‘Minimum-incision’ endoscopically assisted transvesical prostatectomy: Surgical technique and early outcomes

Peer review under responsibility of Arab Association of Urology.

Figures & data

Figure 1 The skin incision used for access to remove large prostatic adenomas.

Table 1 Variables assessed in 60 patients treated by MEATP.

Variable	Mean (SD, range)
Body mass index (kg/m^2)	28.4 (5.6, 20–39.4)
PSA (ng/mL)	5.8 (3.2, 2.1–13.8)
Creatinine (mg/dL)	1.29 (0.3, 1.01–2.8)
TRUS estimated total prostate weight (g)	102.9 (15.4, 80–160)
Enucleated prostate weight (g)	84.9 (13.2, 64–134)
Operative duration (min)	52.3 (8.3, 40–65)
Haemoglobin loss (g/dL)	2.1 (1, 0.4–5)
Haematocrit deficit (%)	5.9 (3.4, 2–15.9)
VAPS at discharge	1.9 (1.3, 0–5)
Catheterisation time (days)	5.2 (1.3, 4–9)
Hospital stay (days)	6.2 (1.4, 5–10)

Table 2 A comparison of operative variables according to the approach used for endoscopic haemostasis.

Mean (SD, range) variable	Transurethral	Transvesical	P
Patient, n (%)	38 (63)	22 (37)
TRUS-estimated total prostate weight (g)	102.3 (14.4, 80–120)	104.1 (17.3, 80–160)	0.662^a
Open enucleation time (min)	37.1 (6.7, 24–52)	36.3 (8.9, 24–55)	0.673^a
Endoscopic haemostasis time (min)	14.7 (1.9, 12–20)	13.3 (2.6, 10–16)	0.021^a
Preop haemoglobin (g/dL)	12.6 (1.1, 10.5–14.5)	12.9 (0.7, 11.5–14)	0.295^a
Postop haemoglobin (g/dL)	10.5 (1.2, 8–13.6)	10.6 (0.9, 9–12.1)	0.732^a
Haemoglobin loss (g/dL)	2 (1, 0.4–5)	2.2 (1, 0.4–4.5)	0.524^a
Preop haematocrit (%)	41.2 (2.3, 37.5–46.7)	42.5 (3, 37.4–46.5)	0.063^a
Postop haematocrit (%)	35.5 (4, 29.4–42.5)	36.3 (4.7, 28.9–42.5)	0.490^a
Haematocrit deficit (%)	5.8 (2.8, 2–11.1)	6.2 (4.3, 2–15.9)	0.708^a
Suprapubic tubes, n (%)	5 (13)	3 (14)	1^b
Blood transfusions, n (%)	3 (8)	2 (9)	1^b

a Student’s t-test for unpaired data.

b Fisher’s exact test.

Table 3 Perioperative complications categorised according to the modified Clavien–Dindo score.

Grade	Complication (n patients,%)	Management
1	Urinary retention after catheter removal (2, 3)	Bedside catheterisation
	Clot retention (2, 3)	Bladder irrigation, temporary catheter traction
	Transient elevation of serum creatinine (2, 3)	Fluid balance
	Prolonged drainage (3, 5)	Continued catheterisation
	Fever <38.5 °C (2, 3)	Antipyretics
	Catheter malfunction (1, 2)	Bedside catheter change
2	Haemorrhage/haematuria (5, 8)	Blood transfusion
	Fever >38.5 °C/bacteraemia (1, 2)	Parenteral antibiotics
3a	Intraperitoneal extravasation (1, 2)	Percutaneous drainage under local anaesthesia
3b	Haematuria/clot retention (1, 2)	Endoscopic evacuation and coagulation
4a	Myocardial infarction (1, 2)	Managed in the intensive care unit
4b	None
5	None

Table 4 Variables assessed at baseline and 1 and 3 months after MEATP.

Variable	Mean (SD, range)	P^⁎	P^†
IPSS
Baseline	21.6 (7.1, 12–35)
1 month	10.9 (3.6, 7–20)	<0.001
3 months	8.6 (3.3, 5–18)	<0.001	0.001
Qmax (mL/s)
Baseline	7.7 (3.9, 0–12)
1 month	18.6 (2.3, 15–22)	<0.001
3 months	19.5 (1.6, 17–23)	<0.001	0.005
PVR (mL)
Baseline	83.9 (32.2, 50–195)
1 month	22.3 (11.4, 15–85)	<0.001
3 months	15.8 (8.1, 10–40)	<0.001	<0.001

⁎ 1 and 3 months vs. baseline.

† 3 months vs. 1 month.