Combined HoLEP and transvesical single port robotic simple prostatectomy
Recommended Citation
Wang Y, Arora S, Bazzi M, Zhuo J, Leavitt D, Rogers CG. Combined HoLEP and transvesical single port robotic simple prostatectomy. Eur Urol 2024; 85:S582-S582.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Obstructive benign prostatic hyperplasia (BPH) for very large glands can be managed with Holmium laser enucleation (HoLEP) or robotic assisted simple prostatectomy (RASP). HoLEP may allow for easier access to the apex of the prostate than the base, whereas RASP may have easier exposure of the base than the apex. Additionally, HoLEP may have a higher risk of transient urinary incontinence, particularly in patients with larger prostates. In this video, we report the first case of combined HoLEP and RASP using a single port (SP) transvesical approach. Materials & Methods: Our patient presented with urinary retention and an enlarged prostate of 332g on pre-operative MRI and elected for a combined HoLEP and RASP approach. HoLEP was first used to release the apex of the adenoma and the enucleation plane was carried past the midpoint of the prostate. We then transitioned to the RASP portion. A cystotomy was made for the placement of the DaVinci access port. The SP robot was docked. The enucleation plane was developed at the base of the prostate and dissected distally to connect to the enucleated portion from HoLEP. The adenoma was excised in a piece-wise manner and retrieved through the access port. Results: Both procedures were performed uneventfully with successful removal of the prostate gland through the access trocar with a combined operative time was 457 minutes and an estimated blood loss of 200 mL. The patient remained inpatient for one day and experienced an uneventful post-operative course with no peri-operative complications. The patient had a successful trial of void after one week and continues to report excellent continence. Conclusions: We demonstrate a novel procedure combining HoLEP and SP transvesical RASP for a very large gland that may be more challenging by either procedure alone. This combination can be done safely and effectively while leveraging the potential advantages of both approaches.
Volume
85
First Page
S582
Last Page
S582
