{"title":"Urethra-preserving and dorsal capsule fenestration with robot-assisted simple prostatectomy for severe LUTS in small prostate: a case report.","authors":"Lijie Wen, Yue Zhang, Yi He, Yang Yu, Bo Yang","doi":"10.3389/fsurg.2024.1497556","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Small prostates (volume <30 ml) induce bladder outlet obstruction with pathophysiological changes distinct from those associated with large prostates. Treatment options often include transurethral incision of the prostate (TUIP) or transurethral resection of the prostate (TURP). Existing treatments have issues with high recurrence and complication rates. Therefore, we aim to explore a new minimally invasive surgical approach for patients with severe lower urinary tract symptoms (LUTS) and a small prostate.</p><p><strong>Methods: </strong>A patient with severe LUTS and a small prostate was admitted to the Department of Urology at the Second Hospital of Dalian Medical University. The patient had no median lobe but presented with multiple bladder stones. Relevant data (IPSS score, urine flow rate, operation time, hemoglobin drop, catheterization time, hospitalization time, residual urine) were collected before and after surgery to assess the safety and efficiency.</p><p><strong>Results: </strong>The patient was 72 years old with a prostate volume of 22.14 ml, a preoperative IPSS score of 28, PSA of 0.314 ng/ml, maximum urine flow rate of 3.5 ml/s, and a prostate MRI PI-RADS score of 2. The patient underwent robot-assisted cystolithotomy, urethra-preserving prostatectomy and dorsal capsule fenestration. The surgery lasted 105 min, with a postoperative hemoglobin drop of 3 g/L. There was no continuous bladder irrigation postoperatively, and the catheter was removed after 10 days. The patient was hospitalized for 4 days and followed up for 24 months. At 6 months postoperative, the patient had an IPSS score of 6, a QoL score of 1, a urine flow rate of 18 ml/s, and residual urine of 8 ml, with nocturia occurring 1-2 times. At 24 months postoperative, the patient had an IPSS score of 7, a QoL score of 1, a urine flow rate of 21 ml/s, and residual urine of 15 ml, with nocturia occurring 1 time.</p><p><strong>Conclusion: </strong>Robot-assisted urethra-preserving prostatectomy and dorsal capsule fenestration is a promising alternative treatment for patient with severe LUTS due to a small prostate in both long-term safety and efficacy. Further large-sample controlled studies are needed for additional evaluation and validation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1497556"},"PeriodicalIF":1.6000,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634874/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fsurg.2024.1497556","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Urethra-preserving and dorsal capsule fenestration with robot-assisted simple prostatectomy for severe LUTS in small prostate: a case report.
Background: Small prostates (volume <30 ml) induce bladder outlet obstruction with pathophysiological changes distinct from those associated with large prostates. Treatment options often include transurethral incision of the prostate (TUIP) or transurethral resection of the prostate (TURP). Existing treatments have issues with high recurrence and complication rates. Therefore, we aim to explore a new minimally invasive surgical approach for patients with severe lower urinary tract symptoms (LUTS) and a small prostate.
Methods: A patient with severe LUTS and a small prostate was admitted to the Department of Urology at the Second Hospital of Dalian Medical University. The patient had no median lobe but presented with multiple bladder stones. Relevant data (IPSS score, urine flow rate, operation time, hemoglobin drop, catheterization time, hospitalization time, residual urine) were collected before and after surgery to assess the safety and efficiency.
Results: The patient was 72 years old with a prostate volume of 22.14 ml, a preoperative IPSS score of 28, PSA of 0.314 ng/ml, maximum urine flow rate of 3.5 ml/s, and a prostate MRI PI-RADS score of 2. The patient underwent robot-assisted cystolithotomy, urethra-preserving prostatectomy and dorsal capsule fenestration. The surgery lasted 105 min, with a postoperative hemoglobin drop of 3 g/L. There was no continuous bladder irrigation postoperatively, and the catheter was removed after 10 days. The patient was hospitalized for 4 days and followed up for 24 months. At 6 months postoperative, the patient had an IPSS score of 6, a QoL score of 1, a urine flow rate of 18 ml/s, and residual urine of 8 ml, with nocturia occurring 1-2 times. At 24 months postoperative, the patient had an IPSS score of 7, a QoL score of 1, a urine flow rate of 21 ml/s, and residual urine of 15 ml, with nocturia occurring 1 time.
Conclusion: Robot-assisted urethra-preserving prostatectomy and dorsal capsule fenestration is a promising alternative treatment for patient with severe LUTS due to a small prostate in both long-term safety and efficacy. Further large-sample controlled studies are needed for additional evaluation and validation.
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
