Endoscopic transvesical adenomectomy of the prostate, a new minimally invasive approach for large benign prostatic hyperplasia. What has our experience taught us?

INTRODUCTION: Recent technical advances have made new minimally invasive techniques possible to treat large volume (>80 ml) benign prostatic hyperplasia (BPH). The endoscopic transperitoneal adenomectomy of the prostate (ETAP) is a new minimally invasive technique developed in our centre. The aim of this study was to describe the safety, efficacy and to evaluate our learning curve in ETAP. MATERIAL AND METHODS: This was a single-centre study that enrolled eighty-eight consecutive patients with large BPH who underwent ETAP. Pre-, per- and postoperative data were prospectively collected. Statistical analysis compared the first 40 patients submitted to ETAP (Group A) with the subsequent 48 patients (Group B). RESULTS: There were no significant differences in the surgical procedure between groups. The median operating time was 94 (80–110) minutes and the estimated blood loss 150 (100–300) ml. There were no perioperative blood transfusions nor any conversions to open approach needed. Median hospital stay was 3 (3–5) days and catheter was removed mainly at day 9 (5–11). The median Qmax improved from 8.0 (6.2–9.9) ml/s to 15.0 (11.5–23.0) ml/s postoperatively and the median International Prostate Symptom Score (IPSS) score decreased from 20 (15–24) to 6 (4–11) after the procedure. CONCLUSIONS: ETAP is a secure and feasible minimally invasive technique for treatment of large BPH. The functional outcomes of this technique are consistent and promising.