Extraperiotneal laparoscopic prostatectomy for very large prostates (>150grams) suitable for endoscopic laser or non-laser management: Early outcomes

Abstract

Background: Management of very large benign enlarged prostate not suitable for endoscopic
management is a challenge. Open surgical removal of adenoma has been offered in the past, the current series is an extraperitoneal laparoscopic removal of large adenomas with good results
Patients and Methods: 28 consecutive patients diagnosed with bladder outflow obstruction (with pr without resistant urinary retention) between January 2012 and December 2014 underwent extraperitoneal laparoscopic removal of adenomatous portion of gland. All men were assessed by team of urologists with access to Holmium: YAG laser and deemed to be unsuitable (glad size more than 150 grams). Patients were followed up using uroflowmetry, bladder scans for residual urine and IPSS. Re-admission and postoperative complications were noted.
Results: Mean age of population was 74 (±10.3) with more than 90% (25/28) were in urinary retention with trial without catheters for at least on two occasions. There were no intraoperative complications. Twenty of these men (70%) did not require any postoperative irrigations. Hospital stay ranged between 1-6 days (mean 36 hours). Two patients required postoperative conservative treatment for urinary tract infection. One patient developed meatal stenosis requiring dilataion and one man had stress urinary leakage for 6 months. Men with symptoms showed a significant improvement in flow rate and IPSS including quality of life and those with urinary retention had successful voiding without catheters (flow more than 15ml/sec; residual urine less than 50ml).
Conclusions: Extraperitoneal laparoscopic prostatectomy is a safe and alternate option for men with very large (more than 150 grams) and urinary retention not suitable for endoscopic management with or without laser.