[Retropublic extraperitoneal laparoscopic prostatectomy with urethra preservation]

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Benign prostatic hyperplasia (BPH) is a common condition in aging men.
• Large prostates present surgical challenges.
• Preserving prostatic urethra is crucial for sexual function.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of retropubic extraperitoneal laparoscopic simple prostatectomy with prostatic urethra preservation for large BPH.
• To assess perioperative outcomes and functional results.

Main Methods:

• Retropubic extraperitoneal laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 45 patients with symptomatic BPH (mean age 70.5 years, mean gland weight 126.1g).
• The technique involved creating an extraperitoneal space, using five trocars, making a transverse capsular incision, developing a subcapsular plane, removing the adenoma while preserving the urethra, and suturing the capsule.
• Demographic, perioperative, and outcome data were collected.

Main Results:

• No conversion to open surgery was required.
• Mean operative time was 123.9 minutes, with estimated blood loss of 230.6 mL; no transfusions were needed.
• Significant improvements in maximum flow rate, IPSS, and QOL were observed three months post-surgery. Erectile function and antegrade ejaculation were preserved; no urinary incontinence was reported.

Conclusions:

• Laparoscopic simple prostatectomy with prostatic urethra preservation is a feasible and reproducible option for large BPH.
• The procedure avoids postoperative bladder irrigation and preserves antegrade ejaculation.
• Patients experience shorter hospital stays and a quicker return to normal activities.