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.
Patients and 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 (Qmax), 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), Qmax (19.5 vs. 7.7, P < 0.001), and PVR (15.8 vs. 83.9 mL, P < 0.001).
Conclusion: MEATP is feasible, safe and effective. Comparative studies and longterm
data are required to determine its role in the surgical treatment of large-volume
BPH.
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