Novel Surgical Technique for Obstructive Benign Prostatic Hyperplasia: Finger-Assisted, Single-Port Transvesical Enucleation of the Prostate

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Abstract
Purpose: To report our experience with finger-assisted, single-port transvesical enucleation of the prostate (F-STEP) compared with transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. Patients and Methods: From January 2009 to April 2010, perioperative data on the 32 patients in the F-STEP group were collected and compared with the 67 patients in the TURP group. Intravesical prostatic protrusion (IPP) grade 3 was included in the F-STEP group. In the F-STEP group, a homemade, single-port device using an Alexis wound retractor was introduced transvesically through a small incision. After establishing a pneumovesicum, the adenoma was enucleated laparoscopically with finger dissection. A conventional method was performed in the TURP group. Results: There was no significant preoperative difference in age, prostate size, maximum uroflow rate (Qmax), dysuria, international prostate symptom score (IPSS), and quality of life score (QoLs) between the two groups. The postoperative IPSS (4.00 vs 8.77, P = 0.03), Qmax (36.19 vs 22.03 mL/min, P = 0.04), dysuria (visual analogue score 1.73 vs 3.14, P = 0.04), and IPSS recovery period (5.54 vs 10.88 weeks, P = 0.01) were significantly improved in the F-STEP group compared with the TURP group. The mean operative time (109.42 vs 68.03 min, P = 0.02) and catheterization time (5.31 vs 2.09 days, P = 0.03) were significantly longer. Weight of the extracted specimen (48.35 vs 29.85 gm, P = 0.03) were greater in the F-STEP than in the TURP group. In the F-STEP group, no urethral stricture developed. Conclusions: F-STEP is an effective technique modification without urethral complications that is indicated for moderate-to-large prostates with intraveiscal protruding adenoma.

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