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

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Abstract

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.

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Data availability

The data used in this research are not publicly available due to concerns about confidentiality; however, we summarise descriptive information about our participants in the manuscript text. The data that support the findings of this study are available from corresponding authors upon reasonable request.

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Funding

This study was funded by the Chang Gung Memorial Hospital, Grant: CMRPD1I0113, BMRP278.

Author information

Authors and Affiliations

  1. Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan

    Yu-Hsiang Lin, Shu-Han Tsao, Chen-Pang Hou, Chien-Lun Chen & Horng-Heng Juang

  2. School of Medicine, Chang Gung University, Taoyuan 333, Taiwan

    Yu-Hsiang Lin, Shu-Han Tsao, Chen-Pang Hou & Chien-Lun Chen

  3. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan

    Shin-Yuan Chang

  4. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan

    Chen-Pang Hou

  5. Department of Urology, MacKay Memorial Hospital, Taipei 112, Taiwan

    Wen-Chou Lin

  6. Department of Urology, Shuang Ho Hospital, Taipei Medical University, Taipei 112, Taiwan

    Ke-Hung Tsui

  7. TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 112, Taiwan

    Ke-Hung Tsui

  8. Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 333, Taiwan

    Horng-Heng Juang

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  1. Yu-Hsiang Lin
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Contributions

Y-HL: conceptualization, resources, writing—original draft; S-YC: data curation, visualization; S-HT: formal analysis, validation; C-PH: visualization, writing—review and editing; C-LC: visualization investigation; W-CL: conceptualization, software; K-HT: methodology, project administration, supervision; H-HJ: conceptualization, supervision.

Corresponding authors

Correspondence to Yu-Hsiang Lin, Ke-Hung Tsui or Horng-Heng Juang.

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Lin, YH., Chang, SY., Tsao, SH. et al. Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach. World J Urol 41, 2127–2132 (2023). https://doi.org/10.1007/s00345-022-04270-2

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  • DOI: https://doi.org/10.1007/s00345-022-04270-2

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