AB051. Technical improvement of HoLEP and prevention strategies of postoperative incontinence

Background: Most laparoscopic enucleation of the prostate (LEP) procedures are performed via the extraperitoneal approach for large benign prostatic hyperplasia (prostate volume >80 mL). Therefore, we evaluate the feasibility of LEP via the transperitoneal approach with a 2-year follow-up. Methods: LEP was performed on seven patients from December 2010 to July 2012. Surgery on all patients was performed using the transperitoneal method. The International Prostate Symptom Score (IPSS), and quality of life (QoL) questionnaire scores, maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR) and other data were recorded preand post-operatively. All patients were followed up at least for 2 years. Results: The mean prostate volume, PVR and Qmax were 95.63±15.06 mL, 108.57±71.46 mL and 8.14±1.99 mL/s respectively. The mean operation time was 240.71±88.05 min. The mean catheterization time and duration of post-operative hospitalization was 9.29±1.98 and 11.00±2.77 d, respectively. In addition, significant improvements were observed in IPSS, QoL and Qmax at the 3-month follow-up. At the 6-, 12-, and 24-month follow-ups, the IPSS, QoL and Qmax remained stable. Only two patients required blood transfusions and two patients complained of urinary tract infection at the 3-month follow-up. None of the patients required recatheterization or repeated surgery. All patients were satisfied with the outcome of the operation. Conclusions: LEP via the transperitoneal approach is a feasible, safe and effective minimally invasive operation for large prostate patients, particularly in cases with coexistent bladder calculi or diverticula. In the future, prospective randomized control trials with larger numbers of patients are warranted to confirm this conclusion.