STEP: A Novel Way to Treat Large Volume BPH
We recently reported our initial experience with single-port transvesical enucleation of the prostate (STEP) performed through a solitary suprapubic incision via a single-access port inserted directly into the bladder in three patients with symptomatic BPH.
Our novel technique may provide an efficient and safe method for removing the entire prostate adenoma in patients with large-volume BPH where transurethral procedures may be less effective and more time-consuming.
Laparoscopic and robotic simple prostatectomy have been reported with encouraging results as an alternative to open simple prostatectomy in select patients with lower urinary tract symptoms due to large-volume prostatomegaly.
More recently, the introduction of novel single-port devices has enabled performance of many laparoscopic ablative and reconstructive procedures in a virtually scarless fashion through a solitary intraumbilical incision. We feel that our novel approach, using a solitary suprapubic incision, is likely to result in less blood loss and allow quicker recovery compared with open simple prostatectomy.
STEP was performed in three patients with large-volume (187 g, 93 g, 92 g) BPH. A novel single-port device (r-Port, Advanced Surgical Concepts) was introduced percutaneously into the bladder through a 2.5-cm skin, fascial, and bladder incision under cystoscopic guidance.
After establishing pneumovesicum, the adenoma was enucleated in its entirety transvesically under laparoscopic visualization using standard and articulating laparoscopic instrumentation. The adenoma was extracted through the solitary skin and bladder incision after bivalving the prostate lobes within the bladder.Our technique was technically feasible in all three cases. Operative time was six hours, 1.5 hours, and 2.5 hours, and blood loss was 900 cc, 250 cc, and 350 cc, respectively. In case No. 1, a patient who had previously undergone open suprapubic surgery, a bowel injury occurred at the time of r-Port insertion; the injury was recognized and repaired intraoperatively without sequelae. Urethral Foley catheters were removed on day 4, and all patients were fully continent and voiding spontaneously with minimal post-void residual.
Monish Aron, MD, David Canes, MD, Khaled Fareed, MD, Daniel Shoskes, MD, James Ulchaker, MD, and Inderbir S. Gill, MD, MCh, also contributed to this article.
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