Korean J Urol.  2010 May;51(5):323-329.

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

• Yun HK
• Kwon JB
• Cho SR
• Kim JS

Abstract

PURPOSE
Laparoscopic 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 METHODS: The 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. RESULTS: The 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. CONCLUSIONS: In 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.

Keyword

Laparoscopy; Prostate; Prostatectomy; Prostatic hyperplasia

MeSH Terms

Adenoma
Conversion to Open Surgery
Follow-Up Studies
Humans
Laparoscopy
Learning Curve
Medical Records
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Hyperplasia
Quality of Life
Retrospective Studies
Urinary Retention
Prostate-Specific Antigen

Figure

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  FIG. 1 Port placement for extraperitoneal laparoscopic prostatectomy. ○: 10 mm port, □: 5 mm port.

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  FIG. 2 Transverse incision of the anterior prostatic capsule.

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  FIG. 3 Enucleation of the adenoma by laparoscopic dissection.

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  FIG. 4 After removal of the adenoma, the prostatic fossa is exposed.

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  FIG. 5 Operative time and estimated blood loss for each patient. (A) Operative time (Spearman's rho correlation coefficient=-0.955, p<0.001), (B) Estimated blood loss (Spearman's rho correlation coefficient=-0.786, p=0.004).

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