[The role of extraperitoneoscopic adenomectomy in the management of benign prostatic hyperplasia greater than 80 cm3].

INTRODUCTION: The current standard of surgery for benign prostatic hyperplasia (BPH) greater than 80 cm3 includes open adenomectomy and holmium enucleation. Transurethral resection and laser vaporization are second line interventions, while the role of laparoscopic extraperitoneal adenomectomy is not fully understood.

AIM: To evaluate the role of laparoscopic technique as a surgical modality for BPH greater than 80 cm3.

MATERIALS AND METHODS: This study retrospectively evaluated the results of 79 patients (mean age 68 years) who underwent transcapsular extraperitoneoscopic adenomectomy from 2011 to 2016.

RESULTS: The mean operative time was 206 (100-450) min; the prostate volume was 134 (80-300) cm3, blood loss was 256 (30-1200) ml. The I-PSS score after surgery decreased by an average of 18.3 points, the maximum urinary flow rate increased by 12 ml/s, the residual urine volume reduced from 147 to 28 ml. 35 (44%) patients underwent simultaneous operations (inguinal hernioplasty, cystolithotomy, etc.). There was one intraoperative complication, and 10 (12.6%) patients had postoperative complications. There were no conversions to open surgery. Incidental prostate cancer was detected in one patient. None of the patients required repeat surgery for infravesical obstruction.

CONCLUSION: Extraperitoneoscopic adenomectomy is efficient, safe and reproducible surgical modality able to take the place of open surgery. There is a need for an evidence base to support the optimal choice between various minimally invasive techniques. Currently, laparoscopic procedure is more justified in patients with concomitant diseases, which can be simultaneously corrected.