[Retropublic extraperitoneal laparoscopic prostatectomy with urethra preservation].
OBJECTIVE
To explore the feasibility and superiority of retropubic extraperitoneal laparoscopic simple prostatectomy with prostatic urethra preservation to treat large volume benign prostatic hyperplasia(BPH) .


METHODS
From January 2006 to August 2009, laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 45 patients with symptomatic BPH,and the age of patients was 70.5+/-7.2 (range 47 to 83) years old. The transrectal ultrasound (TRUS) revealed BPH and calculated prostatic gland weight was 126.1+/-52.4 (range 62 to 365) g. There were 3 cases presented with bladder calculus and 1 case presented with bladder diverticulum. The technique included retropubic extraperitoneal space produced by balloon dilation, five trocars in a reverted U shape placed,transverse prostatic capsular incision made, subcapsular plane developed, prostatic adenoma removed while prostatic urethra preserved as well as prostatic capsule sutured. Demographic, perioperative and outcome data were recorded.


RESULTS
No patient required conversion to open surgery. The mean operative time was 123.9+/-51.3 (range 37 to 270) minutes and the estimated blood loss was 230.6+/-194.5 (range 50 to 800) mL. Blood transfusion was not necessary in this group of patients. Bladder irrigation was not needed except for the initial 2 cases and the average Foley catheter duration was 7.5+/-3.5 (range 2 to 14) days. Significant improvement was noted in the maximum flow rate, the International Prostate Score Symptoms (IPSS) and the quality of life questionnaires (QOL) three months after surgery. The erectile function was preserved in all patients who were potent before surgery and the ejaculation maintained antegrade. No urinary incontinence was reported by patients.


CONCLUSIONS
Laparoscopic simple prostatectomy with prostatic urethra preservation for large benign prostatic hyperplasia is feasible and reproducible. Postoperative bladder irrigation can be avoided and antegrade ejaculation is preserved. The patients have a shorter hospital stay and early return to normal activity.
Yang
Fei-ya
FY
Department of Urology, Beijing Chaoyang Hospital, Capital University of Medical Science, Beijing 100020, China.
Xing
Nian-zeng
NZ
Wang
Jian-wen
JW
Zhang
Jun-hui
JH
Guo
Ying-lu
YL
D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D014521:Urethra / Q000502:physiology