Laparoscopic adenomectomy in BPH – Does it have a role today?

Abstract

Symptomatic benign prostatic hyperplasia (BPH) is managed medically worldwide, but transurethral resection of prostate (TURP) is the gold standard in refractory cases. Holmium laser enucleation of prostate (HoLEP), laser vaporization are other options which are widely practiced. However in larger glands which are more than 80 g, open adenomectomy is still practiced. Laparoscopic adenomectomy is a minimally invasive option in such circumstances. This article explains about different techniques in minimally invasive adenomectomy and the role for this procedure today. Laparoscopic simple prostatectomy (LSP) has a place in symptomatic, larger prostatic adenoma in the hands of experienced laparoscopic surgeons when open simple prostatectomy is needed.

Surgical Treatments of Benign Prostatic Hyperplasia and Prostate Cancer Stereotactic Radiotherapy: Impact on Long-Term Genitourinary Toxicity

“…TURP or adenomectomy through open prostatectomy or the endoscopic transvesical approach for large prostate glands represent the gold standard surgical treatment of BPH refractory to standard medication [5,10]. Urethral strictures (from 2.2 to 9.8%) and bladder neck contracture (from 0.3 to 9.2%) are the most commonly observed late complications occurring after these procedures [11].…”

“…Considering that the average age of prostate cancer patients treated with definitive radiotherapy is about 70 years [1], it is not uncommon to consider patients with a previous history of surgical treatments of benign prostatic hyperplasia (BPH) for lower urinary tract symptoms (LUTS) among the candidates for SBRT treatment. Transurethral resection of the prostate (TURP) or adenomectomy for prostate glands exceeding 80 cm 3 [5] are considered the two standard surgical solutions to treat symptomatic BPH.…”

Extra-peritoneal Laparoscopic Resection of Benign Prostate Adenoma >150 CC with preservation of posterior wall of prostatic urethra: Dundee Technique and early outcomes

“…Although there are other surgical options for treating BPH in very large prostates, in their review Manickam and colleagues conclude that laparoscopic simple prostatectomy still has a role in the hands of an experienced laparoscopic surgeon. 14 With time this approach has evolved to include robotic simple prostatectomy (RSP), first described in 2008 in a series of 7 patients with an average hospital stay of 1.4 days, catheter duration of 7 days, no documented complications, and good functional outcomes. 15 A further series of 10 cases with mean prostate volume of 143.9cm 3 (range 90-250) showed similar results.…”

“…Although there are other surgical options for treating BPH in very large prostates, in their review Manickam and colleagues conclude that laparoscopic simple prostatectomy still has a role in the hands of an experienced laparoscopic surgeon. 14…”

Current consensus and controversies on male LUTS/BPH (part two)

“…With giant-sized prostates, enucleation can still be done with less blood loss. For those centres with expertise in laparoscopic technique, laparoscopic simple prostatectomy may have a place [9] .…”