Modified simple prostatectomy: an approach to address large volume BPH and associated prostate cancers

Simple prostatectomy is an option for management of patients with enlarged prostates and obstructive symptoms. However, the guidelines still do not state a gold-standard treatment for men with BPH and some of these patients with BPH are also known to harbor prostate cancer. This issue can be a challenge because, in the traditional simple prostatectomy, the prostate capsule is often left in place, and that is usually the area of the prostate cancers. With the robotic approach, our goal is to analyze the outcomes of modified simple prostatectomy (MSP) by the elimination of the entire prostate tissue. Thirty-four patients underwent MSP for BPH diagnosis. We evaluated the pre- and postoperative clinical characteristics as well as pathological data. MSP was performed using the DaVinci Xi robot; the entire prostate was removed. We performed a full nerve sparing bilaterally with an intrafascial plane dissection, minimal apical dissection, seminal vesicles sparing, and full vesicourethral anastomosis. The pre- and postoperative AUA scores were compared on paired T test. The mean operative time and blood loss were 126 min and 160.5 ml, respectively. The final pathology report described 17 patients (50%) with BPH and 17 (50%) with BPH and prostate adenocarcinoma. After surgery, 97% had an AUA score improvement. Regarding the patients with a prostate cancer diagnosis, 97% had PSA lower than 0.01 ng/ml. Modified simple prostatectomy is an acceptable treatment option for men with BPH. The procedure allows for significant symptom relief and removal of chronic catheters. Our modified approach was able to eliminate the entire prostate, which was significant because 50% of these patients had prostate cancer on the final pathology.