Bladder outlet obstruction

Nephrology

Surgery

Urethra

Urethral stricture

Urology

Internal medicine

Prostate

Medicine

Enucleation

Urinary incontinence

Cancer

World Journal of Urology

Background Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention. Objective To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO. Design, setting, and participants The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed. Surgical procedure AFS-preserved EEP starts at the 12 o’clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved. Measurements Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed. Results and limitations The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches. Conclusions The preserved AFS provides a nice landmark at the 12 o’clock position during EEP.

Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach