 5-Item International Index of Erectile Function (IIEF-5) score pre- and post- operatively in patients who had erectile function before surgery and no patient complained of retrograde ejaculation during the postoperative follow-up period.ConclusionsLaparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia is feasible and reproducible. With this technique, postoperative morbidity can be reduced and antegrade ejaculation preserved.

Transurethral resection of prostate in the treatment of high risky and senile patients with large volume benign prostatic hyperplasia

Objective To improve the skills and level of TURP and peri-operative period managements to the high risky senile patients with large volume benign prostatic hyperplasia.Methods The clinical data of 318 high risky and senile patients whose ages above 80ys,ASA score ＞ 2 and prostate volume ＞ 60g were analyzed retrospectively.They underwent the treatment of TURP.Results Total 318 patients underwent TURP were safe.The operating time ranged from 40 to 85 minutes,averaged 58.2minutes;the volume of blood transfusion ranged from 200ml to 600ml;No serious complications happened during and after the operation.With follow up of 1 ～ 12 months,the International Prostate Symptom Scores(I-PSS) decreased 14.7 averagely,Quality of Life(QOL) decreased 3.3 averagely,Maximal flow rate( Qmax ) increased 6.4ml/s averagely,and Post-voided Residual(PVR) decreased 85.3ml averagely.Conclusion The actions including sufficient preparations and evaluations pre-operatively,the maintenance to the stability of circulatory system during the operation,guaranteeing the demands of blood exchange in the vital organs such as heart,lungs and brain,are the key points to the success. Key words: Benign prostatic hyperplasia; Transurethral resection of prostate; Aged

Single-Port Extraperitoneal Transvesical Adenomectomy: Initial Operative Experience

Background: Laparoscopic extraperitoneal adenomectomy is occasionally performed for symptomatic large-volume benign prostatic hyperplasia. Two different multichannel ports were used during operations. We describe the technique of single-port extraperitoneal transvesical adenomectomy and present the initial operative experience. Methods: Three patients in whom an open adenomectomy was indicated underwent single-port extraperitoneal transvesical adenomectomy. Following preparation of the extraperitoneal space via an umbilical incision, a multichannel port was inserted. A transverse cystotomy adjacent to the prostatovesical junction, incision of mucosa overlying the adenoma, subcapsular plane development, prostatic adenomectomy and cystotomy repair were performed as the standard steps of the laparoscopic procedure. Results: All cases were completed without conversion to standard laparoscopy. Mean operative time was 105 min. Mean blood loss was 190 ml. Hospital stay was 4 days and catheter duration was 6 days for all patients. No intraoperative or postoperative complication occurred. Conclusions: Single-port extraperitoneal transvesical adenomectomy for large benign prostate hyperplasia is feasible with excellent cosmetic results and minimal morbidity.

Single‐port transvesical enucleation of the prostate: a clinical report of 34 cases

To present our experience with single-port transvesical enucleation of the prostate (STEP) in 34 patients with large-volume benign prostatic hyperplasia (BPH). We performed STEP in 34 patients with large volume (>60 g) BPH (mean age 69 years, body mass index 26 kg/m(2), and American Society of Anesthesiology class 2). The mean prostate volume estimated by transrectal ultrasonography was 102.5 mL and the mean baseline prostate-specific antigen level was 6.7 ng/mL. A novel single-port device was inserted percutaneously into the bladder through a 2-3 cm incision in the suprapubic skin crease. After establishing pneumovesicum, the prostate adenoma was enucleated transvesically using standard laparoscopic instruments, and the adenoma was extracted in pieces through the port. Digital assistance expedited enucleation of the apical adenoma in 19 (55%) cases. Transvesical enucleation was completed in all 34 cases; the mean operative duration was 116 min, and the estimated blood loss was 460 mL. There was one death from postoperative bleeding from uncontrolled coagulopathy in a Jehovah's Witness who refused a transfusion of blood and blood products. There were three complications during STEP (one death, one bowel injury and one haemorrhage) and five afterwards (four bleeding, one epididymo-orchitis). Open conversion was necessary in two patients for complications, and extension of the skin incision by 1-2 cm was necessary in two to expedite apical digital enucleation. The mean hospital stay was 3 days and mean analogue pain score at discharge was 2. All 33 patients (excluding the patient who died) were voiding spontaneously at a maximum follow-up of 8 months, with a mean American Urologic Association symptom score of 3, a maximum urinary flow rate of 44 mL/s, and a postvoid residual of 30 mL at the latest follow-up. No patient developed urinary incontinence. STEP is an effective treatment option for selected patients with large-volume obstructive BPH. Under pneumovesicum using laparoscopic visualization, the entire adenoma can be effectively enucleated and expeditiously extracted through the novel single port. Comparison of the STEP procedure with other open and transurethral techniques will determine its place in the surgical treatment of large-volume BPH.