Lin YH, Chang SY, Tsao SH, Hou CP, Chen CL, Lin WC, Tsui KH, Juang HH. Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach.
World J Urol 2023;
41:2127-2132. [PMID:
36585497 DOI:
10.1007/s00345-022-04270-2]
[Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND
Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention.
OBJECTIVE
To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO.
DESIGN, SETTING, AND PARTICIPANTS
The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed.
SURGICAL PROCEDURE
AFS-preserved EEP starts at the 12 o'clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved.
MEASUREMENTS
Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed.
RESULTS AND LIMITATIONS
The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches.
CONCLUSIONS
The preserved AFS provides a nice landmark at the 12 o'clock position during EEP.
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