Early Experience with Laparoscopic Retropubic Simple Prostatectomy in Patients with Voluminous Benign Prostatic Hyperplasia (BPH)

Abstract

PurposeLaparoscopic simple prostatectomy was recently developed to treat voluminous benign prostatic hyperplasia (BPH). We describe the surgical technique and assess the feasibility of laparoscopic simple prostatectomy through our early experience.Materials and MethodsThe medical records of 11 patients who underwent laparoscopic simple prostatectomy between March 2008 and January 2010 were retrospectively analyzed. The subjects were limited to the patients who satisfied the following conditions: prostate volume was at least 75 g, acute urinary retention repeatedly occurred or maximal flow rate (Qmax) was at most 10 ml/s, and International Prostate Symptom Score (IPSS) was at least 12. The surgery was performed by the laparoscopic extraperitoneal approach with a transcapsular route. Feasibility was assessed by objective operative parameters (reconversion, operating time, and blood loss) and perioperative complications. Data on short-term follow-up were also available.ResultsThe mean age of the patients was 70.6 years. Mean preoperative prostate-specific antigen and prostate volume were 6.1 ng/ml and 109.3 cc, respectively. Mean operation time was 191.9 minutes and estimated blood loss was 390.9 cc. The resected adenoma weighed on average 72.4 g. No conversion to open surgery was required. Mean preoperative IPSS and quality of life (QoL) scores were 26.86 and 4.86. Mean Qmax, measured before the surgery, was 4.5 ml/s and residual urine was 106 ml. Mean postoperative IPSS and QoL scores were 4.2 and 1.5. After the surgery, mean Qmax was 15.5 ml/s and residual urine was 24.1 ml.ConclusionsIn the case of voluminous BPH, laparoscopic retropubic simple prostatectomy is expected to be a useful treatment on the condition that the learning curve can be overcome with clinical experience.

The Surgical Treatment of a Large Prostatic Adenoma: The Laparoscopic Approach—A Systematic Review

“…Figure 1 provides a four-phase diagram on the flow of information through the different phases of this systematic review, which followed the PRISMA guidelines. 23 Eleven studies were case-series, [9][10][11][12][13][14][17][18][19][21][22] and three were comparative retrospective nonrandomized studies. 15,16,20 Both transperitoneal and extraperitoneal approaches, as well as transvesical (Freyer) and transcapsular (Millin) routes, with or without finger assistance, have been described.…”

“…Twelve articles described the extraperitoneal approach, 9,10,12,14-22 one described the transperitoneal approach, 11 and one author used both the extra-and transperitoneal approaches. 13 Transverse capsulotomy (Millin) and a pure transvesical (Freyer) approach were performed in nine [10][11][12]16,17,[19][20][21][22] and two studies, 9,13 respectively; two other articles 14,18 described a mixed transvesicalprostatic approach (longitudinal capsulotomy extending from the anterior aspect of the prostate to the anterior part of the bladder wall), while a single study described both the transcapsular and the transvesical-prostatic approaches. 15 Finger assistance was routinely used by McCullough, 16 Chlosta,19 and Hoepffner, 21 as well as when separation of the hyperplastic tissue was difficult.…”

“…Seven studies were excluded from the statistical analysis of heterogeneity; in five of them only the mean (or median) value of Qmax (with range) was reported without any data on standard deviation 9,13,14,17,19 while in two studies no data on Qmax 16,18 were reported at all. Among the evaluated studies, I-square test demonstrated a high heterogeneity (93%) and consequently a high variability in the intervention effects.…”

“…However, OP is also considered the most invasive surgical treatment of BPH and is associated with high morbidity and complication rates. 24 13 24.5 (AUASS) 9.9 (AUASS) (3 months) 7 22.8 (3 months) Ramó n de Fata Chilló n et al (2010) 14 24 (19-33) 5 (0-9) (2 months) 7.6 (5.3-7.9) 18.8 (15.5-34.8) (2 months) Baumert et al (2006) 15 22.4 -6.9 5.7 -3.6 (3 months) 8.1 -2.5 24.6 -12.1 (3 months) McCullough et al (2009) 16 Not reported Not reported Not reported Not reported Yun et al (2010) 17 26.9 4.2 4.5 15.5 Castillo et al (2011) 18 18 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) Not reported 2 (2-5) Not reported Chlosta et al (2011) 19 29.5 -2. 22 18.5 -5.…”

Minimal Invasive Simple Prostatectomy for Treatment Benign Prostate Hyperplasia with Volume Over 80 Ml: The Smart Option for Simultaneous Surgery

“…The benefits are less blood loss, shorter hospital stage, but MISP requires more operation's time [2]. Laparoscopic and extraperitoneal approaches are used, only laparoscopic or robot-assisted with transcapsular, transvesical and transvesical-prostatic access to adenomas [3][4][5][6][7][8]. The authors describe own experience using of MISP for surgical treatment of BPH.…”