Endoscopic Extraperitoneal Transvesicocapsular Adenomectomy of Prostate (EETAP): A New Operative Method with an Innovative Learning Protocol for Its Performance

The standard surgical treatment of obstructive symptoms of the lower urinary tract by benign prostatic hyperplasia is transurethral resection or classical simple prostatectomy. Inspired by our experience with laparoscopic radical prostatectomy and for the protection of urethra from stricture during prolonged transurethral resection, we studied the literature and started a prospective study for performing a laparoscopic simple prostatectomy. Following informed patient consent, we performed laparoscopic extraperitoneal simple prostatectomy in 17 patients with moderate to severe obstructive symptoms of benign prostatic hyperplasia with a prostate volume of over 80 ml. We did not find a laparoscopic technique for a simple prostatectomy which is the same as our method that we describe and publish. We called our method endoscopic extraperitoneal transvesicocapsular adenomectomy of prostate. We identified an abbreviation for the method of its popularization and systematic presentation, EETAP. In this chapter, we publish for the first time in the literature a minimally invasive surgical method for endoscopic extraperitoneal transvesicocapsular prostate adenоmectomy. We describe and publish the details of the method, the abbreviation of the method, an innovative learning protocol for its performance, as well as hypotheses for preoperative and intraoperative differential diagnosis. In our opinion, a multicenter study of this method could lead to its standardization in the broad urological practice

Infravesical urinary tract obstruction and transurethral endoscopic approach of treatment

Department of Urology and Surgical Nephrology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackqround: The results of scientifical progress in recent years have contributed to the development of transurethral endoscopic surgery, with the implementation of new methods, less invasive, for the treatment of the lower urinary tract diseases of different genesis. Laser surgery, transurethral electorezection, electrovaporization, bipolar surgery (plasmakinetic rezection and vaporization) and the combination of these methods have a number of avantages over traditional open interventions and contribute to a significant change in the treatment approach of most urological diseases, including those causing infravesical obstruction (IVO). Conclusions: The implementation of personalized medicine with correct selecting and pathogenetic motivation of the methods of treatement in management of the IVO have been made in several directions: prophylactics, diagnosis and treatment. Medical and social importance, variety of clinic manifestations and evolution, evident alternation of quality of life, high cost of diagnostic, conservative management and of surgical treatment determine the statuts of infravesical obstruction as a current problem from scientific and practical point of view and motivates the need of a deep study of disorders manifested through IVO, minimizing complications and the rate of their relapse

Experience with Open Prostatectomy in Lomé, Togo

The average blood loss at surgery was 425.92 ± 38.2 ml with an average operating time of 66.05 ± 15.75 mins and the main complications were hemorrhaging and clot retention in 7 (13%), epididymo-orchitis in 9 (16.7%), and urinary incontinence in 6 (11.1%) patients. IPSS scores were under 7 in 92% of patients three months after surgery and the mortality rate was 3.7%. Conclusion: This study has shown that open prostatectomy in our environment is still the commonest surgical option for benign prostatic hyperplasia with good outcomes though with manageable complications

Revista de Științe ale Sănătății din Moldova = Moldovan Journal of Health Sciences. 2023, Vol. 10(2)

Revista de Științe ale Sănătății din Moldova (Moldovan Journal of Health Sciences) a fost lansată în octombrie 2014. Aceasta este editată în limbile română și engleză, conform standardelor și ghidurilor internaționale actuale în domeniul științelor medicale, și are o apariție trimestrială. Revista este înregistrată în Instrumentul Bibliometric Național IBN/IDSI (nr.1 din 16.11.2015), iar din 21 decembrie 2017, prin Hotărârea Consiliului Suprem pentru Știință și Dezvoltare Tehnologică nr. 169, a fost inclusă în lista revistelor științifice de Tip B. Revista este înregistrată în 2 baze de date internaționale

Contemporary surgical options in large benign prostatic hyperplasia treatment

Abstract Introduction. Specialists are currently interested in the method of choice for surgical treatment in patients with enlarged benign prostate hyperplasia (> 80 cm3 ). The introduction of laser and bipolar technologies for benign prostate hyperplasia surgery has allowed effective treatment regardless of the size of the prostate gland. Material and methods. During 2020-2021, 65 patients underwent surgical treatment for large benign prostate hyperplasia. Depending on the type of surgical treatment performed, 3 study groups were identified: 22 patients underwent transurethral Thulium: YAG laser prostate vapoenucleation; 21 patients underwent transurethral bipolar prostate enucleation; and 21 patients underwent a simple prostatectomy. All patients were examined before and after surgery (at 3 and 6 months) using the International Prostate Symptom Score, Quality of Life Score, prostate-specific antigen assessment, transrectal prostate ultrasound examination, and uroflowmetry to assess residual urine volume. Postoperative complications were recorded in accordance with the 2004 Clavien-Dindo classification. Results. There was a significant difference in the mean operative time ranging from 72±19 min (ThuVEP group) vs. 56±10 min (SP group) and 70±15 min (TUEB group), as well as a decrease in hemoglobin levels, viz. 1.2±0.4 g/dl vs. 2.6±1.1 g/dl vs. 1.6±0.5 g/dl (ThuVEP vs. SP vs. TUEB). The catheterization lasted for 2±1 days (ThuVEP) vs. 10±1 days (SP) vs. 3±1 days (TUEB). A significant improvement in Qmax was registered in the ThuVEP group (122.9%) and in the TUEB group (111.7%). However, patients after a simple prostatectomy showed an increase in Qmax of only 94%. The PVR values were reported to be the same. ThuVEP is an effective surgical technique for large BPH patients. The reduced trauma and lower complication rate of ThuVEP, as well as its effectiveness, have confirmed the need for widespread implementation of minimally invasive laser interventions

Benign prostatic hyperplasia - etiology, clinical features and management. Historical and contemporary aspects

Introduction. Benign prostatic hyperplasia and chronic prostatitis are the most common conditions in men, the frequency of which varies with age. Chronic prostatitis (infectious or inflammatory) has a frequency of 8-35% in patients aged 20-50 years, reaching a maximum of 60-70% in those aged over 50 years. Materials and methods. Materials for the study served the medical literature regarding benign prostatic hyperplasia and chronic inflammation, published in the local and international scientific journals. Scientific databases like Cochrane Library, Medline, Scopus, Medicus, NCBI, PubMed, Google Scholar were used to find the necessary articles. Research methods – analysis, synthesis, systematization, and description. Results. After analyzing the available data, a review of the literature was conducted which highlighted both the strong and weak points of the historical medical approaches to addressing benign prostatic hyperplasia, as well as the ontogenetics and anatomical characteristics of the prostate gland. This included examining the incidence rates, concepts of causation and development, principles of diagnosis and classification of benign prostatic hyperplasia. The review also revealed the pros and cons of using mini-invasive treatment strategies versus traditional transvesical approaches in treating this condition, as well as the ongoing and significant socioeconomic impact in underdeveloped countries. Conclusions. There remains the issue of reducing intra- and post-operative complications after benign prostatic hyperplasia surgery, especially a voluminous one, which imposes itself as a very critical problem in the development of an effective treatment strategy. For the first time, a problem was described by assessing the particularities of some biochemical criteria at local surgical site and in blood serum, histological - at the level of nodular prostatic hyperplasia and at the border of the surgical site. This requires a complex correlational study to assess the biochemical, histological and immunohistochemical parameters, including the evaluation of the associations or coexistence of benign prostatic hyperplasia and chronic prostatitis

Robotic simple prostatectomy vs HOLEP, a 'multi single-center' experiences comparison

Introduction: The aim of this study was to compare peri-operative and mid-term outcomes of patients who underwent robot-assisted simple prostatectomy (RASP) vs holmium laser enucleation of the prostate (HOLEP). RASP and HOLEP are the treatments of choice for men with symptomatic benign prostatic obstruction (BPO) and a prostate ≥80 g, achieving comparable short and mid-term efficacy. No randomized controlled studies have proved the superiority of one technique over the other. Material and methods: The prospectively maintained databases of the participating institutions were queried for patients with a prostate volume (PV) ≥80 g, who underwent surgery for BPO between 2011 and 2021. The study population was divided into two subgroups based on surgical approach. Demographics, baseline characteristics, and 12 months outcomes were compared between groups: χ2 and Student t-tests were used for categorical and continuous variables, respectively. The Trifecta composite outcome (post-operative Q-max >15 ml/sec, International Prostate Symptom Score (IPSS) <8 and absence of complications) was used to define surgical quality and the two groups were compared accordingly. Logistic regression analyses investigated predictors of Trifecta achievement. Results: We included 97 patients with comparable pre-operative features (all p >0.30): 43 underwent RASP, 54 HOLEP. Median PV was 102 g (IQR 89-120) and Q-max was 7.2 ml/s (IQR 5.4-9.0). The Trifecta rate was 43% overall, higher in the RASP subgroup (56% vs 33%; p = 0.02). The endoscopic approach was its only independent predictor (OR 0.5; 95% CI 0.28-0.88; p = 0.016). Conclusions: At univariable regression analysis, surgical approach was the only independent predictor of Trifecta achievement, which was significantly higher in the RASP group compared to HOLEP

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

Estudio comparativo de los resultados de las Técnicas Quirúrgicas de Adenomectomía Prostática Retropubica y Adenomectomía Prostática Transvesical en el servicio de Urología del Hospital Nacional Hipólito Unánue. Enero 2003 - Diciembre 2007

OBJETIVO: Describir y comparar las diferentes complicaciones y los resultados obtenidos entre las técnicas quirúrgicas: Adenomectomía prostática retropúbica y Adenomectomía prostática transvesical en el tratamiento de la hiperplasia prostática benigna en el Hospital Nacional Hipólito Unánue, durante el periodo 2003 - 2007. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo en el Hospital Nacional Hipólito Unánue (HNHU) durante el período 2003 y 2007. Se revisaron 233 historias clínicas de pacientes sometidos a cirugía de próstata que acudieron al Servicio de Urología con sintomatología prostática y que cumplieron con los criterios de inclusión. RESULTADOS : Se encontró que de 233 pacientes sometidos a Adenomectomía abierta la técnica quirúrgica más usada fue la Adenomectomía prostática Retropúbica, utilizada en el 56.7% de los casos, mientras que la Transvesical fue utilizada en 43.3%(Tabla Nº1 Gráfico Nº1.) Las edades de los pacientes intervenidos por la técnica retropúbica estuvieron comprendidas entre los 52 y 84 años con una media de 71.16años y para la técnica transvesical tuvo una media de 70.61 y un rango de 58 a 82 años(Gráfico Nº 2.). La complicación intraoperatoria encontrada en ambas técnicas fue la hemorragia siendo menor en los operados por vía retropúbica con 3.7% de los casos mientras que por la vía transvesical se presentó en un 5.9% de los casos(Tabla Nº 2), el 2,3% de los pacientes operados por vía retropúbica y el 3.9% de los pacientes operados por vía transvesical necesitaron transfusión sanguínea durante el acto operatorio(Gráfico No. 3). Entre las complicaciones post operatorias inmediatas, la más frecuente fue el sangrado presentándose en un 26.6% en pacientes operados por vía retropúbica. mientras que por la vía transvesical se presentó en un 36.7% de los casos (Tabla No 2.). Los pacientes operados por vía retropúbica presentaron menor número de complicaciones mediatas, las más frecuentes fueron ITU 12.8%,incontinencia urinaria 3.7%, epididimítis 3.1%,infección de herida operatoria 1.6%, esclerosis de cuello vesical 2.3% , Mientras que por la vía transvesical las más frecuentes fueron ITU 14.9% ,incontinencia urinaria 5.9%,infección de herida operatoria 4.9%,fístula vesicocutanea 2.9%, esclerosis de cuello vesical con 1.9% , disfunción eréctil, dehiscencia de sutura y epididimítis con 0.9%(Tabla Nº 3). El tiempo operatorio promedio para la técnica retropúbica fue de 81.29 minutos mientras que para la técnica transvesical fue de 85.56 minutos. El tiempo de hospitalización para la técnica retropúbica varió entre 6 a 10 días con un promedio de 8.27 días en comparación con la técnica transvesical que varió entre 7 a 12 días y tuvo un promedio de 9.91 días. Así mismo, hay una menor permanencia de la sonda uretral en la adenomectomía retropúbica, con un promedio de 6.48 días en comparación a la técnica transvesical que es de 7.52 días, el retiro del dren del espacio Retzius vario de 4 a 8 días en pacientes operados por vía retropúbica(Tabla Nº 4). Se encontró que de los pacientes operados por vía retropúbica 113 de ellos (85.6%) tuvieron diagnóstico histopatológico de HBP y 19 pacientes (14.4%) con diagnóstico de HBP asociado a inflamación. Asimismo se encontró que de los pacientes operados por vía transvesical 84 de ellos(83.2%) tuvieron diagnostico histopatológico de HBP y 17 pacientes (16.8%) con diagnóstico de HBP asociado a inflamación (Gráfico No.4 Tabla No.5). El antígeno prostático específico promedio para la adenomectomía retropúbica fue de 2.08 ng/ml con un rango de 0,28 a 3.78 ng/ml y la adenomectomía transvesical tuvo un promedio de PSA de 2.39 ng/ml y un rango de 0.84 a 3.94 ng/ml(Tabla Nº 6). El peso de la próstata en pacientes operados por vía transvesical tuvo un rango de 60 a 112 gr. con un promedio de 81 gr. y en pacientes operados por vía retropúbica un rango de 60 a 120 gr. con un promedio de 82.74 gr.(Gráfico Nº 5) En la serie revisada no se encontró mortalidad. CONCLUSIÓN: 1. La técnica quirúrgica más usada fue la retropúbica utilizada en el 56.7% de los casos mientras que la técnica transvesical fue usada en el 43.3%. 2. La adenomectomía retropúbica presenta menor incidencia de complicaciones intraoperatorias, menor necesidad de transfusión y menor porcentaje de sangrado que la vía transvesical . 3. La técnica retropúbica presenta menor porcentaje de sangrado que la técnica transvesical como complicación inmediata. 4. Con respecto a las complicaciones postoperatorias mediatas la adenomectomía retropúbica presenta menor incidencia, número y porcentaje de complicaciones tardías que la adenomectomía transvesical siendo la más frecuente coincidentemente en ambas técnicas la ITU en un 12.8% para la técnica retropúbica y 14.9% para la técnica transvesical, infección de herida operatoria en un 1.6% y 4.9% respectivamente, incontinencia urinaria 3,7% y 5.9% respectivamente para ambas técnicas asimismo la fístula vesicocutanea como complicación mediata solo se presentó en pacientes operados por vía transvesical.. 5. La técnica retropúbica presenta menor tiempo promedio operatorio y de estancia hospitalaria. 6. Ambas técnicas se utilizan para próstatas de gran tamaño pero el presente estudio demostró que la adenomectomía retropúbica es utilizada en próstatas de mayor peso que la adenomectomía transvesical, asimismo la vía retropúbica se ve favorecida en cuanto a complicaciones tempranas y tardías, días de estancia hospitalaria, y días de permanencia de sonda uretral por lo que su uso esta justificado en próstatas mayores de 60 gramos sin patología asociada.HOSPITAL NACIONAL HIPÓLITO UNÁNUETesi