Large prostates removed with single-keyhole surgery

By Will Boggs, MD

NEW YORK (Reuters Health) - An enlarged prostate due to benign prostatic hyperplasia, or BPH, can be safely and effectively removed using a type of minimally invasive single-keyhole surgery, researchers report.

The procedure, known as single-port transvesical enucleation of the prostate, or STEP, is “indicated in patients with large (greater than 80 to 100 grams) prostate glands that require surgery, in lieu of open surgery,” Dr. Mihir M. Desai from the Cleveland Clinic, Ohio told Reuters Health.

“Our preliminary data suggest that it is effective and the postoperative pain is minimal and most patients are discharged the next day,” Desai said, and “there should be minimal to no effect on erectile dysfunction with our approach.”

In the medical journal Urology, Desai and colleagues report their initial experience with STEP performed through a single incision in three patients suffering from bothersome BPH symptoms, which may include frequent and sometimes painful urination.

In two patients, the prostatic mass was successfully removed in less than 2.5 hours. In the other patient, the operation took 6 hours because of an inadvertent injury to the bowel that required traditional open surgery to repair.

The catheter used for draining urine from the bladder was removed within eight days in all three patients, and none of them had trouble urinating or suffered from incontinence.

The two patients without complications were sent home after only one day in the hospital, whereas the patient with the bowel injury was discharged after three days in the hospital.

SOURCE: Urology, November 2008.

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