Transurethral detachment prostatectomy using a tissue morcellator for large benign prostatic hyperplasia.

OBJECTIVE: Transurethral enucleation of the prostate (TUE) is designed for complete removal of the prostate lobes. On the basis of TUE and holmium laser enucleation of the prostate, we developed a new technique of transurethral detachment prostatectomy (TUDP) using a tissue morcellator. MATERIALS AND METHODS: In TUDP, enucleation is performed with a prostate-detaching blade and the tip of a resectoscope, followed by removal of the tissue with a morcellator. This study reports our experience with TUDP in which the weight of retrieved tissue was greater than 30 g in 76 patients with benign prostate hyperplasia. RESULTS: The mean preoperative total prostate and adenoma volumes were 70.7 and 47.4 mL, respectively. The mean times required for enucleation, morcellation, and total operation time were 28.5, 14.4, and 66.3 minutes, respectively. The mean weight of removed prostate tissue was 61.1 g. The mean decreases in the levels hemoglobin and serum sodium were 1.73 mg/dL and 2.41 mEq/dL, respectively. The mean preoperative maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), and quality of life score (QOL) improved from 9.8 mL/sec, 20.2, and 4.9, to 22.3 mL/sec, 3.1 and 1.2, respectively. Complications included mild morcellator-induced mucosal injury in 2 patients (2.6%), nausea in 4 patients (5.2%), transient urinary retention in 2 patients (2.6%), transient urge incontinence in 5 patients (6.4%), and urethral stricture in 2 patients (2.6%). The mean prostate volume and serum prostate-specific antigen level measured 6 months postoperatively in 46 patients were 10.68 mL and 0.89 ng/mL, respectively. CONCLUSIONS: TUDP is effective for complete removal of large prostate lobes in patients with large benign prostate hyperplasia and is associated with lower perioperative morbidity.

Trial of complete detachment of the whole prostate lobes in benign prostate hyperplasia by transurethral enucleation of the prostate.

INTRODUCTION: We tried a complete detachment of the whole prostate lobes for benign prostate hyperplasia (BPH) by transurethral enucleation of the prostate (TUE). The feasibility of a new modified TUE technique (transurethral detaching prostatectomy = TUDP) was assessed by retrospective analysis. MATERIALS AND METHODS: For 46 BPH cases the whole prostate lobes were detached from the surgical capsule completely by a prostate-detaching blade and resectoscope beak, and dropped into the bladder. The detached prostate lobes were removed by a soft tissue morcellator. The preoperative total prostate and adenoma volume by transabdominal ultrasound measurement (TAUS) were 47.75 +/- 25.63 and 27.8 +/- 17.33 ml. RESULTS: In all 46 BPH cases, the whole prostate lobes could be detached completely without a perforation. Transurethral resection (TUR) syndrome and blood transfusion were not seen. Operation time was 54.28 min. The mean of removed tissue weight, that of hemoglobin loss and that of decrease of serum sodium was 37.11 g, 1.65 mg/dl and 1.56 mEq/l, respectively. Postoperative prostate volume and PSA were decreased to 9.56 ml and 0.8 ng/ml with complete removal of an adenoma. CONCLUSIONS: TUDP could achieve complete removal of even a large adenoma without perforation, transurethral resection syndromes and blood transfusion safety.

Is complete resection of hypertrophic adenoma of the prostate possible with TURP?

Whether complete resection was possible with TURP was explained. A lot of adenoma remains after transurethral resection of the prostate (TURP), the other hand transurethral enucleation of the prostate (TUE) is useful for complete resection of an adenoma.

Measurement of residual adenoma after transurethral resection of the prostate by transurethral enucleation technique.

OBJECTIVE: Transurethral resection of the prostate (TURP) leaves a lot of residual adenoma and has a high recurrence rate, but the residual adenoma weight has not been measured surgically. Using surgery we tried to measure the residual adenoma after TURP. MATERIAL AND METHODS: Total adenoma resection was performed via standard TURP in 64 cases with benign prostatic hyperplasia and the weight of the residual adenoma was measured by transurethral enucleation (TUE) of the prostate. RESULTS: Prostate volume averaged 37.4 ml and adenoma volume averaged 20.6 ml by TRUS. The average weight of the prostate removed by TURP was 9.8 g. After TURP residual adenoma was confirmed in all cases by TUE, and the average weight of the residual adenoma was 10.2 g. The total average prostate volume removed by TURP and TUE was 20.1 g. The average residual rate of the adenoma removed by TURP was 54.5%. CONCLUSION: TURP leaves about half of the adenoma. Therefore, TURP might be very difficult for complete resection of an adenoma.

Radical perineal prostatectomy: development of a new surgical technique that divides the dorsal vein complex.

UNLABELLED: Standard radical perineal prostatectomy (RPP) was observed by laparoscope through a small suprapubic incision. To increase radicalness, we designed and investigated a new technique of RPP that decreased bleeding and shortened the operation time. SUBJECTS AND METHODS: Standard RPP was observed by laparoscope through a small suprapubic incision after lymph node dissection in 1 case. In 17 patients with localized prostatic cancer, the dorsal vein complex including the puboprostatic ligament was ligated and divided. The modified RPP was then performed, in which the prostate covered with the prostatic fascia in the anterior region was transected at the bladder neck. RESULTS: The results of the laparoscopic observation in standard RPP confirmed that the prostatic fascia in the prostatic anterior region had been left and the endopelvic fascia could be broken easily and safely by a clamp or finger from the perineum. With modified RPP the dorsal vein complex was easily ligated and divided without bleeding. The prostate could be transected at the bladder neck with the prostatic fascia attached to the anterior prostate as in RRP. The operation time was 140-190 min (mean 160 +/- 20.1) and the volume of bleeding was 150-512 ml (mean 224 +/- 60.4). CONCLUSION: This modified technique of RPP that transects the dorsal vein complex may replace the current technique of RPP.

Prostate-specific antigen levels and density in the internal and external glands of the prostate in benign prostatic hyperplasia patients with normal or gray-zone PSA levels.

OBJECTIVE: In patients with benign prostatic hyperplasia (BPH) showing normal prostate-specific antigen (PSA) levels (normal PSA group) and those with BPH showing gray-zone PSA levels (gray-zone PSA group), we assessed PSA levels secreted from the internal and external glands. MATERIALS AND METHODS: We performed transurethral enucleation of the prostate (TUE) in 102 BPH patients with normal PSA and 59 BPH patients with gray-zone PSA at our department from 1999 to 2001. Preoperatively and approximately 6 months postoperatively, we measured serum PSA levels and determined prostatic volumes via transrectal ultrasonography (TRUS) to calculate PSA levels secreted from the internal and external glands as well as various PSA density (PSAD) values. RESULTS: The total PSA level was 1.8 and 6.1 ng/ml in the normal and gray-zone PSA groups, respectively. The PSA level of the external gland was 0.6 and 0.8 ng/ml and the PSAD of the external gland was 0.07 and 0.08 ng/ml/cm(3) in the normal and gray-zone PSA groups, respectively. The internal gland PSA was 1.3 and 5.4 ng/ml and the internal gland PSAD value was 0.11 and 0.30 ng/ml/cm(3) in the normal and gray-zone PSA groups, respectively. CONCLUSIONS: Our results demonstrated that increased PSA levels in BPH cases with gray-zone PSA were attributable to increased PSA secreted from the internal gland rather than from the external gland. In our opinion, the determination of PSA and PSAD of the internal and external gland may be clinically significant in the future.

Clinical comparative evaluation of radical retropubic and perineal prostatectomy approaches for prostate cancer.

We compared the outcomes, advantages, and disadvantages of retropubic and perineal approaches to radical prostatectomy for prostate cancer. From 1990 to 2000, 37 patients (average age: 66.6 years) who underwent radical retropubic prostatectomy (RRP) and 30 patients (average age: 70.1 years) who underwent radical perineal prostatectomy (RPP) were identified from the database of our department. Outcome measures included operative duration, estimated blood loss, blood transfusions, positive margins, complications, and incontinence rates. There were no differences between the RRP and RPP groups in complications, incontinence rates, or positive margins. The mean operative duration was 228 min in the RRP group and 198 mm in the RPP group (p < 0.05). The mean estimated blood loss was 1,060 ml in the RRP group and 717 ml in the RPP group (p < 0.01). The mean volume of blood transfusions was 620 ml in 17 patients in the RPP group and 700 ml in one patient in the RPP group (p < 0.001). In conclusion, the clinical results of RRP and RPP groups were similar; the advantages of the perineal approach were shorter operative duration, smaller estimated blood loss and less blood transfusion.