Suprapubic transvesical adenoma resection of the prostate (STAR-P): step-by-step technique

Surgical management of benign prostatic hyperplasia (BPH) has evolved significantly, incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes. Despite advancements, transurethral approaches continue to pose risks such as urethral strictures and urinary incontinence due to mechanical and thermal stress. To address these limitations, the Suprapubic Transvesical Adenoma Resection of the Prostate (STAR-P) was developed, offering a direct suprapubic route that bypasses the urethra entirely. Recent studies have validated STAR-P as both feasible and safe, emphasizing advantages such as enhanced visualization of the urinary sphincter, minimized urethral trauma, effective hemostasis, and reduced operative stress. The procedure utilizes specially designed instrumentation, including a large-caliber bipolar resectoscope (42 Fr), allowing the efficient removal of substantial adenoma tissue in fewer resection passes compared to traditional methods.

This article provides a comprehensive, step-by-step description of the STAR-P technique. The primary objective is to detail patient selection criteria, preoperative assessments, procedural steps including mini-open suprapubic access, specialized instrumentation usage, resection techniques, and postoperative management protocols. Highlighting technical considerations and procedural innovations aims to inform urologists about the potential benefits of STAR-P, particularly in patients at higher risk for urethral complications or those with large prostate volumes. By documenting the procedural intricacies and outcomes clearly and thoroughly, we seek to encourage informed adoption of STAR-P as an alternative, effective surgical approach for managing benign prostatic hyperplasia, thus contributing to the evolving landscape of minimally invasive urological surgery.