Objective: To explore the feasibility and superiority of retropubic extraperitoneal laparoscopic simple prostatectomy with prostatic urethra preservation to treat large volume benign prostatic hyperplasia(BPH) .
Methods: From January 2006 to August 2009, laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 45 patients with symptomatic BPH,and the age of patients was 70.5+/-7.2 (range 47 to 83) years old. The transrectal ultrasound (TRUS) revealed BPH and calculated prostatic gland weight was 126.1+/-52.4 (range 62 to 365) g. There were 3 cases presented with bladder calculus and 1 case presented with bladder diverticulum. The technique included retropubic extraperitoneal space produced by balloon dilation, five trocars in a reverted U shape placed,transverse prostatic capsular incision made, subcapsular plane developed, prostatic adenoma removed while prostatic urethra preserved as well as prostatic capsule sutured. Demographic, perioperative and outcome data were recorded.
Results: No patient required conversion to open surgery. The mean operative time was 123.9+/-51.3 (range 37 to 270) minutes and the estimated blood loss was 230.6+/-194.5 (range 50 to 800) mL. Blood transfusion was not necessary in this group of patients. Bladder irrigation was not needed except for the initial 2 cases and the average Foley catheter duration was 7.5+/-3.5 (range 2 to 14) days. Significant improvement was noted in the maximum flow rate, the International Prostate Score Symptoms (IPSS) and the quality of life questionnaires (QOL) three months after surgery. The erectile function was preserved in all patients who were potent before surgery and the ejaculation maintained antegrade. No urinary incontinence was reported by patients.
Conclusion: Laparoscopic simple prostatectomy with prostatic urethra preservation for large benign prostatic hyperplasia is feasible and reproducible. Postoperative bladder irrigation can be avoided and antegrade ejaculation is preserved. The patients have a shorter hospital stay and early return to normal activity.