Bipolar transurethral enucleation of the prostate combined with open cystolithotomy in the treatment of large and giant prostate with bladder stones: Case series.

Abstract

The surgical management of large or giant prostate still has challenges to urologists, especially if combined with bladder stones, and the traditional techniques by open prostatectomy and cystolithotomy have significant morbidity rates. The endoscopic procedure might not be feasible to treat both conditions in a single procedure, despite advances in surgical techniques and instrumentation, we present a one-session procedure by a combined endoscopic and open approach for treating benign prostatic hyperplasia (BPH) larger than 100\u2009g combined with bladder stones in the elderly patient with other comorbidities. Between May 2017 and January 2020, bipolar transurethral plasma kinetic enucleation of the prostate (TUEP) followed by open cystolithotomy was performed to six patients at our institution, three of them combined with a big bladder stone(s). All the patients have other chronic chest and heart diseases; we retrospectively collected the data. All the patients diagnosed as BPH of big size or giant prostate over 100\u2009g, with bladder stone, and all the patients treated with the same procedure. We founded that the combination methods showed a significant effect in terms of surgery time, patient outcomes and recovery, hospital discharge. The mean age of patients was 78.16\u2009±\u20094.2 (73-84) years, and the mean prostate-specific antigen (PSA) value was 16.27\u2009±\u200910.01 (8.32-32.17) ng/mL. The mean size of the prostate measured by MRI/US was 266.16\u2009±\u200989.1 (169-405) mL. The mean total operation time was 70.5\u2009±\u200910.9 (60-90) min, while the mean enucleation time was 28.38\u2009±\u20096.61 (23-40) min. The mean intraoperative blood loss was 193.33\u2009±\u200919.66 (170-220) mL. The mean resected prostate weight was 217.166\u2009±\u200994.67 (117-365) g. The mean post-operative hospital stay was 2.6\u2009±\u20090.81 (2-4) days. One patient was readmitted 2\u2009months later due to urinary tract infection, and one patient complains of urine incontinence who spontaneously subsided in 4\u2009months after surgery, other that no severe postoperative complications observed, a significant reduction of serum PSA and IPSS recorded at 3\u2009months, postoperatively. Although simple open prostatectomy remains the reference standard for the treatment. Of excessively large or giant prostatic hyperplasia, the combination procedure not only facilitates the management of selected cases of hyperplasia but further imparts significant benefits to patients and surgeons alike. This treatment plan is safe, time-consuming, and could revolutionize future treatment approaches to giant prostate.