Open Transvesical Prostatectomy Research Articles

Transvesical open prostatectomy versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia, Iraq: A retrospective study

Background and Objective: Surgical treatment is an effective option for symptomatic benign prostatic hyperplasia (BPH), after failed conservative therapy. Transurethral resection of the prostate (TURP) is considered as a standard treatment method for the management of the small to medium prostate while transvesical open prostatectomy (OP) is a standard option for great prostate. The objective of this study is to evaluate the efficacy and safety of both (B-TURP) and (OP). Methods: The present study included 73 patients underwent either transvesical open prostatectomy (31 patients) or bipolar transurethral resection of the prostate (42 patients) between May 2019 to May 2021, in Erbil-city. The baseline characteristics, intraoperative and postoperative characteristics plus early and late adverse effects were obtained from medical records for all patients in both groups, retrospectively. The data analyzed and compared statistically. Results: The baseline characteristics in the studied groups showed no significant differences except for the prostate size which was more on the OP group. According to the results, operative time was significantly (P <0.001) lower in the OP group. The means of the following variables in the OP group were significantly higher than those of the B-TURP group: Hospitalization days (P <0.001), days of catheter removal, back to normal activity (P <0.001), QoL score (P = 0.027), Qmax (P < 0.001), and PVR (P = 0.046), while no significant difference was detected regarding IPSS (P = 0.404). Conclusion: B-TURP was superior to OP regarding the hospitalization days, recovery time back to normal day-activity, and quality of life. Otherwise, both mentioned approaches work well for the treating symptomatic BPH.

Evaluating the Influence of the Prostate Weight on the Morbidity and Mortality of Transvesical Open Prostatectomy: Prospective Analysis of 108 Cases in the Urology-Andrology Department of the Ignace Deen National Hospital in Conakry

Evaluating the Influence of the Prostate Weight on the Morbidity and Mortality of Transvesical Open Prostatectomy: Prospective Analysis of 108 Cases in the Urology-Andrology Department of the Ignace Deen National Hospital in Conakry

Evaluation of intra-operative trans-urethral endoscopic management of possible open transvesical prostatectomy complications

ObjectiveTo evaluate the benefits of using transurethral cystoscope and resectoscope for managing possible complications that may occur during open transvesical prostatectomy operation.BackgroundOpen transvesical or retropubic prostatectomy remains, in less technologically developed countries, the standard option for treatment of complicated large benign prostatic hyperplasia. Complications rate with open prostatectomy procedures, especially post-operative bleeding and urinary incontinence, represent a real challenge facing urologists. Hopefully, recent advances in endourology section helped greatly in management of complicated benign prostatic hyperplasia and also offered a tool to deal with possible open prostatectomy complications.Patients and methodsIn a prospective study, fifty (50) male patients with complicated large benign prostatic enlargement associated with large single or multiple bladder stones with stone burden ≥ 3cm3 planned to undergo transvesical prostatectomy divided randomly into two groups. Group (A) included 25 patients who underwent standard T.V.P. and group (B) included 25 patients in whom diagnostic urethro-cystoscopy and a mono-polar resectoscope were used pre- and post-prostatic adenoma enucleation. Patients had follow-up evaluation visits at 1, 3 and 6 months postoperatively to evaluate IPSS, post-void urine estimation, Qmax., and quality of life.ResultsA total of 50 patients were divided equally into two groups. Group (A) included 25 patients who underwent standard transvesical prostatectomy, while group (B) included 25 patients who underwent initial diagnostic urethro-cystoscopy, then bilateral ureteric catheter insertion, followed by prostatic apical demarcation using a monopolar resectoscope. Finally, transurethral hemostasis of the prostatic bed is done after standard transvesical adenoma enucleation. Mean operative time in group (A): 48.3 ± 12.4 min. while in group (B): 68.9 ± 14.1 min (p < 0.001), Hemoglobin deficit in group (A): 2.8 ± 1.1 g/dl. while in group (B): 1.1 ± 0.39 g/dl. (p < 0.001). Enucleated prostate volume in group (A): 89.2 ± 16.1g, while in group (B): 91.2 ± 17.2g (p = 0.673). Post-operative IPSS, Post-void residual urine and Qmax showed insignificant differences between the two groups.ConclusionTrans-urethral endoscopically assisted transvesical prostatectomy provides more safety and fewer morbidities and complications rate compared to standard T.V.P.

Giant prostatic enlargement: A presentation of a rare asymptomatic case

Benign prostatic hyperplasia is a histological diagnosis and the most frequent benign tumor in older men, and its incidence strongly correlates with advanced age. Giant prostate enlargement (GPE), also known as giant prostatic hyperplasia, is a term given for severely enlarged prostates that weigh more than 500g. GPE cases reported in literature is less than 30. We describe our experience of removing previously asymptomatic 528g prostate by open transvesical prostatectomy. According to transrectal ultrasound (TRUS) the prostate size is 482 ml and prostate‑specific antigen level of 5.1 ng/ml. Histological examination showed nodular prostatic hyperplasia, an adenomatous variant with foci of cystic atrophy, chronic prostatitis. The patient's post-operative recovery went without any relapses and complications.

Benign prostat hiperplazisinin cerrahi tedavisi sonrası tanı konulan insidental prostat kanseri

Objective: Incidental prostate cancer (PCa) is defined as the clinically inapparent tumor detected after transurethral resection of prostate (TURP) or open prostatectomy with benign preoperative rectal examination, prostate specific antigen (PSA) and imaging. The aim of this study is to determine the incidence and clinical significance of incidental prostate cancer in our clinic. Material and Methods: A retrospective analysis was performed in patients who were treated with TURP or transvesical open prostatectomy (TVP) between January 2014 and December 2019. Age, prostate volume, preoperative PSA value, Gleason score, ISUP score, stage and presence of previous prostate biopsy were noted. Treatment performed for incidental PCA was determined. Results: A total of 1020 patients were surgically treated for benign prostate hyperplasia between January 2014 and December 2019. Incidental PCa was diagnosed in 57 (5.6%) patients. 51 (89%) of the patients had TURP and 6 (11%) had TVP. Mean age was 69.9±7.1 years and mean PSA value was 5.3±4.8 ng/ml. Majority of the patients (82.4%) had a Gleason score of 6 (3+3) and 37 (64.9%) patients were reported as stage 1a. Patients with preoperative prostate biopsy have significantly higher prostate volume and PSA values compared to the patients without biopsy (p&lt;0.01). Active surveillance was performed in 42 patients, 2 patients underwent radical prostatectomy, 6 patients had radiotherapy and 7 patients had androgen blockade. Conclusion: We have an incidental PCa rate similar to the literature. Majority of the patients have stage 1a disease and a Gleason score of 6. Most of the patients were managed conservatively. Keywords: incidental prostate cancer, benign prostate hyperplasia, transurethral resection of prostate

Dynamics of perioperative changes in hemostatic potential according to low-frequency piezoelectric thromboelastography data in open transvesical prostatectomy under epidural analgesia

Background. The anesthetic technique of choice for urological surgeries is a controversial issue, especially for transvesical prostatectomy for patients with benign prostatic hyperplasia (BPH). Often, epidural anesthesia and analgesia are considered as the methods of choice. However, the effect of an anesthetic support on perioperative changes in hemostatic potential has been poorly studied.&#x0D; Aim. The aim of the study was to demonstrate the dynamics of changes in the system of the aggregate blood state regulation by using an instrumental method, a low-frequency piezoelectric thromboelastography (LFPTEG), in the perioperative period for patients with BPH who will undergo transvesical prostatectomy.&#x0D; Material and methods. The state of the hemostatic system in a group of 71 patients with confirmed BPH who required a transvesical prostatectomy was evaluated by the APC ARP-01M Mednord device at the time of the admission, 30 min after the effect of an epidural anesthesia, an hour after the end of a surgery and a day after a surgery.&#x0D; Results. A perioperative dynamic monitoring of the state of a hemostatic balance showed that a preoperative hypercoagulation, compensated by an increased fibrinolysis, was replaced by a normocoagulation at the moment of a surgery, which was observed in the first hour after the end of a surgery and retained until the end of the first day.&#x0D; Conclusion. Hypercoagulation was found out for patients with BPH before a transvesical prostatectomy that was masked by an activation of the fibrinolytic system. The hemostatic potential assumed values identical to the reference values that should be taken into account prescribing a postoperative thromboprophylaxis against the background of a prolonged epidural blockade. The APC ARP-01M Mednord device allows you to assess all parts of a hemocoagulation at each stage of a perioperative treatment quickly and without high material costs.

Robotic assisted laparoscopic radical prostatectomy following open trans-vesical adenomectomy: A single centre experience and review of the literature.

Introduction:Robotic assisted laparoscopic radical prostatectomy (RALRP) following endoscopic resection of the prostate is known to be feasible with good outcomes. However, the literature evidence is limited on the feasibility and outcomes of RALRP following open prostatic surgery. In this study, our aim was to report our experience with RALRP in patients who had undergone trans-vesical adenomectomy of the prostate in the past.Patients and methods:We reviewed our prospectively maintained database of men treated with RALRP at our institution to identify patients with previous history of open suprapubic trans-vesical adenomectomy, between 2016 and 2020. Data were collected on demographic information, interventions, oncological outcomes and follow-up.Results:Out of 362 patients, four individuals were identified that had previous open suprapubic trans-vesical adenomectomy. The mean age was 71 years with a mean pre-operative prostate specific antigen (PSA) of 11.35 ng/ml, and an average of 10 years after their trans-vesical adenomectomy. The mean console time was 119 min with an average estimated blood loss of 137.5 ml and 75% underwent lymphadenectomy. Post-operatively, all patients were discharged after 1 day with their urinary catheters removed at 7 days post-op. For one of the patients, a urine leak was identified, and his pelvic drain was removed at 5 days instead of 1 day as for the other three patients. No other complications were noted within 30 days. The average prostate weight was 54.7 g with all specimens being T3a R0. At 6 weeks follow-up, PSA was undetectable, three patients reported full continence and 1 was using two pads/day.Conclusion:RALRP following previous open trans-vesical prostatectomy is feasible and safe with excellent oncological outcomes. They are, however, more challenging and cumbersome with increased console time.

Comparison of holmium laser enucleation prostatectomy and open transvesical prostatectomy in large prostate more than 80 g in Egyptian men: a randomized controlled trial

Objective The aim was to assess the safety and efficacy of holmium laser enucleation prostatectomy (HoLEP) vs open prostatectomy (OP) for prostate of more than 80 g owing to benign prostatic hyperplasia in Egyptian men regarding micturition parameters and complications. Patients and methods A total of 110 patients were randomly divided into HoLEP (55 patients) and OP (55 patients). The inclusion criteria were American Urological Association-Symptom Score (AUA-SS) of eight or higher, maximum urinary flow rate (Qmax) of 10 ml/s or less, postvoiding residual urine (PVUR) of 50 ml or more, and a total prostate volume of 80 ml or more in transrectal ultrasound. The exclusion criteria included previous prostate or urethral surgery and non-benign prostatic hyperplasia related voiding disorders. Follow-up was done at first week, second week, first month, third month, sixth month, and 12th month postoperatively. Perioperative parameters were operative time, enucleation specimen weight, postoperative hemoglobin, length of hospital stay, and the duration of indwelling catheter. The assessment was done in the form of AUA-SS, Qmax, PVUR, and reported complications. Results Operative time was statistically significantly shorter in HoLEP compared with OP (102.45 vs 170.45 min, respectively). Drop-in hemoglobin concentration was statistically significantly higher in OP compared with HoLEP. Moreover, the duration of catheterization and hospital stay were statistically significantly shorter in HoLEP compared with OP. On the contrary, AUA-SS, PVUR, and Qmax did not reveal statistically significant differences between the two groups. Conclusion Both modalities have similar efficacy; however, HoLEP was superior to OP regarding hospital stay, the duration of catheterization, and the rate of hemoglobin concentration drop.

Die präoperative Anwendung von Dutasterid hat keine Auswirkung auf intraoperative Blutungen bei transvesikaler offener einfacher Prostatektomie zur Behandlung der benignen Prostatahyperplasie.

There are a few studies in the literature investigating the effect of preoperative dutasteride use on bleeding in open simple prostatectomy. We aimed to evaluate the effect of preoperative dutasteride use on perioperative bleeding during open simple prostatectomy. We retrospectively analyzed the medical records of all patients who underwent transvesical open prostatectomy due to benign prostatic hyperplasia in our institution between 2008 and 2018. Patients were divided into 2 groups regarding the use of dutasteride prior to surgery as group 1 = received dutasteride during at least six weeks prior to surgery; group 2 = dutasteride naive. A total of 167 patients who met the inclusion criteria were included in the study. The mean operative time was 86.5±18.7 min while the estimated blood loss was 640.7±55.7 ml. There was no statistically significant difference in operative time, estimated blood loss, hemoglobin, and hematocrit decrease among the two groups. We were not able to find an advantage of pre-operative dutasteride use in terms of perioperative bleeding in open simple prostatectomy performed for benign prostatic hyperplasia.

The Outcome of Transvesical Prostatectomy—A Multicenter Retrospective Study

Background: Benign Prostatic Hyperplasia (BPH) is one of the commonest causes of lower obstructive uropathy and usually presents with lower urinary tract symptoms. However, in developing nations, the presentation is late often large prostate and associated complications of bladder outlet obstruction (diverticulae, stones, impaired renal function etc.) warranting open prostatectomy. Objective: The objective of this study is to share our experience of perioperative outcomes of open transvesical prostatectomy over a year involving two referral centers in Monrovia Liberia. Methodology: This was a retrospective study performed at The John F. Kennedy Medical Center and the Saint Joseph Catholic Hospital involving a total of 31 patients. Results: The mean age was 64.6 years (SD = 9.03) with a range 52 - 85 years. The study showed that 54.8% (17/31) of patients had preoperative catheter. The maximum duration of Catheter was greater than 4 weeks with a mean duration of 3.17 weeks. The mean hemoglobin was 11.30 g/dl. The commonest presenting complication was urinary retention at 25.8% (8/31) followed by hematuria 16.1% (5/31). Hypertension 41.9% (13/31) and diabetes 6.5% (/31) were the commonest comorbidity. The rate of postoperative complication was 38.7% with the commonest being surgical site infection 16.1% (5/31) and clot retentions 9.7% (3/31). There was a high rate of transfusion was 77.4% (24/31) patients. Up to about 13% (4/32) patients had coexisting stricture with 6.5% (2/31) patients treated with urethroplasty and 6.5% (2/31) patients treated by dilatation. The mortality rate was 6.5% (2/31) from renal impairment and severe sepsis. Conclusion: BPH is a common cause of lower obstructive uropathy. Most patients present with complications of the disease such as refractory symptoms, bladder stones or diverticulae necessitating surgery. However, due to the absence of endourological equipments in most parts of Africa and the large prostate at presentation, most settings consider open transvesical prostatectomy as a viable option. The perioperative morbidity is relatively higher, but the outcome remains acceptable.

Lack of evidence of HPV etiology of prostate cancer following radical surgery and higher frequency of the Arg/Pro genotype in Turkish men with prostate cancer.

ABSTRACTObjectives The aim of this study was to assess the possible role of HPV in the development of prostate cancer (PCa) and investigate the distribution of the p53 codon 72 polymorphism in PCa in a Turkish population.Materials and methods A total of 96 tissues, which had been obtained using a radical surgery method, formalin-fixed and parafin-embedded, were used in this study. The study group consisted of 60 PCa tissues (open radical prostatectomy) and the control group contained 36 benign prostatic hyperplasia tissues (BPH) (transvesical open prostatectomy). The presence of HPV and the p53 codon 72 polymorphism was investigated in both groups using real-time PCR and pyrosequencing.Results The results of the real-time PCR showed no HPV DNA in any of the 36 BPH tissue samples. HPV-DNA was positive in only 1 of the 60 PCa samples (1.7%). The HPV type of this sample was identified as HPV-57. The distribution of the three genotypes, Arg/Arg, Arg/Pro and Pro/Pro was found to be 45.6, 45.6, and 8.8% in the PCa group and 57.1%, 34.3% and 8.6% in the control group, respectively. Compared with the control group, patients with PCa had a higher frequency of the Arg/Pro genotype and Proline allele (odds ratio (OR)=1.67, 95% confidence interval (CI)=0.68-4.09, p=0.044; OR=1.13, 95% CI=0.76-1.68, p=0.021, respectively).Conclusions The results of the study do not support the hyphothesis that prostate cancer is associated with HPV infection but indicated that Proline allele can be a risk factor in the development of PCa in the Turkish population.

Use of the adjustable trans-obturator male sling system for the treatment of male incontinence. An initial experience

ObjectiveTo evaluate the safety and efficacy of the “Adjustable Trans-Obturator Male Sling System (ATOMS)” as a new surgical technique for the treatment of different types of male urinary incontinence. Subjects and methodsBetween March 2012 and December 2013, 9 patients with a mean age of 56 (range 15–74) years were operated for urinary incontinence using the ATOMS system. Incontinence had developed following bladder exstrophy repair in 2, after radical cystectomy with construction of an orthotopic neobladder in 3, after transvesical open prostatectomy in one and after radical prostatectomy in 3 patients. Preoperative evaluation included a detailed medical history, physical examination, 24-h pad tests, urodynamic assessment and sonography. ResultsThe mean number of pads used preoperatively was 4.6 (range 3–6). The mean operative time was 45 (range 36–50)min. No intraoperative complications were encountered. The mean hospital stay was 3.8 (range 3–6) days. Transient perineal/scrotal pain was observed in 6 patients (66.7%) and controlled with non-opioid analgesics. There were no perineal infections; however, two port infections occurred (22.2%) and repositioning of the port was done in these cases. At a mean follow-up of 9 (range 6–12) months, the overall success rate was 100% with 77.8% of the patients being completely dry (0 pads per 24h) and 22.2% using less than 2 pads per 24h. ConclusionsOur early experience demonstrated that the ATOMS system may be a safe and effective procedure for the treatment of male urinary incontinence. It has the advantage of being feasible any time after an operation when necessary. However, long-term follow-up on a large number of cases is required to ensure its long-term efficacy and safety.

Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials

To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign prostatic hyperplasia (BPH). Randomized controlled trials (RCTs) comparing TUEP and OP were identified from PubMed, Embase and Web of Science up to February 28, 2015. A meta-analysis was conducted with the STATA 12.0 software. Nine RCTs including 758 patients were enrolled in our meta-analysis. There were no significant differences between the two groups in the maximum urinary flow rate at 1, 3, 6months, 1 and 2years: postvoiding residual urinary volume, prostate-specific antigen, international prostate symptom score and quality of life score at 1, 3, 6months and 1year; or international index of erectile function at 3, 6months and 1year. Perioperative outcomes including hemoglobin level drop, catheter period, irrigation length and hospital stay favored TUEP, while operative time and resected prostate weight favored OP. There was significantly less blood transfusion with TUEP, but no significant differences were found in other complications such as recatheterization, urinary tract infection, reintervention for clots and bleeding control, incidence of pneumonia and infarction, transient incontinence, bladder neck contracture, urethral stricture and recurrent adenoma. TUEP can be performed effectively and safely with functional outcomes and complications similar to OP for large BPH, whereas it has the advantages of a shorter catheter period, shorter hospital stays and less blood transfusion. These findings seem to support TUEP as the next-generation "gold standard" of surgery for large BPH.

Holmium laser enucleation of the prostate for treatment for large-sized benign prostate hyperplasia; is it a realistic endourologic alternative in developing country?

To assess the functional outcome and cumulative health-resource-related cost of holmium laser enucleation of the prostate (HoLEP) in comparison with transvesical open prostatectomy (TVOP) in a developing country. Matching of 92 HoLEP and 91 TVOP procedures was performed using resected prostate tissue weight as a sole matching criterion. Safety, efficacy, and accordingly health-related cost-efficiency of both procedures were statistically compared. Preoperative criteria and mean prostate size (166.7 ± 49.7, 161.4 ± 35.7 ml) were similar in HoLEP and TVOP, respectively; however, HoLEP treated more comorbid patients. Blood transfusion was 2.1 and 26.1 % after HoLEP and TVOP, respectively (P = 0.001). Median time to catheter removal and hospital stay was 2 days after HoLEP and 5 and 9 days, respectively, after TVOP (P < 0.001). On modified Clavien scale, grade per grade, there was no statistically significant difference between the two groups apart from local wound complications in TVOP group. High-grade complications (≥ grade 3) were reported in 3.2 and 6.5 % in HoLEP and TVOP, respectively (P = 0.49). Resected prostate tissue weight was independently associated with high-grade periprocedure complications (OR[95 %CI] 1.22[1.02:1.49], P = 0.03). Last follow-up symptom score, peak urine flow rate, residual urine, % PSA reduction, and need for reoperation were comparable between the two groups. HoLEP costs the hospital in the first 3 months 4111.8EP (575US$) versus 4305.4EP (602US$) for TVOP (P = 0.09). In high-volume hospital, HoLEP procedure seems to be equally safe and effective as TVOP with the advantages of minimally invasive procedures. Two years after adopting the technique, HoLEP equally costs the hospital as TVOP. Significant hospital cost savings are anticipated in subsequent cases.

Transvesical open prostatectomy for benign prostatic hyperplasia in the era of minimally invasive surgery: Perioperative outcomes of a contemporary series

ObjectiveTo assess the perioperative morbidity of transvesical open prostatectomy (OP) and its predictors as a treatment for benign prostatic hyperplasia (BPH), and to update knowledge about the morbidity of OP using a standardised morbidity scale (Clavien), thus providing a platform for comparison with the newly developed techniques. Patients and methodsWe retrospectively review men with BPH who were treated with transvesical OP between April 2002 and December 2012. Preoperative patients’ data were reviewed for relevant variables. Operative details, the postoperative course, and 30-day relevant data were assessed. The study cohort was stratified based on the resected prostate weight, with group 1 having a resected weight of ⩽120g and group 2 >120g. ResultsThe review identified 163 patients. The mean (SD, range) duration of catheterisation after OP was 7.9 (2.2, 5–20) days and the duration of hospitalisation after OP was 8.1 (1.8, 5–15) days; both were significantly longer in group 2. All patients were able to void spontaneously by the first follow-up visit. Of 163 OP procedures, there were 106 perioperative complications in 69 (42.3%). Low-grade complications (grade ⩽2) included 38 (45.2%) and 53 (67%) in groups 1 and 2, respectively (P=0.8). High-grade complications (⩾3) included 3 (3.5%) and 12 (15.1%) in groups 1 and 2, respectively (P=0.02). The blood transfusion rate was 24.5%, the perioperative mortality rate was 1.2% and the re-admission rate within the first 30days after OP was 1.2%. High-grade complications were significantly associated with a greater resected prostate weight (odds ratio 1.08, 95% CI 1.001–1.17, P=0.046). ConclusionThe OP procedure is associated with a significant perioperative morbidity that correlated significantly with the resected prostate weight, especially for high-grade complications.

Plasmakinetic Enucleation of the Prostate Versus Transvesical Open Prostatectomy for Benign Prostatic Hyperplasia >80 mL: 12-Month Follow-up Results of a Randomized Clinical Trial

To prospectively evaluate perioperative results and 12-month follow-up after plasmakinetic enucleation of the prostate (PKEP) and transvesical open prostatectomy (OP) for benign prostatic hyperplasia (BPH) >80 mL. A total of 83 patients with a prostate >80 mL were randomized to either PKEP or OP. Perioperative and postoperative outcome data were obtained during a 12-month follow-up. No statistical differences were observed in the preoperative data. Both groups resulted in a similar and significant postoperative improvement in International Prostate Symptom Score (IPSS), quality of life (QOL), maximum uroflow rate (Qmax), postvoid residual (PVR) urine volume and prostate specific antigen (PSA), but no significant difference was found between the groups at the 12-month follow-up. Compared to OP, operation time (111.2 ± 27.1 minutes vs 109.6 ± 28.2 minutes, P= .708) were not significantly different between the groups, but blood loss was significantly less (10.2 ± 4.5 g/l vs 15.1 ± 4.3 g/l, P<.001), and bladder irrigation (2.4 ± 1.0 days vs 4.3 ± 1.1 days, P<.001), catheterization time (3.3 ± 1.1 days vs 6.2 ± 1.3 days, P<.001), and hospital stay (5.4 ± 1.2 days vs 9.3 ± 1.1 days, P<.001) were significantly shorter in the PKEP group. Effects on erectile function were similar in both groups, but adverse events were less frequent in the PKEP group. PKEP can be performed safely and is an equally effective procedure for treatment of large BPH with OP, with minimal complications and faster postoperative recovery. The PKEP helps to reduce the morbidity associated with OP and may become the attractive alternative to OP for patients with large BPH.

1991 TWO-YEAR PROSPECTIVE, RANDOMIZED COMPARISON BETWEEN THE BIPOLAR PLASMA ENUCLEATION OF THE PROSTATE AND OPEN PROSTATECTOMY IN BPH CASES OVER 80 ML

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (II)1 Apr 20131991 TWO-YEAR PROSPECTIVE, RANDOMIZED COMPARISON BETWEEN THE BIPOLAR PLASMA ENUCLEATION OF THE PROSTATE AND OPEN PROSTATECTOMY IN BPH CASES OVER 80 ML Bogdan Geavlete, Florin Stanescu, Catalin Iacoboaie, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete Bucharest, Romania More articles by this author , Florin StanescuFlorin Stanescu Bucharest, Romania More articles by this author , Catalin IacoboaieCatalin Iacoboaie Bucharest, Romania More articles by this author , and Petrisor GeavletePetrisor Geavlete Bucharest, Romania More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2410AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This long term, prospective, randomized trial aimed to evaluate the viability of the bipolar plasma enucleation of the prostate (BPEP) by comparison to open transvesical prostatectomy (OP) in cases of large prostates concerning surgical efficacy, perioperative morbidity and follow-up parameters. METHODS A total of 140 benign prostatic hyperplasia (BPH) patients with prostate volume over 80 mL, maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19 were randomized in the 2 study arms (70 cases each). All patients were assessed preoperatively and every 6 months after surgery for a period of 2 years by IPSS, Qmax, quality of life score (QoL), post-voiding residual urinary volume (PVR), postoperative prostate volume and PSA level. RESULTS The two series were characterized by similar preoperative parameters, including the prostate volume (132.6 versus 129.7 mL). The BPEP and OP techniques emphasized similar mean operating times (91.4 versus 87.5 minutes) and resected tissue weights (108.3 versus 115.4 grams). The postoperative hematuria rate (2.9% versus 12.9%) as well as the mean hemoglobin drop (1.7 versus 3.1 g/dL), catheterization period (1.5 versus 5.8 days) and hospital stay (2.1 versus 6.9 days) were significantly improved for BPEP. The re-catheterization for acute urinary retention was more frequent in the OP group (8.6% versus 1.4%), while the rates of early irritative symptoms were similar for BPEP and OP (11.4% versus 7.1%). During the 2 year' follow-up period, no statistically significant difference was determined in terms of IPSS, Qmax, QoL, PVR, PSA level and postoperative prostate volume between the two series. Consequently, the calculated prostate volume decrease (83.0-84.7% versus 82.1-83.9%) and PSA level reduction (90.6-92.5% versus 90.1- 92.6%) by comparison to the preoperative measurements were statistically equivalent for the BPEP and OP groups. CONCLUSIONS BPEP represents a promising endoscopic approach in large BPH cases, characterized by good surgical efficiency and similar BPH tissue removal capabilities when compared to standard open prostatectomy. Plasma enucleation patients benefited from significantly reduced complications, shorter convalescence period and satisfactory long term follow-up symptom scores and voiding parameters. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e817 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Geavlete Bucharest, Romania More articles by this author Florin Stanescu Bucharest, Romania More articles by this author Catalin Iacoboaie Bucharest, Romania More articles by this author Petrisor Geavlete Bucharest, Romania More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases – a medium term, prospective, randomized comparison

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: According to the EAU Guidelines 2012, large size benign prostatic hyperplasia (BPH) cases (>80 mL) continue to have open prostatectomy as the first line treatment alternative, despite the substantial peri-operative morbidity and extended catheterization and convalescence periods related to this undoubtedly invasive approach. During the past two decades, holmium laser enucleation of the prostate was constantly described as a successful choice for this category of patients. According to rather numerous studies, the technique displayed superior results in terms of surgical safety and postoperative recovery compared with the open procedure. On the other hand, the concept of electrosurgical enucleation of the prostate, using either a monopolar or bipolar cutting current, materialized into several technical applications that eventually failed to gain general acknowledgement as reliable alternatives to the BPH transurethral approach. While keeping in mind the already proved advantage of enucleating substantial quantities of BPH tissue, bipolar plasma enucleation of the prostate was introduced as a novel endoscopic approach in cases of large prostates. The present trial represents the first prospective, medium-term, randomized comparison to be published of this innovative technique with standard open prostatectomy. Basically, the premises for a viable alternative relied on the practical advantages provided by the 'button' electrode, mainly the large surface creating the conditions for a fast enucleation process, continuous vaporization and concomitant haemostasis. Eventually, it was concluded that the plasma enucleation procedure distinguished itself as a successful treatment option in large BPH patients, characterized by good surgical efficiency, significantly reduced complications, faster postoperative recovery, similar prostatic tissue ablation capabilities and satisfactory follow-up results compared with the open technique. Most importantly, plasma-button enucleation patients benefited from a similar 12 months' outcome from the perspectives of symptom scores and voiding parameters when drawing a parallel with open surgery results, thus underlining the reliable viability of this type of endoscopic approach. To evaluate the viability of bipolar plasma enucleation of the prostate (BPEP) by comparison with open transvesical prostatectomy (OP) in cases of large prostates with regard to surgical efficacy and peri-operative morbidity. To compare the medium-term follow-up parameters specific for the two methods. A total of 140 benign prostatic hyperplasia (BPH) patients with prostate volume >80 mL, maximum flow rate (Qmax ) <10 mL/s and International Prostate Symptom Score (IPSS) >19 were randomized in the two study arms. All cases were assessed preoperatively and at 1, 3, 6 and 12 months after surgery by IPSS, Qmax , quality of life score (QoL) and post-voiding residual urinary volume (PVR). The prostate volume and prostate specific antigen (PSA) level were measured at 6 and 12 months. The BPEP and OP techniques emphasized similar mean operating durations (91.4 vs 87.5 min) and resected tissue weights (108.3 vs 115.4 g). The postoperative haematuria rate (2.9% vs 12.9%) as well as the mean haemoglobin drop (1.7 vs 3.1 g/dL), catheterization period (1.5 vs 5.8 days) and hospital stay (2.1 vs 6.9 days) were significantly improved for BPEP. Recatheterization for acute urinary retention was more frequent in the OP group (8.6% vs 1.4%), while the rates of early irritative symptoms were similar for BPEP and OP (11.4% vs 7.1%). During the follow-up period, no statistically significant difference was determined in terms of IPSS, Qmax , QoL, PVR, PSA level and postoperative prostate volume between the two series. BPEP represents a promising endoscopic approach in large BPH cases, characterized by good surgical efficiency and similar BPH tissue removal capabilities compared with standard transvesical prostatectomy. BPEP patients benefited from significantly reduced complications, shorter convalescence and satisfactory follow-up symptom scores and voiding parameters.

Complication rates of open transvesical prostatectomy according to the Clavien-Dindo classification system

Traditional open prostatectomies either transvesical or retropubic remains the reference standard for managing benign prostatic enlargement in some centers, especially in developing countries. The comparison of complication rates between the various types of open prostatectomies is usually a source of significant debate among urologists, most times with conflicting results. The Clavien-Dindo classification system is an excellent attempt at standardization of reporting complications associated with surgeries. We reviewed retrospectively the records of patients who had open transvesical prostatectomy (TVP) in three specialist urology centers in Anambra state, Southeast Nigeria, over a period of 5 years (January 2004-December 2009), with the aim of documenting medical and surgical complications arising from open TVP. These complications were then categorized according to the Clavien-Dindo system. A total of 362 patients had open TVP over the period under review. Of this number, 145 had documented evidence of complications. The mean age of the patients was 66.3 years (SD 9.4 years; range 49-96 years). The mean follow-up period was 27.8 months (SD 12.6 months; range 6-33 months). The overall complication rate for open TVP in this study was 40.1% (145/362). Complication rates for grades i, id, ii, iiia, and iiib were 0.8%, 0.6%, 35.1%, 0.6%, and 3.0%, respectively. Most complications of open TVP occur in the early postoperative period. Open TVP still remains a valid surgical option in contemporary environment where advanced techniques for transurethral resection of the prostate and laparoscopic prostatectomy are unavailable. Most complications occur in the early postoperative period, with bleeding requiring several units of blood transfusion accounting for the commonest complication. This should be explained to patients during the preoperative counselling.

Giant Benign Prostatic Hyperplasia In A Nigerian: Report Of A Case

Giant benign prostatic hyperplasia (GBPH) is a rare pathology of the prostate gland. Here, we report the successful removal of the 16 th heaviest prostate ever reported in the world literature. This also forms the first case report of giant prostatic hyperplasia from Nigeria. The rare GBPH case described here presented in an 87-year-old man with significant lower urinary tract obstructive symptoms, an episode of hematuria, retention and a high prostate specific antigen (PSA) value of 49ng/ml. His treatment was by open transvesical prostatectomy. The surgical specimen measured 14 x 14cm and weighed 510g. The