Transcervical Transvesical Prostatectomy in Patients with Benign Prostate Hyperplasia

Open prostatectomies (transvesical, retropubic) are the first choice surgery in the surgical treatment of large benign prostate hyperplasia (more than 80 ml). Due to the disadvantages of transvesical prostatectomy (injury of the detrusor, impossibility of visualization of the prostate bed, the need to drain the bladder with a suprapubic drain, long postoperative patient day) and retropubic (transcapsular) prostatectomy (depth of operative approach, possibility of bleeding from the capsular veins of the prostate, impossibility of performing simultaneous operations for bladder diseases through a narrow opening in the neck of the bladder) we proposed a transcervical transvesical prostatectomy. The objective: to present the technique of performing and evaluate the immediate (inpatient) results of transcervical transvesical prostatectomy in patients with large benign prostate hyperplasia (more than 80 ml). Materials and methods. The immediate (inpatient) results of transcervical transvesical prostatectomy are presented in 50 patients with benign prostate hyperplasia who were operated on in the urology department of the Vinnytsia Regional Hospital named after M. I. Pyrogov in the period from May 2023 to February 2024. The average age of the patients was 67.8±5.5 years, the average body mass index was 27.3±1.4, and the average prostate volume was 92.9±33.4 ml. Transcervical transvesical prostatectomy was performed by transversal dissection of the bladder neck up to 2–2.5 cm long, removal of hyperplastic prostate nodes, prostatic artery suture, installation of a threeway Foley catheter in the bladder with a load and bladder irrigation system attached to it, and bladder neck suturing with the prostate capsule. In cases of parenchymal bleeding from the bed of the prostate, trigonization of the posterior semicircle of the bladder neck into the lumen of the bed was performed using two P-like catgut sutures. The urethral catheter was removed on the 7th day after the opeartion. Results. The average time of the surgery was 68.7±12.8 minutes, the average intraoperative blood loss was 219.7±23.5 ml. In 5 (10%) patients, stones were removed from the bladder through the neck. One patient (2%) underwent hemotransfusion due to moderate bleeding from the prostate bed and blood loss on the second day after surgery. One patient underwent bilateral simultaneous pre-peritoneal inguinal hernioplasty with mesh implants in connection with oblique hernias. The average postoperative patient day was 9.2±1.9 days. Fatalities were not observed. Conclusions. Our first experience of performing transcervical transvesical prostatectomy in patients with large benign prostate hyperplasia showed its reliable intraoperative hemostasis with low intraoperative blood loss and a low percentage of hemotransfusions, as well as a low percentage of immediate (inpatient) postoperative complications. Further studies of the immediate and long-term results of transcervical transvesical prostatectomy in comparison with retropubic and transvesical prostatectomies are needed, as well as evaluation the of urination using uroflowmetry.