Background
Simple prostatectomy has been established as a management option for lower urinary
tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with glands larger
than 80 cc.
1
Robotic-assisted simple prostatectomy (RASP) has been established as a safe and effective
management option. This has been reported in multiple studies comparing it with the
open approach where no statistically significant differences in complication rates
have been found.
2
The intrafascial approach is intended to add multiple benefits, such as not requiring
continuous bladder irrigation and resection of a larger percentage of the adenoma,
potentially leading to a lower reoperation rate and diagnosis of prostate cancer in
patients in which this was missed preoperatively.
3
Objective
To present the resection of a very large prostate can lead to significant intraoperative
challenges. Therefore, we demosntrate our intrafascial robotic management of a 470g
prostate.
Materials and Methods
A 56-year-old with LUTS (IPSS: 34) for over 6 years, complicated with multiple episodes
of urinary retention. PSA: 20.6 ng/mL. MRI reported a 463 cc prostate volume without
focal lesions. First, the retropubic space was developed. Cystotomy was performed
at the anterior bladder neck. A plane between the prostatic capsule and the surrounding
fascia was dissected while carefully preserving the neurovascular bundles. Due to
its large size, the prostate was divided into segments to facilitate its extraction.
Hemostatic control and vesicourethral anastomosis were performed.
Results
Discharged on postoperative day 1 with a Jackson-Pratt drain and Foley catheter removed
on days 6 and 9, respectively. Pathology was negative for malignancy. Patient-reported
improvement of LUTS (IPSS: 3) and preservation of erectile function (SHIM: 23) at
the 3-month follow-up.
Conclusion
The intrafascial technique can be useful in cases where a large-sized prostate hinders
a transvesical approach. Additionally, it allows for an easier piecemeal of the gland.
A larger series is needed to determine its potential benefits.
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References
- Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part I–initial work-up and medical management.The Journal of urology. 2021; 206: 806-817
- Robot-assisted versus open simple prostatectomy for benign prostatic hyperplasia in large glands: a propensity score–matched comparison of perioperative and short-term outcomes.J Endourol. 2017; 31: 1164-1169
- Robot-assisted intrafascial simple prostatectomy: novel technique.J Endourol. 2013; 27: 328-332
Article info
Publication history
Published online: March 23, 2023
Accepted:
February 28,
2023
Received:
January 20,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of Interest: None.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
