The following modalities were discussed;
- TURP: Dr. Anne Pelletier Cameron debated using bipolar TURP, specially bipolar vaporization. She cited a comparative study of of bipolar vaporization, HoLEP and open simple prostatectomy for large prostate. While less tissue is resected, it showed good safety and good outcome.
- HoLEP: Dr. Mitchell R. Humphreys argued for HoLEP as his choice. He mentioned that AUA guidelines, 2010, reviewed 2014 stated that emergent evidence suggests role of transurethral laser vaporization as options for men with large prostate (>100 g). EUA guidelines 2015 recommended open prostatectomy and holmium laser enucleation are the first choice for men with prostates >80 g and with moderate to severe symptoms. The Mayo experience in 63 patients with prostates >200 g showed enucleation tie of 80 minutes and morcellation of 53 minutes with average estimated blood loss of 121 ml.
- Simple Open Suprapubic Prostatectomy (OP): Dr. Gregory T. Bales argued that OP is still on AUA guidelines for first choice in large prostates, but recognized the morbidity associated with it and increased length of stay in the hospital. Other advantages are: treating concomitant pathology like large stone burden, bladder diverticulum and hernia. Also suitable for patients with ankylosed hip disease. He stated it is effective and fun. He recommended using a combined retro/supra pubic technique by extending the incision into the anterior capsule of the prostate. He emphasized the importance of placating bladder neck to the prostatic capsule.
- Simple Robotic Retropubic Prostatectomy: Dr. Jaspreet S. Sandhu argued that the steps are straight forward and has excellent outcomes. More important that young urologists are already trained in robotic surgery and should not have a steep learning curve and can be opportunity to expand the robotic skills.
Presented by: John C. Hairston, MD
HoLEP - Mitchell R. Humphreys, MD, Mayo Clinic, Arizona
TURP: Anne Pelletier Cameron, MD, FPMRS, University of Michigan, Ann Arbor
Simple Open Suprapubic Prostatectomy: Gregory T. Bales, MD
Simple Robotic Retropubic Prostatectomy: Jaspreet S. Sandhu, MD, Memoriial Sloan Kettering
Written by: Gamal Ghoniem, MD, FACS, FPMRS, Professor and Vice Chair of Urology, University of California, Irvine, California at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas