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

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Publicado el: 2010-04-04

GelPoint® la plataforma laparoscópica en un solo puerto

Single-port transvesical enucleation of the prostate: a clinical report of 34 cases  (artículo completo)


Mihir M. Desai, Khaled Fareed, Andre K. Berger, Juan Carlos Astigueta*, Brian H. Irwin, Monish Aron, James Ulchaker and Rene Sotelo*
Department of Urology, Cleveland Clinic, Cleveland, OH, USA, and *Clinica La Floresta, Caracas, Venezuela


Correspondence to Andre Berger, Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089-2211, USA.
e-mail: andrekberger@hotmail.com
KEYWORDS
single port • transvesical • enucleation • BPH • prostate
Study Type – Therapy (case series)
Level of Evidence 4

ABSTRACT
To present our experience with single-port transvesical enucleation of the prostate (STEP) in 34 patients with large-volume benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS
We performed STEP in 34 patients with large volume (>60 g) BPH (mean age 69 years, body mass index 26 kg/m2, 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.

RESULTS
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.

CONCLUSIONS
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.

Accepted for publication 23 July 2009