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Objectives: To assess the efficacy and the simplicity of a modified open transvesical prostatectomy for large prostates (>80 mL)., Methods: A total of 165 patients with benign prostatic hyperplasia were treated with transvesical prostatectomy through a 3-cm incision. Prostate size was 85-144 cm(3) (mean 101 cm(3)). Surgery is performed as the standard transvesical prostatectomy but skin incision is much smaller (approximately 3 cm), whereas muscle incision underneath is about 7 cm long. Prostate adenoma was removed with finger dissection without the placement of hemostatic sutures., Results: Operation time was 15-36 minutes (mean 24 minutes). Catheter was removed on the third day and patients left the hospital after successful voiding. Preoperative hematocrit was 40.6-49.2 (mean 43.4), while postoperative hematocrit was 28.3-42.4 (mean 38.3). Transfusion rate was 0-3 blood units (mean 1 U). Mean preoperative flow was 11.5 cm/s and mean postoperative flow was 22.3 cm/s. Mean IPSS score improve from 28 preoperatively to 15 postoperatively., Conclusions: Open transvesical prostatectomy with a 3-cm incision is a minimally invasive technique for the treatment of large prostates (>80 mL) in which transurethral prostatectomy or laser prostatectomy may not be the first choice., (2010 Elsevier Inc. All rights reserved.)

Objectives: To provide information about the long-term efficacy of transvesical prostatectomy from a contemporary series of patients. When comparing minimally invasive procedures with open prostatectomy, the data for the latter are usually provided from old studies or from recent ones performed in developing countries. However, this procedure is still used frequently for large-size prostates., Methods: During a 5-year period, 232 patients with large (greater than 75 g) prostates underwent open transvesical prostatectomy for symptomatic benign prostatic hyperplasia. Patient charts were retrospectively reviewed for preoperative and postoperative International Prostate Symptom Scores, postvoid residual urine volumes, maximal flow rates, early and late postoperative complications, and the need for reoperation. The preoperative International Prostate Symptom Score, postvoid residual urine volume, and maximal flow rate were compared with the corresponding postoperative data at 8 to 12 months and at the last follow-up visit., Results: Complete data evaluation was possible for 151 patients, with a mean follow-up of 41.8 +/- 15.6 months. Improvement in International Prostate Symptom Score, postvoid residual urine volume, and maximal flow rate was statistically significant (P <0.001) at 8 to 12 months and remained statistically significant at the last follow-up visit. Long-term complications included bladder neck contraction in 5 (3.3%) occurring at a mean of 10 months (range 5 to 17), urethral strictures in 1 (0.6%), and meatal stenosis in 2 (1.3%) of 151 patients. Re-operation was required in 6 patients (3.9%)., Conclusions: Transvesical prostatectomy in a contemporary series of patients proved to be successful, with a low rate of complications. Its success has a durable effect and only rarely was a corrective procedure necessary. This approach should be included in the list of possible treatments to discuss with the patient with a large prostate.

Objectives: To determine the effect of puboprostatic ligament sparing and bladder neck preservation on postoperative continence and positive margins after radical retropubic prostatectomy., Methods: A total of 149 men with clinically localized prostate cancer underwent radical retropubic prostatectomy. A bladder neck preservation technique was used in 48 patients (group 1), puboprostatic ligament sparing in 51 patients (group 2), and both techniques in 50 men (group 3). Urinary continence and margin status were assessed., Results: A statistically significant difference in the early return of continence was found 3 and 6 months postoperatively between groups 1 and 2 (P < 0.05), as well as between groups 2 and 3 (P < 0.05), in favor of groups 1 and 3. However, the long-term continence rates recorded 1 year postoperatively did not differ, at 92%, 92%, and 94% for groups 1, 2, and 3, respectively. Positive margins were found in 10 patients (21%) from group 1, in 9 (18%) from group 2, and in 11 (22%) from group 3. Positive margins at the bladder neck were found in 3 (6%), 1 (2%), and 2 (4%) patients, respectively, in groups 1, 2, and 3. These were the sole sites found in 1 patient (2%) in each of groups 1 and 3 and in none of group 2 (0%). Positive margins on the prostatic apex were found in 3 patients (6%) in group 1, 2 patients (4%) in group 2, and 4 patients (8%) in group 3. The apex was the only site found in 0 (0%), 1 (2%), and 2 (4%) patients for groups 1, 2, and 3, respectively. No statistically significant difference was found in the margin status among the groups studied., Conclusions: The final continence rates did not differ among the three groups. However, bladder neck preservation offered an earlier return of continence compared with the puboprostatic ligament-sparing technique. The positive margin status was similar for all three groups.