Open Simple Prostatectomy (OSP)
OSP is the gold standard surgical management for high volume (> 80 cc) prostatic adenoma. Advantages of this approach include more complete removal of prostatic adenoma under direct visualization, lower re-treatment rates, and no risk of TUR syndrome. A randomized controlled trial comparing transvesical open simple prostatectomy (TVP) with TURP for prostates > 80 cc demonstrated significant reduction in IPSS scores at 12 months post-op for the TVP group. Unfortunately, the peri-operative blood transfusion rate was 11% and 14% for the TVP and TURP arms, respectively (Figure 1) . This morbidity associated with OSP has encouraged urologists to seek other alternatives for the management of large prostatic adenoma.
|Figure 1: Complications for both TURP (n= 35) and Transvesical Open |
Simple Prostatectomy (TVP) (n = 34). Ou et al. Urology 2010.
Holmium Laser Therapy
Photoselective Vaporization of the Prostate (PVP)
Robot assisted laparoscopic Simple Prostatectomy (RASP)
Figure 2: Transvesical RASP: Incision in bladder mucosa distal to the ureteral orifices.
Screen shot credit: Misop Han, M.D. Brady Urological Institute at Johns Hopkins Hospital.
Figure 3. RASP vs. OSP Peri-operative Outcomes.
Brady Urological Institute at Johns Hopkins Hospital.
- Open simple prostatectomy is the gold standard surgical management for large prostatic adenoma
- Bipolar TURP may remove less adenoma than OSP
- HoLEP has prostate “size independent” effectiveness
- PVP is effective but bleeding my obscure visualization
- RASP is an excellent alternative for severe BPH for those well versed in robotic radical prostatectomy
1. Speakman et al. Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) - focus on the UK. BJU Int. 2015 Apr;115(4):508-19. doi: 10.1111/bju.12745. Epub 2014 Oct 16.
2. Ou et al. A randomized trial of transvesical prostatectomy versus transurethral resection of the prostate for prostate greater than 80 mL. Urology. 2010 Oct;76(4):958-61. doi: 10.1016/j.urology.2010.01.079. Epub 2010 Apr 15.
3. Geavlete et al. Bipolar vaporization, resection, and enucleation versus open prostatectomy: optimal treatment alternatives in large prostate cases? J Endourol. 2015 Mar;29(3):323-31. doi: 10.1089/end.2014.0493. Epub 2014 Sep 17.
5. Matlaga et al. Holmium laser enucleation of the prostate for prostates of >125 mL. BJU Int. 2006 Jan;97(1):81-4.
6. Kuo et al. Holmium laser enucleation of prostate (HoLEP): the Methodist Hospital experience with greater than 75 gram enucleations. J Urol. 2003 Jul;170(1):149-52.
7. Hueber et al. Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia Using the 180 Watt System: Multicenter Study of the Impact of Prostate Size on Safety and Outcomes. J Urol. 2015 Aug;194(2):462-9. doi: 10.1016/j.juro.2015.03.113. Epub 2015 Apr 4.
8. Patel et al. Robotic-assisted Simple Prostatectomy: Is there Evidence to go Beyond the Experimental Stage? Curr Urol Rep (2014) 15:443.