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. 2024 Apr 30;24(1):99.
doi: 10.1186/s12894-024-01487-8.

Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery

Changhao Hou #  1   2 , Zhiqiang Luo #  1   2 , Nailong Cao  1   2 , Xiaoyong Hu  1   2 , Lujie Song  1   2 , Qiang Fu  1   2 , Jiong Zhang  3   4 , Jianwen Huang  5   6
Affiliations

Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery

Changhao Hou et al. BMC Urol. .

Abstract

Objective: To evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery.

Methods: We retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months.

Results: All patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100-145). Median estimated blood loss was 224 ml (IQR: 190-255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up.

Conclusions: US-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.

Keywords: Begin prostatic hyperplasia; Laparoscopy Prostatectomy; Urethral stricture.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flexible cystoscopy. Flexible cystoscopy revealed asymptomatic anterior urethral stricture (A) and asymptomatic posterior urethral stricture (B), respectively (16Fr flexible cystoscopy pass freely through the stenoses in all patients) (arrow)
Fig. 2
Fig. 2
Surgical steps of US-LSP. A, The transversal incision near vesicoprostatic junction was performed on the anterior wall of the prostate capsule using the harmonic scalpel; B, Looking for the plane between the prostatic surgical capsule and hyperplastic gland; C, Hyperplastic gland was enucleated to reach the apex along capsule plane; D, Separating the hyperplastic glands from the urethra and try to preserve the integrity of the urethra (arrow denotes urethra); E, Dissociation of hyperplastic glands at prostatic apex; F, Checking the prostatic fossa to confirm that there was no residual prostate gland and hemostasis (arrow denotes urethra); G, The prostatic capsule was reconstructed with running 2 –0 V-lock suture; H, General view of enucleated glands
Fig. 3
Fig. 3
A and B, Postoperative flexible cystoscopy revealed that bladder neck and urethra were unobstructed, and the mucosa at bladder neck and prostatic urethra was intact; C, Preoperative mp-MRI showed a large and obstructive prostatic adenoma; D, postoperative mp-MRI revealed that the grands were completely removed and urethras were unobstructed and intact
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References

    1. Mishra K, Baeza C, Bukavina L, Gómez RG. Modified transurethral resection of the prostate for the management of BPH-related refractory lower urinary tract symptoms in patients with a history of pelvic fracture urethral injury reconstruction. Int Urol Nephrol. 2019;51(12):2137–41. doi: 10.1007/s11255-019-02276-1. - DOI - PubMed
    1. Lumen N, Campos-Juanatey F, Dimitropoulos K, Greenwell T, Martins FE, Osman N et al. EAU Guidelines on Urethral Strictures. 2023. https://uroweb.org/guidelines/urethral-strictures.
    1. Kim JH, Park JY, Shim JS, Lee JG, Moon du G, Yoo JW, et al. Comparison of outpatient versus inpatient transurethral prostate resection for benign prostatic hyperplasia: comparative, prospective bi-centre study. Can Urol Assoc J. 2014;8(1–2):E30–5. - PMC - PubMed
    1. Gunseren KO, Akdemir S, Çiçek MC, Yıldız A, Arslan M, Yavaşcaoğlu İ, et al. Holmium Laser Enucleation, laparoscopic simple prostatectomy, or open prostatectomy: the role of the prostate volume in terms of Operation Time. Urol Int. 2021;105(3–4):285–90. doi: 10.1159/000511637. - DOI - PubMed
    1. Zell MA, Abdul-Muhsin H, Navaratnam A, Cumsky J, Girardo M, Cornella J, et al. Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc) World J Urol. 2021;39(1):129–34. doi: 10.1007/s00345-020-03156-5. - DOI - PubMed