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Purpose: Open simple prostatectomy (OSP) has been a cornerstone in treating large prostate volumes (> 80 ml) in benign prostatic hyperplasia (BPH). With evolving minimally invasive procedures like minimally invasive simple prostatectomy (MISP) and laser enucleation, the role of OSP needs contemporary evaluation. This way, we assessed the efficacy and safety of OSP to understand its current standing in the treatment of BPH, especially in comparison with newer surgical modalities., Methods: A comprehensive search of MEDLINE, Cochrane and EMBASE was conducted to include randomized controlled trials (RCTs) comparing OSP with other treatments for BPH from 1993 to 2023. A total of 10 RCTs were included in the meta-analysis. Data on various outcomes including IPSS, Qmax, PVR, quality of life, perioperative factors, and postoperative complications were analysed., Results: Our meta-analysis, covering 557 patients, confirms OSP's significant improvement in voiding symptoms and objective voiding metrics. However, it also reveals a higher incidence of postoperative complications, such as bleeding and transfusion requirements. The study found moderate to high heterogeneity in perioperative outcomes, indicating variations in surgical techniques and postoperative care. OSP remains a reliable option with an easily accessible and effective approach for managing large prostates, despite advancements in minimally invasive surgeries., Conclusion: OSP continues to be a relevant surgical option for BPH in large prostates, offering significant symptom relief. However, the associated higher morbidity warrants careful patient selection and highlights the need for continued research into optimizing surgical techniques and improving outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The benefit of transurethral laser prostatectomy over open simple prostatectomy (OSP) is controversial in aged symptomatic benign prostatic hyperplasia (BPH) patients with large volume prostates, and the aim of this study is to compare the safety and efficiency of these two methods. Meta-analysis was applied using the Review Manager V5.3 software and the retrieved randomized controlled clinical trials (RCTs) comparing transurethral laser prostatectomy with OSP were analyzed for the treatment of large volume prostates from 2000 to 2019 in PubMed, Web of Science, Cochrane, and EMBASE datasets. Five RCTs assessing transurethral laser prostatectomy versus OSP were considered suitable for this meta-analysis, which included a total of 448 patients, with 232 patients undergoing laser and 216 patients undergoing OSP. Compared with OSP, although transurethral laser prostatectomy required a longer operative time (weighted mean difference (WMD) 27.49 mins; 95% confidence interval (CI) 16.54-38.44; P < 0.00001) and obtained a less resected prostate weight (WMD - 11.72 g; 95% CI - 21.75 to - 1.70; P = 0.02), patients undergoing laser prostatectomy benefited from significantly less hemoglobin decline (- 0.97 g/dL; 95% CI - 1.31 to - 0.64; P < 0.00001), shorter time of catheterization (WMD - 3.67 days; 95% CI - 5.60 to - 1.75; P = 0.0002), shorter length of hospital stay (WMD - 4.75 days; 95% CI - 6.57 to - 2.93; P < 0.00001), and less blood transfusion (odds ratio 0.10; 95% CI 0.03 to 0.35; P = 0.0003). During postoperative follow-up, no significant difference was observed between the two groups in IPSS, QoL, Q max , and PVR. Both transurethral laser prostatectomy and OSP are safe and effective for large prostates that require prostate resection. Taking into account of less blood loss, shorter catheterization time and hospital stay, and less blood transfusion, transurethral laser prostatectomy may be a better treatment for patients with large prostates., (© 2020. Springer-Verlag London Ltd., part of Springer Nature.)

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.

The purpose of this study was to investigate the effects of radical prostatectomy (RP) for prostate cancer, transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH), and the alterations induced by ageing on quality of life, urinary and sexual function, and bother. We evaluated 283 patients who filled in and returned the questionnaire used. A total of 105 were treated with RP and were selected prostate cancer patients with localised disease without recurrences. An additional 98 underwent TURP for BPH and a third group consisted of 80 apparently healthy men. The general quality of life was estimated by the Rand 36-Item Health Survey 1.0. Urinary function was estimated by the AUA Symptom Index and the UCLA Prostate Cancer Index (urinary function and bother scale). Sexual function and bother, were explored using the Brief Male Sexual Function Inventory for Urology. Patient outcome 2 years post treatment was compared to the pre-treatment status and to that of the matched control population. General quality of life was not affected by RP or TURP, with the exception of an increase in the emotional/well being domain in RP patients to control group levels. After RP there was more bother reported for the urinary function than urinary malfunction itself, while TURP, as expected, restored urinary function and bother to normal population norms. Elderly males had urinary function and bother similar to the operated patients. Estimating sexual function on RP patients, erectile dysfunction (ED) predominates, leading to decreased sexual life. TURP marginally affects sexual life, mainly due to the loss of ejaculation, while in men from the control group, sexual function, although affected, was still present., (Copyright 2004 Springer-Verlag)

Objective: Stricture of the vesicourethral anastomosis remains a well-documented complication after radical retropubic prostatectomy., Materials and Methods: We performed a retrospective study of 294 patients with prostate cancer who underwent radical retropubic prostatectomy. Possible correlations between anastomotic stricture formation, tumor stage, positive surgical margins, number of anastomotic sutures, bladder neck preservation, urine leakage, previous prostate surgery and/or intraoperative blood loss were examined., Results: An anastomotic stricture was found in 18 cases (6%) requiring some kind of treatment. In 10 patients (56%), the bladder neck stricture occurred within 3 months after surgery, in 5 (28%) at 4-12 months after surgery and in 3 (16%) more than 12 months after surgery. Intraoperative blood loss (>1,000 ml) was found to be significantly correlated with urinary leakage (p < 0.001) and both correlated with anastomotic stricture formation (p < 0.005)., Conclusion: Excessive intraoperative blood loss (>1,000 ml) and urine leakage was found to be significantly correlated to the formation of anastomotic stricture following radical retropubic prostatectomy., (Copyright 2004 S. Karger AG, Basel)

This study assesses the correlation of p53 immunoreactivity and DNA ploidy status with biochemical recurrence after radical prostatectomy. p53 protein expression and DNA ploidy were evaluated on 84 archival paraffin-embedded radical prostatectomy specimens. Patients were divided into two groups: those with low (38/84, 45%) and those with high (46/84, 55%) p53 immunoreactivity. The results were correlated with Gleason score, stage and serum PSA. Kaplan-Meier biochemical recurrence free survival and the Cox hazard-regression model were used for analysis. Multivariate analysis revealed p53, DNA ploidy, Gleason score, PSA and stage to be independent prognostic factors in this order. Kaplan-Meier analysis showed a significant difference in biochemical recurrence when p53 high expression and DNA aneuploidy were combined. The results of this study suggest that stratification for p53 expression and DNA ploidy status can provide additional prognostic information for patients with prostate carcinoma after radical prostatectomy.

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.

Objective: Urinary incontinence (UI) is one of the most common complications of radical prostatectomy (RP). Impaired urethral sphincter function is generally considered to be the most important contributing factor for UI; however, the mechanism of onset and recovery of urinary continence has not been fully elucidated. The objective of this research was to evaluate preoperative functional urethral length (FUL) and maximum urethral closure pressure (MUCP) as early continence recovery predictors after open retropubic RP (ORRP)., Methods: The research was conducted on a group of 43 patients with localized prostate cancer (PCa) in the period from July 2019 to May 2021. The urodynamic method of urethral pressure profile (UPP) was used to assess FUL and MUCP, and correlate with the postprostatectomy continence recovery. The severity of UI and bothersome were assessed using fully validated International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) and number of pads used in 24 h. Patients were interviewed about the use of urinary pads and asked to fill out the ICIQ-UI SF before and 2, 8, 16 and 24 weeks after ORRP., Results: The median value of FUL (mm) and MUCP (cmH2O) was 69 (28-94) and 76 (16-223), respectively. Correlation and linear regression showed a statistically significant negative correlation between preoperative values of FUL and MUCP with ICIQ symptom score and the number of pads used per day at the four observed time intervals (p < 0.05). Such a result showed that patients with higher preoperative FUL and MUCP values were more likely to recover urinary continence earlier. A value of 65 mm for FUL and 80 cmH 2 O for MUCP proved to be the cut-off values for continence recovery in 24 weeks after ORRP., Conclusion: Preoperatively evaluated FUL and MUCP seem to be valuable prognostic factors for early continence recovery after ORRP. Further investigation on a larger patient cohort is needed to evaluate the role of UPP in the preoperative management of patients with PCa., (© 2022 Wiley Periodicals LLC.)

Purpose: To compare long-term outcomes between photoselective vaporization (PVP) and Open simple prostatectomy (OSP) for prostates > 80 cc., Methods: Men operated either by PVP or OSP for BPH > 80 cc were included in two expert centres. Functional and uroflowmetric outcomes were assessed pre- and postoperatively. Data were collected prospectively in the PVP group and retrospectively in the OSP group and compared at long-term follow-up. Complications and re-intervention rates were used as main outcomes., Results: 332 men underwent surgery: 132 PVP were performed in a fist expert-centre and 200 OSP were performed in a second one with a median follow-up of 54 and 48 months, respectively. Mean Prostate volume was similar between OSP and PVP group (119 vs 116 cc). Major complications were more common in the OSP group (12.5 vs 1.5%, p < 0.001). At long-term follow-up, Qmax was higher and PVR was lower (p < 0.05) in the OSP group. IPSS score was similar between groups (p = 0.45) but the Qol was better in the OSP group (0.9 vs. 1.6; p < 0.05). There were more re-interventions in the PVP group compared to OSP (15.2 vs. 0%, p < 0.005)., Conclusion: PVP is a good alternative for prostates > 80 cc particularly for fragile patients as it is associated with a lower complication rate. At long-term follow-up, IPSS was similar between groups, but Qol was better in the OSP group. Patients treated by PVP should be informed that they could require reoperation in 15% of the cases.

Purpose: Open simple prostatectomy (OSP) is a standard surgical technique for patients with benign prostatic hyperplasia with prostate size larger than 80 ml. As a minimally invasive approach, robot-assisted simple prostatectomy (RASP) emerged as a feasible surgical alternative. Currently, there are no definite recommendations for the standard use of RASP. Therefore, we aimed at investigating various clinical outcomes comparing RASP with OSP., Methods: In this retrospective single-center study, we evaluated clinical data from 103 RASP and 31 OSP patients. Both cohorts were compared regarding different clinical characteristics with and without propensity score matching. To detect independent predictive factors for clinical outcomes, multivariate logistic regression analysis was performed., Results: Robot-assisted simple prostatectomy patients demonstrated a lower estimated blood loss and need for postoperative blood transfusions as well as less postoperative complications. OSP had a shorter operative time (125 min vs. 182 min) longer hospital stay (11 days vs. 9 days) and longer time to catheter removal (8 days vs. 6 days). In the multivariate analysis, RASP was identified as an independent predictor for longer operative time, lower estimated blood loss, shorter length of hospital stay, shorter time to catheter removal, less postoperative complications and blood transfusions., Conclusion: Robot-assisted simple prostatectomy is a safe alternative to OSP with less perioperative and postoperative morbidity. Whether OSP (shorter operative time) or RASP (shorter length of hospital stay) has a more favorable economic impact depends on the particular conditions of different health care systems. Further prospective comparative research is warranted to define the value of RASP in the current surgical management of benign prostatic hyperplasia.