Laparoscopic retropubic simple prostatectomy for large benign prostatic hyperplasia: first case report in Thailand

At Rajavithi Hospital, open retropubic simple prostatectomy was started in 1985. The purpose of the present was to describe a surgical technique and early post-operative results of the first successful laparoscopic retropubic simple prostatectomy (LRSP) in Thailand.

A 69-year-old Thai male presented with a chief complaint of refractory urinary retention. Digital rectal examination was performed with prostate gland of 4 finger breadths, firm consistency and smooth surface. The PSA level was 27.16 ng/ml. Transrectal ultrasound volume was 143 gm. The biopsy sample confirmed BPH and chronic prostatitis. The cystoscopy revealed prostate gland enlargement with obstruction. This patient's manifestation required surgical treatment of BPH, and the LRSP technique was chosen. The prostatic capsule was incised by monopolar scissors and the prostatic adenoma was enucleated. The prostatic capsule was closed and a 22 Fr three-way irrigating Foley catheter was inserted. The operative time was 2 hours, with estimated blood loss of 600 ml and no immediate post-operative complications. The prostate specimen weighed 169 gm. The pathologic results confirmed BPH and prostatitis. Postoperative ambulation and catheter removal was on the 2nd and the 7th day, respectively. Postoperative uroflowmetry report showed a Qmax of 15 ml/s.

Operated by an experienced laparoscopic team, laparoscopic retropubic simple prostatectomy for large BPH is a feasible alternative approach to open surgery.