-Original-

Transurethral Detachment Prostatectomy Using a Tissue Morcellator for Large Benign Prostatic Hyperplasia

Kazuya Iwamoto, Yasunori Hiraoka and Yuji Shimizu

Department of Urologic Surgery, Graduate School of Medicine, Nippon Medical School
Department of Urology, Nippon Medical School Tama Nagayama Hospital

Objective: Transurethral enucleation of the prostate (TUE) is designed for complete removal of the prostate lobes. On the basis of TUE and holmium laser enucleation of the prostate, we developed a new technique of transurethral detachment prostatectomy (TUDP) using a tissue morcellator.
Materials and Methods: In TUDP, enucleation is performed with a prostate-detaching blade and the tip of a resectoscope, followed by removal of the tissue with a morcellator. This study reports our experience with TUDP in which the weight of retrieved tissue was greater than 30 g in 76 patients with benign prostate hyperplasia.
Results: The mean preoperative total prostate and adenoma volumes were 70.7 and 47.4 mL, respectively. The mean times required for enucleation, morcellation, and total operation time were 28.5, 14.4, and 66.3 minutes, respectively. The mean weight of removed prostate tissue was 61.1 g. The mean decreases in the levels hemoglobin and serum sodium were 1.73 mg/dL and 2.41 mEq/dL, respectively. The mean preoperative maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), and quality of life score (QOL) improved from 9.8 mL/sec, 20.2, and 4.9, to 22.3 mL/sec, 3.1 and 1.2, respectively. Complications included mild morcellator-induced mucosal injury in 2 patients (2.6%), nausea in 4 patients (5.2%), transient urinary retention in 2 patients (2.6%), transient urge incontinence in 5 patients (6.4%), and urethral stricture in 2 patients (2.6%). The mean prostate volume and serum prostate-specific antigen level measured 6 months postoperatively in 46 patients were 10.68 mL and 0.89 ng/mL, respectively.
Conclusions: TUDP is effective for complete removal of large prostate lobes in patients with large benign prostate hyperplasia and is associated with lower perioperative morbidity.

J Nippon Med Sch 2008; 75: 77-84

Keywords
prostate, benign prostatic hyperplasia, prostatectomy, transurethral resection of the prostate, transurethral detachment prostatectomy

Correspondence to
Kazuya Iwamoto, MD, Department of Urology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
hiraokay@nms.ac.jp

Received, June 25, 2007
Accepted, December 13, 2007