[Monoplane versu biplane holmium laser enucleation of the prostate for the treatment of large-volume benign prostatic hyperplasia].

OBJECTIVE: To compare the clinical effect and safety of monoplane holmium laser enucleation of the prostate (MP-HoLEP) from those of biplane HoLEP (BP-HoLEP) in the treatment of large-volume BPH. METHODS: We retrospectively analyzed the clinical data on 67 cases of large-volume BPH treated in Jintan People's Hospital from June 2017 to December 2018, 30 by MP-HoLEP with incisions at 5- and 7-o'clock positions beside the verumontanum and the other 37 by BP-HoLEP with incision at 12 o'clock in the bladder neck to expose the surgical capsule layer. We compared the perioperative, postoperative and follow-up data between the two groups of patients. RESULTS: There were no statistically significant differences between the two groups of patients in the age, disease course, prostate volume or preoperative post-void residual urine volume (PVR), maximum urine flow rate (Qmax), IPSS, PSA level and quality of life score (QOL). Compared with the patients in the MP-HoLEP group, those treated by BP-HoLEP showed a significantly shorter operation time (ï¼»97.65 ± 34.72ï¼½ vs ï¼»125.46 ± 47.58ï¼½ min, P < 0.01) and tissue-enucleation time (ï¼»60.34 ± 23.45ï¼½ vs ï¼»97.43 ± 35.51ï¼½ min, P < 0.01) and lower intraoperative level of hemoglobin (ï¼»14.58 ± 1.11ï¼½ vs ï¼»21.44 ± 1.28ï¼½ g, P < 0.01). Statistically significant differences were not observed in the intraoperative adverse events, volume of the resected tissue, time of bladder irrigation or length of postoperative hospital stay, nor in the incidence of transient urinary incontinence (33% vs36.8%, P > 0.05). PVR, Qmax, IPSS and QOL were improved similarly in both of the groups at 6 months postoperatively. CONCLUSIONS: Both MP-HoLEP and BP-HoLEP are definitely effective for the treated of large-volume BPH, but the latter is superior to the former for shorter operation and enucleation time and less bleeding.

Trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy: A case series.

Objective: To detail a novel technique of robotic-assisted simple prostatectomy that makes handling the gland protruding into the bladder neck easier and can preserve the urethra and retain ejaculation function as much as possible. Patients and methods: This is a prospective case series. Clinical data of 17 male patients who had large volume (>80 mL) benign prostatic hyperplasia (BPH) were enrolled to undergo trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy (usRASP). We adopted the approach through the space between the bladder neck and seminal vesicle to perform a usRASP that can avoid the detrusor skirt and fibrous matrix area of the retropubic prostate. Between the transitional zone and the peripheral zone of the large prostate, the hyperplastic prostatic gland tissue can be enucleated under direct vision while preserving the prostatic urethra and retaining the ejaculatory duct and bladder neck intact. All preoperative, perioperative and postoperative clinical data were collected, and descriptive analysis was performed. Results: The median intravesical prostatic protrusion was 19.3 mm (8.5-32.2). The median operative time was 100 min (75-140), and the median estimated blood loss was 100 mL (10-500). The median time to catheter removal was 7 days (5-7), with a median postoperative hospital stay of 2 days (2-4). After at least 6-month follow-up, the median maximum urine flow rate and postvoid residual volume were 40.1 mL/s (12.7-52.4) and 15 mL (5-23), respectively; the median International Prostate Symptom Score and Quality of Life score were 0 (0-6.3) and 1 (0-3), respectively; and the median total prostate-specific antigen was 0.84 ng/mL (0.15-1.01). All patients successfully underwent usRASP. Fifty-eight percent of patients with normal ejaculation function before surgery can still retain normal ejaculation function. Conclusion: We described a new approach to performing usRASP. This new method remarkably improved the voiding function, maintained antegrade ejaculation and did not increase the post-operative complications.