title: 'Minimum-incision' endoscopically assisted transvesical prostatectomy: Surgical technique and early outcomes.
abstract: OBJECTIVE
  To describe the surgical technique and report the early outcomes of a 'minimum-incision' endoscopically assisted transvesical prostatectomy (MEATP) for managing benign prostatic obstruction secondary to a large (>80 g) prostate.
  
  
  METHODS
  In a prospective feasibility trial, 60 men with large benign prostates underwent MEATP. The baseline and postoperative evaluation included the International Prostate Symptom Score (IPSS), a measurement of maximum urinary flow rate (Q max), and the postvoid residual (PVR) urine volume. The adenoma was enucleated digitally through a 3-cm suprapubic skin incision, and haemostasis was completed with endoscopic coagulation of the prostatic fossa. Perioperative complications were recorded and stratified according to the modified Clavien-Dindo score.
  
  
  RESULTS
  The mean (SD, range) prostate weight estimated by ultrasonography was 102.9 (15.4, 80-160) g, the operative duration was 52 (8, 40-65) min, the haemoglobin loss was 2.1 (1, 0.4-5) g/dL, the catheterisation time was 5.2 (1.3, 4-9) days, and the hospital stay was 6.2 (1.4, 5-10) days. There were 21 complications recorded in 16 (27%) patients, and most (86%) were of grades 1 and 2. The most frequent complications were bleeding requiring a blood transfusion (8%), and prolonged drainage (5%). There was a significant improvement at 3 months after surgery in the IPSS (8.6 vs. 21.6, P < 0.001), Q max (19.5 vs. 7.7, P < 0.001), and PVR (15.8 vs. 83.9 mL, P < 0.001).
  
  
  CONCLUSIONS
  MEATP is feasible, safe and effective. Comparative studies and long-term data are required to determine its role in the surgical treatment of large-volume BPH.
authors.affiliation: Benha Faculty of Medicine, Benha, Egypt.
authors.forename: Tarek M
authors.initials: TM
authors.lastname: El-Karamany
authors.affiliation: Benha Faculty of Medicine, Benha, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Al-Adl
authors.affiliation: Benha Faculty of Medicine, Benha, Egypt.
authors.forename: Shabieb A
authors.initials: SA
authors.lastname: Abdel-Baky
authors.affiliation: Benha Faculty of Medicine, Benha, Egypt.
authors.forename: Abdallah F
authors.initials: AF
authors.lastname: Abdel-Azeem
authors.affiliation: Benha Faculty of Medicine, Benha, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Zaazaa
keywords: BPO, benign prostatic obstruction; Benign prostatic hyperplasia; Endoscopy; HoLEP, holmium laser enucleation of the prostate; MEATP, ‘minimum-incision’ endoscopically assisted transvesical prostatectomy; Minimum incision; OP, open prostatectomy; PVR, postvoid residual urine volume; Prostatectomy; Qmax, maximum urinary flow rate; STEP, single-port transvesical enucleation of the prostate; VAPS, visual analogue pain scale