Abstract
Introduction:
Lower urinary tract symptoms (LUTS) are a growing problem in men >50 years old and they are often related to benign prostatic hyperplasia (BPH). Retrograde ejaculation is a major pitfall of BPH surgical treatment. To overcome this pitfall, Madigan described, in 1990, a simple prostatectomy with preservation of prostatic urethra for large benign prostate. With this technique higher rates of postoperative antegrade ejaculation were achieved. Later, laparoscopic and robot-assisted techniques were also developed and published with solid benefits in terms of blood loss, bladder irrigation, bladder catheterization time, hospital stay, and, more relevantly, ejaculatory function. With urethra-sparing technique, postoperative anterograde ejaculation rates were as high as 81%. However, according to data, urethra-sparing simple prostatectomy is only being performed for large size prostates (>80–100 g). There is no record of applying urethra-sparing simple prostatectomy to average size prostate (30–80 g).
Materials and Methods:
We present a laparoscopic urethra-sparing simple prostatectomy performed in a patient with a 50 g prostate (transrectal ultrasound) willing to undergo BPH-related surgery and wishing maintaining anterograde ejaculatory function.
Results:
With the use of this technique on an average size prostate, all the previously named benefits were achieved, namely discharge 2 days after surgery with no bladder catheter and normal anterograde ejaculatory function at follow-up.
Conclusions:
Although currently excluded from the main BPH average size prostate surgical management algorithms, we strongly believe this technique may be a paradigm shift in surgical management of bothering LUTS in patients with prostates 40 to 100 g, wishing to preserve normal ejaculatory function.
Patient Consent:
Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.
There were no conflicts of interest or obligations resulting from this study. There were no commercial associations during the past three years that might create a conflict of interest in connection with the video.
Runtime of video: 4 mins 59 secs
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Hard Boiled by Kevin MacLeod
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