Evaluation of intra-operative trans-urethral endoscopic management of possible open transvesical prostatectomy complications

Abstract

Abstract Objective To evaluate the benefits of using transurethral cystoscope and resectoscope for managing possible complications that may occur during open transvesical prostatectomy operation. Background Open transvesical or retropubic prostatectomy remains, in less technologically developed countries, the standard option for treatment of complicated large benign prostatic hyperplasia. Complications rate with open prostatectomy procedures, especially post-operative bleeding and urinary incontinence, represent a real challenge facing urologists. Hopefully, recent advances in endourology section helped greatly in management of complicated benign prostatic hyperplasia and also offered a tool to deal with possible open prostatectomy complications. Patients and methods In a prospective study, fifty (50) male patients with complicated large benign prostatic enlargement associated with large single or multiple bladder stones with stone burden ≥ 3cm3 planned to undergo transvesical prostatectomy divided randomly into two groups. Group (A) included 25 patients who underwent standard T.V.P. and group (B) included 25 patients in whom diagnostic urethro-cystoscopy and a mono-polar resectoscope were used pre- and post-prostatic adenoma enucleation. Patients had follow-up evaluation visits at 1, 3 and 6 months postoperatively to evaluate IPSS, post-void urine estimation, Qmax., and quality of life. Results A total of 50 patients were divided equally into two groups. Group (A) included 25 patients who underwent standard transvesical prostatectomy, while group (B) included 25 patients who underwent initial diagnostic urethro-cystoscopy, then bilateral ureteric catheter insertion, followed by prostatic apical demarcation using a monopolar resectoscope. Finally, transurethral hemostasis of the prostatic bed is done after standard transvesical adenoma enucleation. Mean operative time in group (A): 48.3 ± 12.4 min. while in group (B): 68.9 ± 14.1 min (p < 0.001), Hemoglobin deficit in group (A): 2.8 ± 1.1 g/dl. while in group (B): 1.1 ± 0.39 g/dl. (p < 0.001). Enucleated prostate volume in group (A): 89.2 ± 16.1g, while in group (B): 91.2 ± 17.2g (p = 0.673). Post-operative IPSS, Post-void residual urine and Qmax showed insignificant differences between the two groups. Conclusion Trans-urethral endoscopically assisted transvesical prostatectomy provides more safety and fewer morbidities and complications rate compared to standard T.V.P.