Endoscopic Transvesical Adenomectomy of the Prostate, a New Minimal Invasive Approach for Large Benign Prostate Hyperplasia. A Description of the Technique and the Results of the First 40 Patients

Objective: The objective of this study is to present the results in the first 40 patients treated with a new minimal invasive technique in the treatment of large-volume benign prostate hyperplasia: the endoscopic transvesical adenomectomy of the prostate (ETAP).

Patients and methods: From 2014 to 2016 we performed the ETAP in 40 patients with large volume benign prostate hyperplasia (>80 cc). The mean volume on ultrasound was 117 cc. The mean baseline Qmax was 8.1 ml/s and the International Prostate Symptom Score was 20.5. Seventeen patients (43%) had a urinary retention preoperatively. A cystotomy through a small infraumbilical incision was performed and a camera port was placed through the bladder dome. A pneumovesicum was created and 2 instrument ports were placed into the bladder. The prostate was transected and removed in 1 piece through the umbilical incision.

Results: The operation was completed in all 40 patients, without need for conversion. The mean operation time was 102 minutes with a mean blood loss of 185 ml. The average hospital stay was 5 days. There were no grade V complications and 1 grade IV complication. The transfusion rate was 2.5%. After the procedure, all 40 patients were able to void spontaneous. The Qmax increased to 21.2 ml/s (+13.1 ml/s) and the International Prostate Symptom Score decreased to 7.5 (-13 pts).

Conclusion: This study shows that the ETAP is a feasible, safe, and truly minimal invasive procedure. The functional outcomes are promising as well. We believe the ETAP is good alternative to open surgery.